主动脉瓣成形术于A型主动脉夹层治疗中的应用△

目的总结采用主动脉瓣成形术治疗主动脉夹层撕裂引起的主动脉瓣反流（aorticregurgitation,AR）的经验及术后随访分析。方法分析2007年3月至2011年9月广东省人民医院收住的100例因主动脉夹层引起的AR,采用主动脉瓣成形术处理纠正AR的患者的资料,并对术后患者进行门诊随访,了解术后病情变化。所有患者病因均排除马凡氏综合征。结果住院死亡5例。随访（110＋39）周,术后1周、3个月及9个月患者AR面积、左心室舒张末期内径（1eftventficularenddiastolicdimension,LVEDd）、左心室收缩末期内径（1eftventricularend-systolicdimension,LYESd]、左心室射血分数（1eftventricularejectionfraction,LVEF）均较术前有明显改善,差异有统计学意义（P〈O．05）。术后1周、3个月及9个月后患者AR面积、LVEDd、LVESd及LVEF两两比较,差异无统计学意义（P〉0．05）。1例患者术后2年因AR加重而再次返院行主动脉瓣置换术,余患者门诊随访效果良好。结论主动脉瓣成形术是治疗主动脉夹层撕裂引起的AR有效的手术方法,且效果稳定。     

Respecting Symptoms in Thoracic Aortic Aneurysm Management: A Case of Symptomatic Necrotizing Granulomatous Aortitis

A 41-year-old woman presented with chest pain of unclear etiology in the setting of a mildly dilated ascending aorta. Computed tomography angiography showed an aorta with an irregular contour and an aneurysm of 4.5 cm. There was no radiographic evidence of rupture or dissection. The patient was taken to the operating room and was found to have severe aortitis with marked localized wall thinning at imminent risk of aortic rupture. Aortic pathology demonstrated necrotizing granulomas of noninfectious etiology. This case illustrates the importance of respecting symptoms in surgical decision making for thoracic aortic aneurysms that may not meet standard interventional criteria.     

仿“Z”字主动脉窦部成形技术在急性Stanford A型主动脉夹层中的应用

目的：评估仿“Z”字主动脉窦部成形技术在急性Stanford A型主动脉夹层中的临床疗效;方法：回顾性分析自2014年9月至2018年12月在武汉亚洲心脏病医院大血管中心共收治急性Stanford A型主动脉夹层412例,其中入组125例,包含主动脉瓣重度关闭不全患者60例。男性80例,女性45例;年龄 30-77岁,平均年龄（51.9±9.37）岁。该组患者根部处理均应用仿“Z”字主动脉窦部成形技术,远端半主动脉弓置换15例,全主动脉弓置换110例。全主动脉弓置换患者均置入“象鼻”支架。结果：全组体外循环时间（170±41.2）min;主动脉阻断时间（130.1±30.6）min;深低温停循环时间（25.1±5.9）min。术后随访1.5月—4.3年,术后所有患者主动脉瓣返流程度均为0-1级。 术后经食道超声检查即刻主动窦部残余夹层3例,分别随访1.5年、2.5年和3.0年,未形成动脉瘤,主动脉窦部直径分别为4.3cm、4.2cm和4.5cm。余患者随访期间未发现因主动脉瓣返流及窦部情况再次手术。结论;仿“Z”字主动脉窦部成形技术在急性Stanford A型主动脉夹层中的临床疗效较好,手术操作简单、易掌握、安全有效、易开展。尤其在合并主动脉瓣反流的患者中,避免了换瓣手术,缩短了手术时间,提高了患者的生活质量。     

Mixed aortic valve disease treated with transcatheter aortic valve replacement in a high risk patient presenting with acute decompensated heart failure

Mixed aortic valve disease refers to the combination of aortic regurgitation (AR) and aortic stenosis (AS). Commonly etiologies include a bicuspid aortic valve, rheumatic heart disease, and endocarditis superimposed upon a stenotic aortic valve. Treatment depends upon the severity of disease, the presence of symptoms and the size and function of the left ventricle. We present a case of a young patient that presented with new onset acute decompensated heart failure with mixed aortic valve disease that was successful treated with transcatheter aortic valve replacement (TAVR). Invasive hemodynamics at baseline and following TAVR provide an insight into the characteristic features of mixed aortic valve disease. TAVR represents a new treatment option for critically ill patients deemed high risk or nonoperable for surgical aortic valve replacement.     

