Morales D L, Quin J A, Braxton J H, Hammond G L, Gusberg R J, Elefteriades J A
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Ann Thorac Surg. 1998 Nov;66(5):1679-83. doi: 10.1016/s0003-4975(98)00901-1.
Aortic fenestration is used clinically to treat organ ischemia in acute descending aortic dissection. However, fenestration has not been studied experimentally. This study does so using an animal model.
Descending aortic dissection was created in six dogs, with subsequent fenestration of the infrarenal aorta. Blood flow (femoral, cephalic, and renal), blood pressure (femoral and carotid), and aortic distensibility were measured at baseline, after dissection, and after fenestration. Values were compared using paired t tests.
Baseline femoral, cephalic, and renal arterial flows were 53+/-37, 78+/-65, and 83+/-52 mL/min, respectively. Baseline femoral and carotid pressures were 82+/-13 and 81+/-11 mm Hg, respectively. After dissection, femoral, cephalic, and renal arterial flow decreased to 20+/-21 (p < 0.05), 38+/-26, and 56+/-36 mL/min, respectively. Femoral blood pressure decreased to 28+/-17 mm Hg (p < 0.05). With fenestration, femoral, cephalic, and renal flows increased to 60+/-37 (p < 0.05), 78+/-51, and 80+/-48 mL/min, respectively. Femoral blood pressure increased to 85+/-28 mm Hg (p < 0.05). Carotid pressure remained unchanged with dissection and fenestration (77+/-17 mm Hg, 82+/-17 mm Hg, respectively). Baseline aortic distensibility (21%) decreased significantly after dissection (to 1.4%, p < 0.05) and increased after fenestration (to 12%, p < 0.05).
Experimental aortic fenestration restored blood pressure and flow to hypoperfused organs in acute descending aortic dissection. The continued clinical application of fenestration is supported.
主动脉开窗术在临床上用于治疗急性降主动脉夹层的器官缺血。然而，尚未对开窗术进行实验研究。本研究使用动物模型进行此项研究。
对6只犬制造降主动脉夹层，随后对肾下主动脉进行开窗。在基线、夹层形成后及开窗后测量血流量（股动脉、头臂动脉和肾动脉）、血压（股动脉和颈动脉）以及主动脉可扩张性。使用配对t检验比较数值。
基线时股动脉、头臂动脉和肾动脉血流量分别为53±37、78±65和83±52 mL/分钟。基线时股动脉和颈动脉血压分别为82±13和81±11 mmHg。夹层形成后，股动脉、头臂动脉和肾动脉血流量分别降至20±21（p<0.05）、38±26和56±36 mL/分钟。股动脉血压降至28±17 mmHg（p<0.05）。开窗后，股动脉、头臂动脉和肾动脉血流量分别增至60±37（p<0.05）、78±51和80±48 mL/分钟。股动脉血压增至85±28 mmHg（p<0.05）。夹层形成和开窗后颈动脉血压保持不变（分别为77±17 mmHg和82±17 mmHg）。基线时主动脉可扩张性（21%）在夹层形成后显著降低（降至1.4%，p<0.05），开窗后增加（增至12%，p<0.05）。
实验性主动脉开窗术可恢复急性降主动脉夹层中灌注不足器官的血压和血流。支持继续在临床中应用开窗术。
