Aoyagi S, Akashi H, Kawara T, Oryoji A, Kosuga K, Oishi K, Fujisawa M, Yamamoto K
Second Department of Surgery, Kurume University School of Medicine, Japan.
Thorac Cardiovasc Surg. 1994 Feb;42(1):58-60. doi: 10.1055/s-2007-1016457.
A 57-year-old Japanese man presented with symptoms of congestive heart failure 9 years after aortic valve replacement. On auscultation, a continuous murmur was heard at the left lower sternal border. Chest radiograph showed moderate cardiomegaly and a widened upper mediastinum. Computed tomographic scans showed a dilated ascending aorta, in which there was no intimal flap, and also showed a large mass which compressed the right atrium. Two-dimensional Doppler echocardiography revealed abnormal continuous blood flow directed from the dilated ascending aorta to the right atrium and no periprosthetic leak. At operation, a false aneurysm of the ascending aorta which originated from the aortotomy suture line and a fistula from the aorta to the right atrium were confirmed. The fistula was closed with pledgeted sutures, and the ascending aorta was replaced with a collagen-coated double woven velour dacron graft. The patient recovered uneventfully. Computed tomographic scan and two-dimensional echocardiography are complementary techniques for reliable non-invasive assessment of the complexity of an aortic aneurysm.
一名57岁的日本男性在主动脉瓣置换术后9年出现充血性心力衰竭症状。听诊时，在胸骨左下缘听到连续性杂音。胸部X线片显示中度心脏扩大和上纵隔增宽。计算机断层扫描显示升主动脉扩张，其中无内膜瓣，还显示一个巨大肿块压迫右心房。二维多普勒超声心动图显示异常的连续性血流从扩张的升主动脉流向右心房，且无人工瓣膜周漏。手术中，证实为起源于主动脉切开缝合线的升主动脉假性动脉瘤以及从主动脉到右心房的瘘管。用带垫片的缝线封闭瘘管，并用胶原涂层的双层编织丝绒涤纶移植物替换升主动脉。患者恢复顺利。计算机断层扫描和二维超声心动图是可靠的非侵入性评估主动脉瘤复杂性的互补技术。
