Saito T, Fuse K, Kato M, Kamisawa O, Kano M, Hata M, Oki S, Hasegawa N, Kawashima T, Horimi H
Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan.
Kyobu Geka. 1994 Oct;47(11):906-8.
A 25-year-old man of Marfan syndrome with chronic stage aortic dissection of Stanford type A underwent concomitant graft replacement of the total aortic root and transverse aortic arch. The surgical procedure were performed with an aid of extracorporeal circulation, blood cardioplegia, using the techniques of "open distal anastomosis" under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. The operative techniques consisted of total aortic root replacement using a composite graft with Piehler's and Carrel patch technique for left and right coronary artery, and total arch replacement using en bloc distal arch reconstruction and a composite graft replacement for innominate artery. There were no neurological complications. In the case of Marfan syndrome, type A aortic dissection involving aortic arch should be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch in order to reduce the late risk of aortic dissection or annular dilatation.
一名患有马凡综合征的25岁男性，处于斯坦福A型慢性主动脉夹层，接受了主动脉根部和主动脉弓全弓置换术。手术在体外循环、血液停搏液辅助下进行，采用“开放远端吻合”技术，在深度低温循环停搏下进行，并在循环停搏期间持续逆行脑灌注以保护大脑。手术技术包括使用带Piehler和Carrel补片技术的复合移植物进行主动脉根部全置换，用于左、右冠状动脉，以及使用整块远端弓重建和无名动脉复合移植物置换进行全弓置换。无神经并发症。对于马凡综合征患者，累及主动脉弓的A型主动脉夹层应通过同时进行主动脉根部和主动脉弓全弓置换术来治疗，以降低主动脉夹层或瓣环扩张的晚期风险。
