Bachet J, Mesnildrey P, Goudot B, Tawil N, Dubois C, Brodaty D, Schlumberger S, Guilmet D
Presse Med. 1984 Oct 20;13(37):2253-6.
From October, 1969 to December, 1982, 1117 aortic valve replacements were performed at the Foch Medico-Surgical Centre. Five of these operations (0.4%) were followed, within 6 months to 6 years (mean 37 months), by acute dissection of the whole ascending aorta with a varying degree of extension further down. Such accidents raise problems of aetiology, diagnosis, treatment and possibly prevention. All 5 patients had an emergency operation with prosthetic replacement of the ascending aorta; in some cases the 2 cylinders were glued to the distal and proximal aortic stumps. The other forms of treatment were related to the lesions encountered. All patients survived and underwent follow-up angiography after 6 months to 5 1/2 years. Lesions of cystic necrosis of the media were regularly found at histology. In every case during the first operation the surgeon reported that the aorta was dilated or particularly fragile. The question therefore arises as to whether ascending aortas that are fragile and of more than 5 cm in diameter should be systematically replaced.
1969年10月至1982年12月期间，福煦医疗外科中心共进行了1117例主动脉瓣置换手术。其中5例手术（0.4%）在术后6个月至6年（平均37个月）内发生了升主动脉全层急性夹层，并不同程度地向下延伸。此类意外引发了病因、诊断、治疗以及可能的预防等问题。所有5例患者均接受了急诊手术，用人工血管置换升主动脉；在某些情况下，将两个血管段分别与主动脉远近端残端吻合。其他治疗方式则与所遇到的病变有关。所有患者均存活，并在术后6个月至5年半接受了随访血管造影检查。组织学检查经常发现中层囊性坏死病变。在首次手术时，每位外科医生均报告主动脉扩张或特别脆弱。因此，对于直径超过5厘米且脆弱的升主动脉是否应常规进行置换这一问题便出现了。
