Matsushiro Takuya, Tamura Tomoki, Ishiwaki Daiki, Umibe Takumi, Inoue Nobuyuki
Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku, Tokyo, Japan.
Gen Thorac Cardiovasc Surg Cases. 2024 Dec 20;3(1):53. doi: 10.1186/s44215-024-00180-4.
Acute heart failure due to aortic regurgitation (AR) is a severe comorbidity of type A acute aortic dissection (AAD). Valve-sparing aortic root replacement is typically performed when the aortic valve remains intact.
A 33-year-old male presented to our hospital with chest pain. Initial computed tomography (CT) scans did not clearly identify an aortic dissection. However, subsequent evaluations suggested acute coronary syndrome. Catheter angiography revealed difficulties in catheterizing the coronary arteries, and echocardiography detected aortic insufficiency. Electrocardiogram-gated CT angiography ultimately confirmed a localized aortic root dissection, necessitating urgent surgical intervention. The patient underwent valve reimplantation to preserve the aortic valve. The postoperative course was uneventful, with follow-up echocardiography and CT showing no residual dissection or regurgitation.
This report highlights a case of acute aortic root dissection resulting in acute AR. The primary cause of AR in this case was the intussusception of the disrupted aortic intima. The dissection was confined solely to the aortic root. The patient underwent successful valve reimplantation, with no postoperative complications. Electrocardiogram-gated CT angiography and transesophageal echocardiography proved valuable in identifying localized aortic abnormalities with precision.
主动脉瓣关闭不全（AR）所致急性心力衰竭是A型急性主动脉夹层（AAD）的一种严重合并症。当主动脉瓣保持完整时，通常进行保留瓣膜的主动脉根部置换术。
一名33岁男性因胸痛就诊于我院。最初的计算机断层扫描（CT）未明确显示主动脉夹层。然而，后续评估提示急性冠状动脉综合征。导管血管造影显示冠状动脉插管困难，超声心动图检测到主动脉瓣关闭不全。心电图门控CT血管造影最终证实为局限性主动脉根部夹层，需要紧急手术干预。患者接受了瓣膜再植入术以保留主动脉瓣。术后过程顺利，随访超声心动图和CT显示无残余夹层或反流。
本报告强调了一例导致急性AR的急性主动脉根部夹层病例。该病例中AR的主要原因是破裂的主动脉内膜套叠。夹层仅局限于主动脉根部。患者成功接受了瓣膜再植入术，无术后并发症。心电图门控CT血管造影和经食管超声心动图在精确识别局限性主动脉异常方面被证明具有重要价值。
