Likaj Ermal, Ibrahimi Alfred, Kuci Saimir, Zeitani Jacob
Cardiac Surgery Department, Mother Teresa University, Tirana, Albania.
Anesthesiology and Reanimation Department, Mother Teresa University, Tirana, Albania.
Braz J Cardiovasc Surg. 2025 Mar 18;40(2):e20220468. doi: 10.21470/1678-9741-2022-0468.
A 58-year-old man, who has undergone ascending aorta replacement, started to complain of pain in the lower limbs, shortness of breath, and progressive fatigue a few months after surgery. Transthoracic and transesophageal Doppler echocardiographies revealed a diseased bicuspid aortic valve and a subocclusive mass in the ascending aorta. Thoracic computed tomography angiography confirmed the presence of a subocclusive mass, pseudoaneurysm formation, and a distorted shape of the Dacron® graft. The patient underwent urgent surgery to remove the mass, which appeared to be a thrombus, and aortic valve and ascending aorta replacement. Kinking of vascular graft has been reported including surgical techniques to correct the excessive length to avoid gradients and guarantee laminar flow. When kinking is severe, high gradients and hemolysis can be detected. However, thrombus formation in the ascending aorta segment is less likely, due to the high blood velocity flow. Therefore, several concurrent causes should be considered. In this case, the most probable explanation for thrombus formation was kinking of a too long Dacron® graft, combined with extrinsic compression effect of the graft by the pseudoaneurysm at the anastomosis site and anomalous flow directed from the diseased bicuspid aortic valve. Various grades of Dacron® graft kinking might occur following ascending aorta replacement and undiagnosed at follow-up especially if resulting in mild symptoms, thus, careful visual and echocardiography evaluation should be done at the end of surgery. Finally, distorted Dacron® graft might trigger thrombus formation when inflammation and coagulation processes are set off during bacteria or viral infection.
一名58岁男性，接受了升主动脉置换手术，术后几个月开始出现下肢疼痛、呼吸急促和进行性疲劳。经胸和经食管多普勒超声心动图显示病变的二叶式主动脉瓣以及升主动脉内的亚闭塞性肿块。胸部计算机断层扫描血管造影证实存在亚闭塞性肿块、假性动脉瘤形成以及涤纶人工血管形状扭曲。患者接受了紧急手术，切除了似乎是血栓的肿块，并进行了主动脉瓣和升主动脉置换。已有血管移植物扭结的报道，包括纠正过长以避免梯度并保证层流的手术技术。当扭结严重时，可检测到高梯度和溶血。然而，由于升主动脉段血流速度高，血栓形成的可能性较小。因此，应考虑多种并发原因。在这种情况下，血栓形成最可能的解释是涤纶人工血管过长导致扭结，再加上吻合部位假性动脉瘤对人工血管的外部压迫作用以及病变的二叶式主动脉瓣导致的异常血流。升主动脉置换术后可能会出现不同程度的涤纶人工血管扭结，在随访中未被诊断出来，尤其是如果仅导致轻微症状，因此，手术结束时应进行仔细的肉眼和超声心动图评估。最后，当细菌或病毒感染引发炎症和凝血过程时，扭曲的涤纶人工血管可能会引发血栓形成。
