主动脉夹层分离的超声心动图诊断

主动脉夹层分离（Ａｏｒｔｉｃｄｉｓｓｅｃｔｉｏｎ,ＡＤ）是血液渗入主动脉中层形成夹层血肿并沿着主动脉壁纵轴延伸剥离的严重心血管急症 ,易漏诊及误诊 ,且病死率高 ,及早诊治是降低死亡的关键［１］。我院１９９１年１月～１９９８年５月间经超声心动图（ＵＣＧ）诊断ＡＤ１２例 ,漏诊２例 ,为提高对ＡＤ的认识 ,总结分析如下。１资料和方法１ １一般资料本组１４例 ,男１２例 ,女２例 ,年龄２５～７３岁 ,平均５２ ２±１３ １岁 ,其中合并高血压１０例 ,患者在活动或情绪激动时突发胸痛或腹痛１１例 ,心悸、胸闷、呼吸困难、有主动…     

主动脉夹层的超声心动图诊断及与其他影像诊断的比较

目的 探讨经胸超声心动图（ＴＴＥ）、经食管超声心动图（ＴＥＥ）对主动脉夹层的诊断价值。并与磁共振影像（ＭＲＩ）、超高速ＣＴ）ＵＦＣＴ）等影像诊断进行比较。方法 对１３９例经手术证实的主动脉夹层患者临床资料进行分析。对照手术结果,评价超声心动图诊断主动脉夹层ＤｅＢａｋｅｙ分型以及并发症的准确性,并与ＭＲＩ、ＵＦＣＴ诊断结果进行比较,结果 ＴＴＥ、ＴＥＥ、ＵＦＣＴ、ＭＲＩ对主动脉夹层的诊断率分别为８９     

超声在StandordB型主动脉夹层腔内隔绝术中初步应用体会

现将我科配合我院血管外科中心进行6例腔内隔绝术(endovascular graft exclusion,EVGE)中经食管超声心动图(TEE)的初步应用体会作一报道.     

超声心动图诊断单纯右肺动脉异常起源于升主动脉

目的 探讨单纯右肺动脉异常起源于升主动脉的超声心动图诊断价值.方法 回顾性分析5例单纯右肺动脉异常起源于升主动脉患者的超声心动图特征.结果 5例右肺动脉均起源于升主动脉近端左后壁,除合并动脉导管未闭外,无其他心内畸形;均存在重度肺动脉高压.3例手术,1例术前漏诊动脉导管未闭,1例院外多次彩色超声漏诊右肺动脉异常起源或误诊为大动脉转位.结论 单纯右肺动脉异常起源于升主动脉在解剖、血流动力学上有许多相似之处,把握共性并多部位、多切面探测有助于超声心动图作出准确诊断并减少漏、误诊.     

A型主动脉夹层累及冠状动脉超声表现及预后

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%,χ²=5.52,P=0.02）,其晕厥或肢体障碍发生率高于未累及组（χ²=6.47,P=0.01）。累及组多见左心室壁增厚（23/34,67.65%,χ²=4.692,P=0.030）、左心室壁运动减低（14/34,41.18%,χ²=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（χ²=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（χ²=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%,χ²=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。     

实时三维经食管超声心动图评估主动脉夹层

目的 探讨实时三维经食管超声心动图（3D-TEE）评估主动脉夹层分型、判断是否累及主动脉根部及冠状动脉的价值。方法 回顾性分析30例主动脉夹层患者的3D-TEE、二维经胸超声心动图（2D-TTE）、CTA检查结果,并与术中所见进行比较,计算3种成像方式对主动脉夹层分型诊断的符合率,以及3D-TEE、CTA诊断主动脉根部及冠状动脉受累的符合率。结果 3D-TEE、CTA判断主动脉夹层Debakey Ⅰ型、Ⅱ型、Ⅲ型的诊断符合率均为100%,2D-TTE的诊断符合率分别为76.47%（13/17）、80.00%（4/5）、75.00%（6/8）;3D-TEE、CTA诊断累及冠状动脉的符合率分别为66.67%（4/6）、83.33%（5/6）,诊断累及主动脉根部的符合率分别为100%（11/11）、72.73%（8/11）。结论 实时3D-TEE可对主动脉夹层的范围、主动脉根部、冠状动脉等部位进行实时动态三维重建,为诊断主动脉夹层以及判断重要解剖结构受累情况提供影像学支持。     

