主动脉瓣置换术后继发夹层的CT影像分析

CT image analysis of aortic dissection after aortic valve replacement.

目的分析CT对主动脉瓣置换术后继发夹层的影像表现。提高对该病的认识,指导临床手术方式的选择。方法回顾性分析11例主动脉瓣置换术后再发夹层病例的临床及CT检查资料。结果8例为单纯AVR术后,2例为主动脉瓣置换术后并冠状动脉搭桥术后,1例为主动脉瓣、二尖瓣置换术后;主动脉瓣置换术后复查CT时间4月~11年不等。CTA显示9例为Stanford A型夹层,2例为Stanford B型夹层;11例均出现升主动脉不同程度扩张,扩张严重处内径达89mm;1例夹层近段累及左、右冠状动脉开口;3例主动脉弓上三分叉血管不同程度受累;6例腹腔血管不同程度受累。结论主动脉瓣置换术后继发夹层重在预防,对于升主动脉扩张大于4cm者应积极行升主动脉置换。

Objective To analyze the CT imaging manifestations of aortic dissection after aortic valve replacement so as to improve the knowledge of the disease and to guide the selection of clinical operation.Methods The clinical and CT examination data of 11 cases with aortic dissection after valve replacement were retrospectively analyzed.Results 8 cases were performed AVR;2 case performed AVR combined with coronary artery bypass surgery;1 case performed AVR combined with MVR;Aortic dissection occured at intervals from 4 months to 11 years after surgery.9 cases were diagnosed Stanford A aortic dissection,and 2 cases were diagnosed Stanford B aortic dissection.All of the 8 cases were enlarged with different degrees of ascending aorta,and the internal diameter of the enlarged aorta was 8.9 mm.The opening of coronary arteries was affected in 1 case;the branches of aortic arch were affected by different degrees in 3 cases.large branches of the abdominal aorta were affected in 6 cases.Conclusion It is important to prevent the aortic dissection occurrence after aortic valve replacement;and the patients of aortic valve diseases and aorta dilation greater than 4 cm should be performed AVR combined with ascending aorta replacement.