Lindsay J
Division of Cardiology, Washington Hospital Center, DC 20010.
Am Heart J. 1993 Aug;126(2):441-3. doi: 10.1016/0002-8703(93)91064-l.
The false channel of an aortic dissection only rarely ruptures into a cardiac chamber producing an aorto-cameral fistula. Reports of 20 cases have been published, and two distinct clinical patterns have emerged. In nine patients, severe cardiac decompensation associated with chest pain developed abruptly months to years after coronary bypass graft surgery or aortic valve replacement. Continuous murmurs were observed infrequently. In 11 patients, progressive chronic or subacute congestive heart failure developed in patients with aortic dissection known or suspected to have occurred months to years previously. A continuous murmur was almost always present. The frequency with which aortocameral fistula occurred in patients who had undergone cardiac surgery suggests a pathogenetic mechanism. It seems probable that postoperative adhesions favor fistula over free rupture.
主动脉夹层的假腔很少破裂进入心腔形成主动脉-心腔瘘。已发表了20例报告，并出现了两种不同的临床模式。9例患者在冠状动脉搭桥手术或主动脉瓣置换术后数月至数年突然出现与胸痛相关的严重心脏失代偿。很少观察到连续性杂音。11例患者在已知或疑似数月至数年之前发生主动脉夹层的患者中出现进行性慢性或亚急性充血性心力衰竭。几乎总是存在连续性杂音。心脏手术患者发生主动脉-心腔瘘的频率提示了一种发病机制。术后粘连似乎更易导致瘘形成而非自由破裂。
