Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneury...Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53±15 years, and 70%were men. Of these, 50(83%) had undergone previous cardiac surgery, including 22(37%) composite valve graft operations. The preferred cannulation site was femoral-femoral(n=27, 45%), with deep hypothermic circulatory arrest in 62%and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Results: Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients(25%) presented with chest pain, 13(22%) with heart failure, and 20%with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced(n=45, 75%) or repaired(n=15, 25%) using various methods. Hospital mortality was 6.7%(n=4). Reexploration for bleeding was required in 8.3%, and 3.3%had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60%and freedom from reoperation was 95%, 77%, and 67%, respectively. Conclusions: Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.展开更多
患者女，53岁，因“动脉导管未闭结扎术后30余年，间断咯血10余年并进行性加重”来我院就诊，患者33年前因心脏杂音诊断动脉导管未闭，并经左腋下切口行动脉导管未闭结扎术，10余年前开始出现间断咯血，近期加重，并出现活动后胸闷、憋...患者女，53岁，因“动脉导管未闭结扎术后30余年，间断咯血10余年并进行性加重”来我院就诊，患者33年前因心脏杂音诊断动脉导管未闭，并经左腋下切口行动脉导管未闭结扎术，10余年前开始出现间断咯血，近期加重，并出现活动后胸闷、憋气及口唇发绀等表现。查体：血压130/85 mm Hg（1 mm Hg=0.133 kPa），心率89次/min，律齐。听诊胸骨左缘2~3肋间可闻及2/6级收缩期杂音。超声心动图检查示：（1）左心房、左心室扩大，右心房、右心室大小正常；（2）大动脉短轴切面观可见主动脉与肺动脉主干位置正常，内径正常，肺动脉主干无分叉结构，仅向左侧延续发出一支肺动脉，未探及右侧肺动脉分支，于升主动脉近端左后方发出右肺动脉，右肺动脉扩张（图1）；（3）彩色多普勒血流成像显示右肺动脉开口处见由升主动脉至右肺动脉的低速连续性分流血流信号（图2）并见少量由右肺动脉至升主动脉的分流血流信号；（4）动脉导管未闭结扎处未见残余分流血流信号。心导管造影检查示：右肺动脉起源于升主动脉。展开更多
文摘Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53±15 years, and 70%were men. Of these, 50(83%) had undergone previous cardiac surgery, including 22(37%) composite valve graft operations. The preferred cannulation site was femoral-femoral(n=27, 45%), with deep hypothermic circulatory arrest in 62%and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Results: Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients(25%) presented with chest pain, 13(22%) with heart failure, and 20%with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced(n=45, 75%) or repaired(n=15, 25%) using various methods. Hospital mortality was 6.7%(n=4). Reexploration for bleeding was required in 8.3%, and 3.3%had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60%and freedom from reoperation was 95%, 77%, and 67%, respectively. Conclusions: Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.
文摘患者女，53岁，因“动脉导管未闭结扎术后30余年，间断咯血10余年并进行性加重”来我院就诊，患者33年前因心脏杂音诊断动脉导管未闭，并经左腋下切口行动脉导管未闭结扎术，10余年前开始出现间断咯血，近期加重，并出现活动后胸闷、憋气及口唇发绀等表现。查体：血压130/85 mm Hg（1 mm Hg=0.133 kPa），心率89次/min，律齐。听诊胸骨左缘2~3肋间可闻及2/6级收缩期杂音。超声心动图检查示：（1）左心房、左心室扩大，右心房、右心室大小正常；（2）大动脉短轴切面观可见主动脉与肺动脉主干位置正常，内径正常，肺动脉主干无分叉结构，仅向左侧延续发出一支肺动脉，未探及右侧肺动脉分支，于升主动脉近端左后方发出右肺动脉，右肺动脉扩张（图1）；（3）彩色多普勒血流成像显示右肺动脉开口处见由升主动脉至右肺动脉的低速连续性分流血流信号（图2）并见少量由右肺动脉至升主动脉的分流血流信号；（4）动脉导管未闭结扎处未见残余分流血流信号。心导管造影检查示：右肺动脉起源于升主动脉。
