Uchida K, Kondo J, Imoto K, Tobe M, Sakamoto A, Sugiyama M
Critical Care and Emergency Medical Center, Yokohama City University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):1024-7.
A 73-year-old woman was admitted with chest pain of sudden onset and hypotension. Enhanced CT showed the dilated ascending aorta with an intimal flap. Emergency surgery was performed under a diagnosis of type A acute aortic dissection and cardiac tamponade. Replacement of the ascending aorta was planned, but during the operation we found that the dissection had extended to the aortic root and that the laceration of the adventitia was located just distal to the aortic annulus. Since the laceration was closer to the aortic annulus than the coronary ostium, it was impossible to reconstruct the aortic stump by classical techniques using Teflon felt strips. Gelatine-Resorcine-Formol (GRF) glue was therefore used to reinforce the proximal aortic stump. We then curved the suture line of the proximal anastomosis so as to resect the laceration while preserving the ostia of the coronary arteries. We were thus able to perform simple replacement of the ascending aorta successfully and the postoperative course was uneventful. By using GRF glue, replacement of the aortic root can be avoided in such cases.
一名73岁女性因突发胸痛和低血压入院。增强CT显示升主动脉扩张并伴有内膜瓣。在诊断为A型急性主动脉夹层和心脏压塞后进行了急诊手术。计划进行升主动脉置换，但术中发现夹层已延伸至主动脉根部，外膜撕裂位于主动脉瓣环远端。由于撕裂处比冠状动脉口更靠近主动脉瓣环，因此无法使用特氟龙毡条通过经典技术重建主动脉残端。因此，使用明胶-间苯二酚-甲醛（GRF）胶水加固主动脉近端残端。然后我们将近端吻合口的缝线弯曲，以便在保留冠状动脉口的同时切除撕裂处。这样我们成功地进行了升主动脉的简单置换，术后过程顺利。通过使用GRF胶水，在此类病例中可以避免进行主动脉根部置换。
