A型主动脉夹层累及冠状动脉超声表现及预后

Ultrasonic manifestations and prognosis of Stanford type Aaortic dissection with involvement of coronary artery

目的结合冠状动脉CT血管造影(CTA)结果,分析急性A型主动脉夹层(AAD)累及冠状动脉超声表现及预后。方法回顾性分析148例因ADD接受Bentall手术患者的临床、冠状动脉CTA及超声心动图资料,根据AAD是否累及冠状动脉将分为累及组和未累及组,比较组间临床资料、超声心动图表现及预后差异。结果148例AAD中,34例累及冠状动脉(34/148,22.97%,累及组),多累及右冠状动脉(33/34,97.06%),114例未累及冠状动脉(未累及组)。累及组AAD患者多有高血压病史(28/34,82.35%,χ^(2)=5.52,P=0.02),其晕厥或肢体障碍发生率高于未累及组(χ^(2)=6.47,P=0.01)。累及组多见左心室壁增厚(23/34,67.65%,χ^(2)=4.692,P=0.030)、左心室壁运动减低(14/34,41.18%,χ^(2)=4.481,P=0.034),升主动脉内径增宽、左心房增大发生率均低于未累及组(χ^(2)=4.509、6.114,P=0.034、0.013)。围手术期53例患者死亡(53/148,35.81%),累及组死亡率(13/34,38.24%)与未累及组(40/114,35.09%)差异无统计学意义(χ^(2)=0.113,P=0.737)。累及组心力衰竭发生率(6/13,46.15%)高于未累及组(7/40,17.50%,χ^(2)=4.352,P=0.037)。结论ADD常累及右冠状动脉,超声心动图多见左心室壁增厚及室壁运动减低;围手术期易发生心力衰竭致死。

Objective To analyze the ultrasonic manifestations and prognosis of Stanford type A aortic dissection(AAD)involving coronary arteries combined with results of coronary CT angiography(CTA).Methods Data of 148 AAD patients who underwent Bentall surgery for ADD were retrospectively analyzed.The patients were divided into involved group and non-involved group according to whether AAD involved coronary artery or not.The clinical,echocardiographic manifestations and prognosis were compared between 2 groups.Results Among 148 AAD patients,coronary artery involvement was observed in 34 cases(34/148,22.97%,involved group),including 33 cases of the right coronary artery(33/34,97.06%)involvement,whereas 114 cases were found without coronary artery involvement(non-involved group).Most patients in involved group had the history of hypertension(28/34,82.35%,χ^(2)=5.52,P=0.02),and the incidence of syncope or physical disorder in involved group was higher than that in non-involved group(χ^(2)=6.47,P=0.01).In involved group,Thickened left ventricular wall(23/34,67.65%,χ^(2)=4.692,P=0.030)and decreased left ventricular wall motion(14/34,41.18%,χ^(2)=4.481,P=0.034)were more common,and the incidence of widen ascending aorta and enlarged left atrium were lower than those in non-involved group(χ^(2)=4.509,6.114,P=0.034,0.013).During perioperative period,53 patients died(53/148,35.81%),and there was no significant difference of the mortality between involved group(13/34,38.24%)and non-involved group(40/114,35.09%,χ^(2)=0.113,P=0.737).The incidence of heart failure in involved group was higher(6/13,46.15%)than that of non-involved group(7/40,17.50%,χ^(2)=4.352,P=0.037).Conclusion ADD often involved the right coronary artery,with left ventricular wall thickening and decreased wall motion,and the patients were prone to death from heart failure during perioperative period.