DeBakeyⅢ型术后复发同期主动脉弓和升主动脉根部替换

REPLACEMENT OF AORTIC ROOT AND TOTAL ARCH AFTER DEBAKEY Ⅲ OPERATION

目的 :介绍 1例DeBakeyⅢ型术后复发急性升主动脉与主动脉弓夹层动脉瘤患者施行了主动脉根部替换加全弓替换手术。方法 :患者男 ,59岁 ,7a前于我科行DeBakeyⅢ型夹层动脉瘤行手术 ,效果良好。 1 999年 5月 1 8日突发胸痛急诊入院。诊断为DeBakeyⅢ型夹层动脉瘤术后 ,升主动脉、主动脉弓及头臂分枝夹层动脉瘤 ,主动脉瓣重度返流 ,心功能Ⅲ级。于体外循环、深低温停循环下 ,联合无名动脉、颈总动脉选择顺行脑灌注 ,流量为 1 0ml/(kg·min) ,用人造主动脉弓重建主动脉弓 ,用带管道人工瓣 (StJude 2 5)重建主动脉根部。结果 :停循环为 65min ,脑选择灌注 92min ,阻断升主动脉 2 4 0min。 48h拔除气管插管 ,无脑及脊髓并发症。随访 1 4个月 ,情况良好。结论 :深低温停循环联合选择性脑灌注 ,可以提供足够的时间行主动脉弓的替换。采用头臂干分枝吻合 。

Objective:To discuss experience in the first case of aortic root replacement concomitant with total arch replacement after graft replacement of DeBakey Ⅲ aortic dissection.Methods:A 59 year old male with DeBakey Ⅲ aortic dissection was operated 7 years ago.However,he was admitted to our emergency clinic due to chest pain.The diagnosis was 3 branches dissecting aneurysm in ascending aorta and aortic arch,severe aortic regurgitation and NYHA Ⅲ after DeBakey Ⅲ aortic dissection.Aortic arch replacement was done under cardiac pulmonary bypass with deep hypothermic circulatory arrest,combining with selective cerebral perfusion of INA and LCCA.The aortic arch was replaced with artificial aortic arch and aortic root replacement with a conduct with aortic valve as well.Results:Circulatory arrest time was 65 minutes,cerebral perfusion time was 92 minutes,and cross clamping time was 240 minutes.The patient woke up 8 hours after operation,tracheal tube was detubated 48 hours after operation,no cerebral and spinal complications were found.The patient was in good condition on follow up for 14 months.Conclusion:Circulatory arrest with deep hypothermia combining with selective cerebral perfusion via brachial cephalic trunk can offer enough time to finish the arch replacement.Aortic arch replacement with the artificial aortic arch with 3 branches were seperatiely anastomosied to IA,LCCA and LSA,is an easy method.