Atypical echocardiographic findings in traumatic aortic transection

Aortic rupture and transection are constituents of the acute aortic syndrome. Injury to the thoracic aorta during motor vehicle crashes is associated with blunt chest trauma and rapid deceleration mechanisms. Type A dissections and/or rupture of the aorta at the level of the aortic isthmus are the more common presentations of aortic injuries associated with motor vehicle crashes. We present the case of atypical echocardiographic findings of a nearly complete circumferential transection of the proximal ascending aorta injury after a motorcycle crash.     

Procedural and clinical outcomes of the valve‐in‐valve technique for severe aortic insufficiency after balloon‐expandable transcatheter aortic valve replacement

Objective : To describe the clinical and procedural outcomes of patients treated with the valve‐in‐valve technique for severe aortic insufficiency (AI) after balloon‐expandable transcatheter aortic valve replacement (TAVR). Background : Severe AI immediately after valve implantation is a notable complication of TAVR. It can be treated with a valve‐in‐valve technique which involves deploying a second valve within the first one to crush the leaflets of the first implant leaving a new functional valve. Methods : We analyzed data on 142 consecutive patients at our institution undergoing TAVR with the Sapien valve between November of 2007 and April of 2011. Etiologies of acute AI, procedural and intermediate term clinical outcomes were reported for those in whom a valve‐in‐valve procedure was necessary. Post‐hoc analysis of these cases with C‐THV imaging (Paieon Medical Ltd.) was performed to elucidate the mechanism for successful AI treatment. Results : A total of 5 of 142 (3.5%) patients were treated with the valve‐in‐valve technique. Etiologies of the aortic valve insufficiency included bioprosthesis malposition (n = 3), valve dysfunction (n = 1), and valve undersizing (n = 1). With placement of the second valve, the first valve dimensions increased to approach the nominal valve size while the second valve size remained less than nominal. Conclusions : The valve‐in‐valve technique is an appropriate bailout measure for patients with acute valvular AI after balloon‐expandable TAVR. © 2012 Wiley Periodicals Inc.     

3D morphometric analysis of ascending aorta as an adjunctive tool to predict type A acute aortic dissection

BackgroundAcute type A aortic dissection (AAAD) is a pathological process that implicates the ascending aorta and represents a surgical emergency burdened by high mortality if not promptly treated in the first hours of onset. Despite best efforts, the annual incidence rates of aortic dissection has remained stable over the past decades. We measured aortic dimensions (aortic diameters, area, length and volume) using 3D multiplanar reconstruction imaging with the purpose of refining the risk- morphology for AAAD.MethodsComputerized tomography angiography studies of three groups were compared retrospectively: patients affected by AAAD (AAAD group; n=71), patients affected by aortic aneurysm and subsequently subjected to ascending aorta replacement (Aneurysm, n=77) and a healthy aorta’s group (Control, n=75).ResultsMean diameters of AAAD (4.9 cm) and Aneurysm (5.1 cm) aortas were significantly larger than those of the control group (3.4 cm). In AAAD patients, an ascending aorta diameter greater than 5.5 cm was observed in 18% of patients. Multiple comparisons showed statistically significant differences among mean of the ratio of aortic root area to height between the three groups (P<0.001). In frontal and sagittal planes, the length of the ascending aorta was significantly greater in patients affected by aortic pathology (AAAD and aneurysm) than in the control group (P<0.001). Significant differences were confirmed when indexing the aortic length to patient’s height and BSA, and the aortic volume to patient’s BSA.ConclusionsMaximum transverse diameter, considered separately, is not the best predictor of aortic dissection. In our opinion, the introduction into clinical practice of measurements of the area, length, and volume of the aorta, as absolute or indexed values, could improve the selection of patients who would benefit from preventive surgical aortic replacement.     

Unicuspid aortic valve: Case series and review

A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging. Herein, we present a case series of three patients with unicuspid aortic valves treated at our institution, with a focus on 2D and 3D echocardiographic imaging.     

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文章论述主动脉夹层(AD)、主动脉壁间血肿(出血)、主动脉穿透性溃疡的影像学诊断的进展,并讨论三者的关系,提出影像学检查在诊断和鉴别诊断中具有重要的作用。