超声心动图引导下置入覆膜支架治疗StanfordB型主动脉夹层

Echocardiography guided coated stent-graft implantation for patients with Stanford B aortic dissection

目的创建应用超声心动图引导下置入覆膜支架治疗StanfordB型主动脉夹层的新方法，探讨其可行性、安全性及疗效。方法5例经CT证实的StanfordB型主动脉夹层患者在术前应用超声心动图判断病变，并根据测量参数选择覆膜支架型号。术中以超声心动图（包括经食管和经胸超声心动图）实时、动态地引导和监测，精确定位后置入覆膜支架封闭主动脉夹层破口。术后以经胸超声心动图随访，评估置入覆膜支架的疗效。结果5例患者应用超声心动图引导置入覆膜支架治疗StanfordB型主动脉夹层，均成功置入真腔。1例患者主动脉夹层的远端有一小破口未覆盖。术后随访3个月，未发现覆膜支架移位及新生内漏，未发现主动脉管壁穿孔、肾功能衰竭、截瘫等严重并发症。与术前2d比较，术后1个月和3个月左心室射血分数（中位数分别为59．9％、67．4％、68．1％）和左心室短轴缩短率（中位数分别为31．4％、33．7％、39．1％）均显著增高（均P〈0．05）。结论创建了临床治疗StanfordB型主动脉夹层的新方法。超声心动图引导下置入覆膜支架治疗B型主动脉夹层安全、有效、并发症少，近期效果满意，中、远期结果需进一步观察。

Objective To evaluate the feasibility, safety and efficacy of transesophageal echocardiography （TEE） and transthoracic echocardiography （TTE） guided coated stent-graft implantation for patients with Stanford B aortic dissection. Methods In 5 patients with CT confirmed Stanford B aortic dissection, TEE and TTE were used to determine the parameters for pre-surgery diagnosis and selection of suitable coated stent. During surgery, TEE and TTE provided real-time and dynamic monitoring and guiding for precise implantation of the coated stent to effectively seal the tear of the aortic dissection. After surgery, efficacy of implanted coated stent was evaluated by TI＇E. Results In all 5 patients, the coated stents were successfully implanted in the true lumen, a small distal tear was not covered in 1 case. Displacement of stent-graft or new endoleak was not observed at follow-up examinations performed at 3 months post-surgery. There were no aortic perforation, renal failure, paraplegia or other complications. The medians of left ventricular ejection fraction （LVEF） in 2 days before surgery, I month post-surgery and 3 months post- surgery are 59. 9%, 67.4% and 68.1% and the medians of fraction shortening （FS） are 31.4%, 33.7% and 39. 1%. Compared with 2 days before surgery, significant increase of LVEF and FS was observed in 1 month post-surgery and 3 months post-surgery （ all P 〈 0. 05 ）. Conclusion Our results showed that echocardiography guided coated stent-graft implantation for patients with Stanford B aortic dissection was safe and effective with lower risk of complications.