Nakano H, Hashimoto A, Aomi S, Nemoto S, Yamaki F, Kitamura M, Hachida M, Nishida H, Endo M, Koyanagi H
Department of Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Sep;43(9):1664-9.
From March 1973 to December 1994, 8 patients (2 males and 6 females) aged 34.4 +/- 7.8 years, underwent composite graft replacement (CGR) for aortitis syndrome combined with annuloaortic ectasia (AAE) in our institute. Five patients showed active aortitis syndrome and steroid therapy was administrated to 2 of them. The mean value of the C-reactive protein (CRP) was 1.6 +/- 1.8 before the operation. The maximum diameter of the ascending aorta was 67.1 +/- 10.3 mm (range 53 to 85 mm). Stenosis and/or ectasia of the neck vessels were recognized in 5 cases, as well as the coronary artery in 2 cases. Isolated CGR was performed in 6 cases, and combined with single CABG to LAD in 1 case and with total arch replacement in 1 case. The enlarged ascending aorta was replaced with main graft using the exclusion method and interposed grafts for coronary arteries were sutured with pledgetted mattress sutures all around the coronary ostia. In patients with stenosis of neck vessels, oxygen saturation of the jugular vein was monitored during extracorporeal circulation for surveillance of cerebral ischemia. There was 1 early death due to pulmonary failure. Seven cases survived without any complications during 4-132 months (mean 83.4 months) of the follow-up period. After the operation, 3 cases required steroid therapy during 4-50 months. We concluded that preoperative control of active inflammation, selection of operative procedures, timing for the operation, and the long-term precise management of the intractable disease were essential for successful treatment of aortitis syndrome with AAE.
1973年3月至1994年12月，我院8例年龄为34.4±7.8岁的患者（2例男性，6例女性）因大动脉炎综合征合并主动脉瓣环扩张（AAE）接受了复合移植物置换术（CGR）。5例患者表现为活动性大动脉炎综合征，其中2例接受了类固醇治疗。术前C反应蛋白（CRP）的平均值为1.6±1.8。升主动脉的最大直径为67.1±10.3mm（范围53至85mm）。5例患者存在颈部血管狭窄和/或扩张，2例患者存在冠状动脉狭窄和/或扩张。6例行单纯CGR，1例联合左前降支单支冠状动脉旁路移植术（CABG），1例联合全主动脉弓置换术。采用旷置法用主移植物替换扩大的升主动脉，用带垫片褥式缝线在冠状动脉开口周围全周缝合冠状动脉间置移植物。对于颈部血管狭窄的患者，在体外循环期间监测颈静脉血氧饱和度以监测脑缺血情况。1例患者因呼吸衰竭早期死亡。7例患者在4至132个月（平均83.4个月）的随访期内无任何并发症存活。术后，3例患者在4至50个月内需要类固醇治疗。我们得出结论，术前控制活动性炎症、选择手术方式、把握手术时机以及对该难治性疾病进行长期精确管理对于成功治疗大动脉炎综合征合并AAE至关重要。
