Ohtani N, Akasaka N, Kawakami T, Goh K, Sasajima T, Kubo Y
Department of Cardiovascular Surgery, Shin-Nittetsu Muroran General Hospital, Muroran, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jun;45(6):865-8.
The ruptured thoracic aortic aneurysm is still a dramatic even with very poor outcome, whereby its survival depends largely on early diagnosis and operation. We report a successful case of aortic arch replacement for ruptured aortic arch aneurysm with cardiac tamponade. Lethal hemopericardium causing cardiac tamponade is most commonly seen as a complication of acute myocardial infarction or acute aortic dissection, and subsequent rupture of the heart or ascending aorta leads to the rapid accumulation of blood within the poorly distensible pericardial sac. Our case was operated upon emergency basis due to hemopericardium. On operative findings, the aortic aneurysm located the minor curvature of aortic arch and was a huge saccular shape. In surgical procedure, the total arch replacement was completed using selective cerebral antegrade perfusion with deep hypothermia. Postoperative course was uneventful and no cerebral complication was observed after surgery.
破裂性胸主动脉瘤仍然是一种严重的疾病，预后很差，其存活很大程度上取决于早期诊断和手术。我们报告一例成功进行主动脉弓置换术治疗破裂性主动脉弓瘤并伴有心脏压塞的病例。导致心脏压塞的致命性心包积血最常见于急性心肌梗死或急性主动脉夹层的并发症，随后心脏或升主动脉破裂导致血液在扩张性差的心包腔内迅速积聚。我们的病例因心包积血而进行了急诊手术。手术发现，主动脉瘤位于主动脉弓的小弯处，呈巨大囊状。在手术过程中，采用选择性脑顺行灌注和深低温技术完成了全弓置换。术后过程顺利，术后未观察到脑部并发症。
