Morota T, Ando M, Okita Y, Takamoto S
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Dec;43(12):1972-6.
The patient was a 48-year-old man who was brought to our hospital complaining of chest pain, paresthesia of the lower extremities, and pain in the lumbar region. At first, acute myocardial infarction was diagnosed, but transthoracic echocardiogram revealed an intimal flap in the ascending aorta. The presence of an intimal tear below the left subclavian artery was confirmed by intraoperative transesophageal echocardiogram, and a diagnosis of myocardial infarction accompanying type IIIb aortic dissection with retrograde extension to the ascending aorta was made. Coronary artery bypass grafting to segment #2 using a section of saphenous vein and total aortic arch replacement with "elephant trunk" technique, which concurrently served as a means of amputated stump plasty, was performed. The cerebral circulation was preserved by retrograde cerebral circulation. The post operative progress was good, and thrombo-occlusion of the false lumens of the proximal descending aorta was verified. Type IIIb aortic dissection complicated with myocardial infarction is rare, but examination with both transthoracic and transesophageal echocardiograms were useful for the morphological diagnosis and for determining the surgical technique for the dissection.
患者为一名48岁男性，因胸痛、下肢感觉异常及腰部疼痛被送至我院。最初诊断为急性心肌梗死，但经胸超声心动图显示升主动脉存在内膜瓣。术中经食管超声心动图证实左锁骨下动脉下方存在内膜撕裂，诊断为伴有IIIb型主动脉夹层并逆行延伸至升主动脉的心肌梗死。采用一段大隐静脉进行冠状动脉旁路移植至第2节段，并采用“象鼻”技术进行全主动脉弓置换，同时作为残端成形术的一种手段。通过逆行脑循环保护脑循环。术后恢复良好，近端降主动脉假腔血栓形成得到证实。IIIb型主动脉夹层合并心肌梗死较为罕见，但经胸和经食管超声心动图检查对于夹层的形态学诊断和确定手术技术均有帮助。
