Orihashi K, Matsuura Y, Hamanaka Y, Sueda T, Kagawa T, Hotei Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Feb;43(2):276-80.
A 57-year-old female with hypotension and consciousness disturbance was referred to our institute. Echocardiography and plain CT revealed cardiac tamponade, but no apparent evidence of aortic dissection was obtained. With sudden onset of hypotension, she was immediately operated without information of aortography, enhanced CT, and MRI. Approximately 200 g of pericardial hemorrhage and slight subadventitial hematoma was grossly found and surface ultrasonography revealed the mild localized intramural hematoma (crescent-shaped translucent layer of at most 5 mm in width) at the proximal ascending aorta. Because neither false lumen with blood flow nor intimal flap was found, pericardial drainage without aortic replacement was performed. However, DeBakey type II of aortic dissection with wide false lumen was found with CT and MRI within three weeks, and re-operation was carried out. The dissection ranged from the ostium of right coronary artery to the beginning of innominate artery, but did not involve the coronary arteries and major branches of aortic arch. The surface ultrasonography and transesophageal echocardiography, as well as preoperative CT and MRI, demonstrated that false lumen was thrombosed except at the anterior aspect of mid-portion of ascending aorta. The ascending aorta was replaced. A careful follow-up is mandatory for even a localized intramural hematoma, which can progress into aortic dissection in a short period.
一名57岁女性因低血压和意识障碍被转诊至我院。超声心动图和普通CT检查显示心包填塞，但未发现主动脉夹层的明显证据。由于突然发生低血压，在未进行主动脉造影、增强CT和MRI检查的情况下，她立即接受了手术。术中大体发现约200克心包积血和轻度外膜下血肿，体表超声检查显示升主动脉近端有轻度局限性壁内血肿（新月形半透明层，宽度最多5毫米）。由于未发现有血流的假腔和内膜瓣，遂进行了心包引流而未行主动脉置换术。然而，术后三周内的CT和MRI检查发现为DeBakey II型主动脉夹层，假腔较宽，于是再次进行了手术。夹层范围从右冠状动脉开口至无名动脉起始部，但未累及冠状动脉和主动脉弓主要分支。体表超声检查、经食管超声心动图以及术前CT和MRI检查均显示，除升主动脉中段前部外，假腔内均有血栓形成。遂对升主动脉进行了置换。即使是局限性壁内血肿也必须进行仔细随访，因为其可能在短时间内进展为主动脉夹层。
