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一例使用新型A型主动脉夹层冠状动脉处理方法的病例报道

A case report of coronary artery management using a novel type A aortic dissection
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摘要 急性Stanford A型主动脉夹层是十分凶险的疾病,具有很高的病死率,严重威胁患者生命。外科手术被认为是治疗急性Stanford A型主动脉夹层的有效手段,它显著提高了患者的生存率。具体手术方式的抉择因夹层病变累及范围而异,但是Stanford A型主动脉夹层其根部处理策略对外科医师而言无疑极具挑战,尤其是需要同期处理冠状动脉的Stanford A型主动脉夹层。本文旨在通过报道惠州市第一人民医院心脏外科急诊手术成功救治一例大体重急性Stanford A型主动脉夹层累及无冠窦合并主动脉瓣关闭不全患者的成功案例,分享术中经验和相关文献。患者为44岁男性,体重指数为29.4 kg/m2,手术应用带瓣人工血管置换主动脉瓣、升主动脉,在于人工血管对应左、右冠状动脉开口处分别打孔,沿升主动脉STJ平面连续缝合自体主动脉与人工血管完成冠状动脉移植,术后44 d患者步行出院,随访半年余效果良好。 Acute Stanford type A aortic dissection is a very dangerous disease with high mortality,which seriously threatens patients'lives.Surgery is considered as an effective method to treat acute Stanford type A aortic dissection,which significantly improves the survival rate of patients.The treatment modalities varies with the extent of dissection,but the aortic root management strategy of Stanford type A aortic dissection is undoubtedly very challenging for surgeons,especially Stanford type A aortic dissection which needs to treat coronary artery at the same time.This paper aims to report the successful treatment of a heavy patient with acute Stanford type A aortic dissection involving noncoronary sinus and aortic valve regurgitation in the emergency operation of cardiac surgery in Huizhou First People's Hospital,and to share the intraoperative experience and related literature.The patient was a 44-year-old male with a body mass index of 29.4 kg/m2.In the operation,the aortic valve and ascending aorta were replaced by valved vascular prosthesis,and then holes were punched in the valved vascular prosthesis corresponding to the left and right coronary arteries,and the autologous aorta and the valved vascular prosthesis were continuously sutured along the STJ plane of the ascending aorta to complete the coronary artery transplantation.The patient was discharged on foot 44 days after operation,and the follow-up for more than half a year showed good results.
作者 黄志辉 何海锋 HUANG Zhihui;HE Haifeng(Department of Cardiac Surgery,Huizhou First People's Hospital,Guangdong Province,Huizhou 516000,China)
出处 《中国当代医药》 CAS 2023年第21期167-171,共5页 China Modern Medicine
关键词 主动脉夹层 冠状动脉疾病 主动脉根部疾病 主动脉窦部 主动脉瓣关闭不全 Aortic dissection Coronary artery disease Aortic root disease Aortic sinus Aortic valve regurgitation
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