Kohno M, Ohuchi H, Fukuda I
Department of Emergency, Critical Care Medicine and Traumatology, Tsukuba Medical Center Hospital, Ibaraki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Oct;44(10):1882-6.
Aortic valve injury due to blunt trauma is rare and often difficult to diagnose. Therefore, most reported cases are operated on months or years after initial injury. Reported below is the case of a 55-year-old male, who was involved in a head-on collision with a bus. He was transported to Tsukuba Medical Center by ambulance, 34 minutes after the accident. The patient presented acute shock without obvious evidence of hemorrhaging. On physical examination a murmur was detected. The murmur was evaluated by Doppler echocardiography and revealed aortic regurgitation. On further physical examination he had gross hematuria and intratracheal bleeding. Computerized tomography (CT) showed evidence of contusions to his lungs, liver, and kidneys. The individual was diagnosed with an aortic valve injury, causing aortic insufficiency. It was necessary to continuously monitor the patients' hemodynamic state, assessing when conditions to operate were most favorable. However, in the hyper-acute phase the bleeding is difficult to control. We waited for his platelet count to recover before operating on the fifth day. When the patient underwent valve repair using extracorporeal circulation (ECC), aprotinin was added to the procedure. The surgery revealed a large laceration on the right coronary cusp of the aortic valve. Repair to the valve was impossible, so replacement of the aortic valve was required. A Carbomedics mechanical valve (phi 21 mm) was inserted. The patient did well after surgery, and eventually returned to work. To date, in Japan, there are eleven such cases of aortic valve injury on file. However, this is the first reported case that involved operating during the acute phase. This case demonstrates that, with careful evaluation of coexisting injuries and control of bleeding, successful treatment of aortic valve injury using ECC is possible, even in the acute phase.
钝性创伤导致的主动脉瓣损伤罕见且常难以诊断。因此，大多数报道的病例是在初次受伤数月或数年后才进行手术。以下报道的是一名55岁男性的病例，他与一辆公共汽车发生了正面碰撞。事故发生34分钟后，他被救护车送往筑波医疗中心。患者出现急性休克，无明显出血迹象。体格检查时发现有杂音。通过多普勒超声心动图对该杂音进行评估，显示存在主动脉瓣反流。进一步体格检查发现他有肉眼血尿和气管内出血。计算机断层扫描（CT）显示其肺部、肝脏和肾脏有挫伤迹象。该患者被诊断为主动脉瓣损伤，导致主动脉瓣关闭不全。有必要持续监测患者的血流动力学状态，评估何时进行手术最为有利。然而，在超急性期出血难以控制。我们等待他的血小板计数恢复后，于第五天进行手术。当患者使用体外循环（ECC）进行瓣膜修复时，术中添加了抑肽酶。手术发现主动脉瓣右冠状动脉瓣有一个大的撕裂伤。无法对瓣膜进行修复，因此需要更换主动脉瓣。植入了一个Carbomedics机械瓣膜（直径21毫米）。患者术后恢复良好，最终重返工作岗位。迄今为止，在日本，有11例此类主动脉瓣损伤病例记录在案。然而，这是首例报道的在急性期进行手术的病例。该病例表明，通过仔细评估合并伤并控制出血，即使在急性期，使用ECC成功治疗主动脉瓣损伤也是可能的。
