Parr G V, Kouchoukos N T
Ann Thorac Surg. 1979 Aug;28(2):151-7. doi: 10.1016/s0003-4975(10)63773-3.
This report describes successful staged surgical repair in 2 patients with dissection of the upper descending thoracic aorta (DeBakey type III) with coexisting discrete Marfan's aneurysms of the ascending aorta. Initial repair of the descending aortic dissection was done through a left thoracotomy using a transverse aorta--femoral artery shunt in 1 patient and a left ventricular apex--femoral artery shunt without systemic heparinization in the other. Emphasis is placed on the need for pharmacological reduction of blood pressure during aortic cross-clamping as well as the use of a shunt to prevent dissection of the ascending aortic aneurysm. In both patients, subsequent repair of the ascending aortic aneurysm was accomplished using composite graft replacement of the aortic valve and ascending aorta. This operation is advised for such patients even in the absence of notable aortic valve incompetence.
本报告描述了2例降主动脉上段夹层（DeBakeyⅢ型）合并升主动脉孤立性马方动脉瘤患者分期手术修复成功的案例。1例患者通过左胸切口，使用横断主动脉-股动脉分流术进行降主动脉夹层的初始修复；另1例患者则采用左心室心尖-股动脉分流术，术中未进行全身肝素化。重点强调了在主动脉阻断期间进行药物降压的必要性以及使用分流术以防止升主动脉瘤夹层形成。在这2例患者中，随后均采用主动脉瓣和升主动脉复合移植物置换术完成了升主动脉瘤的修复。即使在没有明显主动脉瓣关闭不全的情况下，也建议对这类患者进行此手术。
