20例心血管术后主动脉假性动脉瘤CTA表现与临床分析

CTA features and clinical analysis 20 cases of cardiovascular postcperatiure aorta pseudoaneurysms

目的探讨心血管手术后主动脉假性动脉瘤的CTA及临床特点,评价主动脉CTA检查的诊断价值。方法回顾分析2009年3月～2013年12月20例心血管手术后主动脉假性动脉瘤患者的CTA图像和临床资料。其中男性17例,女性3例,年龄21～70岁,平均年龄（50.3±7.9岁）。20例患者均有心血管手术史,其中行胸主动脉腔内修复术Thoracic endovascular aortic repair TAVAR 8例（包括烟囱术2例）,主动脉替换术7例（升主动脉替换术2例,升主动脉＋全弓替换术1例,升主动脉＋主动脉弓替换术＋降主动脉支架植入术2例,降主动脉替换术2例）,室间隔缺损及动脉导管未闭修补术1例,先天弓部瘤修补术1例,双瓣替换术2例,心包穿刺术1例。结果假性动脉瘤位于升主动脉6例,弓部4例,降主动脉9例,腹主动脉1例,均位于主动脉轮廓之外,单发。瘤体偏于一侧、形状不规则,瘤壁较厚,瘤体大小10.8～98cm^2,平均（48.5±9.3）cm^2。20例均可见破口与瘤腔相通,破口直径5.0～24.0mm,平均直径（12.3±4.2）mm。18例患者进行再次手术,CTA测量假性动脉瘤瘤体和破口大小与术中所见无明显差异,P〉0.05。18例获得随访,随访率18/20,平均随访时间146天,随访期间总病死率2/20。结论心血管手术是主动脉假性动脉瘤常见原因,破裂以致死亡的风险较大,一经发现需及时手术治疗。心血管手术后需定期复查,主动脉CTA可及时准确显示假性动脉瘤的特异性征象,适用于术前确诊及术后随诊。

Objective To discuss the CTA and clinical features of postoperative aortic pseudoaneurysm and to evaluate the diagnostic value of CTA.Methods We retrospectively analyzed the CTA images and clinical dates of postoperative patients with aortic pseudoaneurysm from March 2009 to December 2013 undergoing cardiovascular surgery.We identified 20patients（17male,3females respectively）,with mean age（50.3±7.9）years（range 21～70years）.All of them had histories of cardiovascular surgeries,including 8cases of thoracic endovascular aortic repair TAVAR（including 2cases of chimney surgery）,7cases of aorta replacement（2cases of ascending aorta replacement,1case of ascending aorta and complete archreplacement,2cases of ascending aorta and aortic arch replacement＋descending aorta stent implantation,2cases of descending aorta replacement）,1case of ventricular septal defect and patent ductus arteriosus repair,1case of congenital aortic aneurysm repair,2cases of the combined mitral and aortic valve replacement,1case of pericardiocentesis.Results We found 6cases of the pseudoaneurysm located in the ascending aorta,4cases in the aortic arch,9cases in the descending aorta and 1case in the abdominal aorta.In all cases,the pseudoaneurysm was solitary and lopsided,locating outside the outline of aorta,with anomalous formation and thick aneurismal wall.Themean tumor size was（48.5±9.3）cm^2（range 10.8～98cm^2）.It can be seen that holes communicated with lumens in all cases.The mean diameter of holes was（12.3±4.2）mm（range 5.0～24.0mm）.18 patients underwent the second operations.The sizes of pseudoaneurysm and holes measured by CTA were not significantly different from those of found during operations.18 patients were followed up,with the mean follow-up period of 146 days and the follow-up rate of 90%.The mortality during follow-up was10%.Conclusion The cardiovascular surgery is a common cause of the formation of aortic pseudoaneurysm,which has a high risk of rupture and death.It should be cured immediately once observed.Meanwhile,the regular check is also essential for patients after cardiovascular surgery.Aortic CTA images can show the sign of pseudoaneurysm specially andaccurately,and are suitable for the preoperative diagnosis and postoperative follow-up.