彩色多普勒超声心动图诊断主动脉-左室隧道1例

患者男，8岁，发现心脏杂音8年，无紫绀，活动耐力差。查体：心界向左下扩大；于胸骨右缘2肋间与左缘2、3肋间闻及舒张期连续性杂音；P减低，腹部、四肢及神经系统查体未见异常，临床诊断：主动脉瓣返流。     

主动脉夹层急诊诊断与误诊分析

目的 探讨主动脉夹层的临床表现，急诊诊断及误诊情况。方法 分析53例主动脉夹层临床表现、体格检查、实验室检查及心电图、X线片、CT、B超等辅助检查结果，分析急诊诊断的依据及急诊误诊情况。结果 53例主动脉夹层临床表现各异，部份病例以并发症为首发症状，如瘤体破裂造成的急性心脏压塞征、出血性休克，亦有主动脉分枝急性闭塞造成器官缺血坏死或压迫所致的单瘫、截瘫、急性左心衰、气胸、中等量以上心包积液，是造成本组误诊的主要原因。主动脉夹层系一少见疾病，临床医师缺乏对本病的认识也是原因之一。初诊误诊率28％。结论 主动脉夹层临床表现复杂，易误诊，应引起急诊工作者的重视。     

Successful treatment of aortic dissection with pulmonary embolism: A case report

BACKGROUNDAortic dissection (AD) and pulmonary embolism (PE) are both life-threatening disorders. Because of their conflicting treatments, treatment becomes difficult when they occur together, and there is no standard treatment protocol.CASE SUMMARYA 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical examination. Further examination of the head, chest and abdomen by computed tomography revealed a subdural hemorrhage, multiple rib fractures, a hemopneumothorax and a renal hematoma. He was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy, external rib fixation, analgesia and enteral nutrition. The patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 kPa. Computed tomography angiograms confirmed that he had both AD and PE. We subsequently performed only nonsurgical treatment, including nasal high-flow oxygen therapy, nonsteroidal analgesia, amlodipine for blood pressure control, beta-blockers for heart rate control. Eight weeks after admission, the patient improved and was discharged from the hospital.CONCLUSIONPatients with AD should be alerted to the possibility of a combined PE, the development of which may be associated with aortic compression. In patients with type B AD combined with low-risk PE, a nonsurgical, nonanticoagulant treatment regimen may be feasible.     

Hemorrhagic fever with renal syndrome complicated with aortic dissection: A case report

BACKGROUNDHemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever, hemorrhage, and acute kidney injury. Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection. Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically. Here, we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection.CASE SUMMARYA 56-year-old man complained of high fever and generalized body ache, with decreased platelet counts of 10 × 10⁹/L and acute kidney injury. The enzyme-linked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive. During the convalescent period, he complained sudden onset acute chest pain radiating to the back, and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery. He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection. The patient recovered completely after surgery with other support treatments. CONCLUSIONHemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition. Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment. A causal relationship has yet to be confirmed.     

44例主动脉夹层临床分析

目的 探讨主动脉夹层患者的患病危险因素、临床特征、诊治方法及预后.方法 对我院2005-2008年诊治的44例主动脉夹层患者临床资料进行回顾性分析.结果 主动脉夹层发生的常见病因是高血压.首发表现以胸痛为常见(部分病例以并发症为首发).CT和MRI检查对主动脉夹层的确诊率较超声检查高,但由于超声检查价格便宜,床旁操作方便,故有疑诊患者,可做常规超声检查.主动脉夹层的治疗有内科保守治疗,外科手术治疗和血管内带膜支架治疗.结论 高血压是主动脉夹层的主要危险因素,其临床表现复杂多变,误诊率高.内科治疗时血压控制多需多种降压药物联合应用,然而根据临床分型和病情采取外科手术、介入治疗可降低病死率和改善患者的预后.     

Acute thoracic aortic dissection: The basics

With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnostic possibility in patients presenting to the emergency department with acute chest or back pain. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode. But with successful initial therapy, the 5-year survival rate increases to 75%. Hence, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. This article reviews acute thoracic aortic dissection, including ED diagnosis and management.     

Gender-Differences in aortic dissection

ObjectivesAortic dissection is a truly emergency in daily practice, and for gender factor, we want to compare the epidemiology, biomarkers, symptoms and outcome.MethodsA retrospective review six-year AD cases in a northern Taiwan medical center from January, 1, 2005 to December, 31, 2010. by gathering data of 134 AD patients including gender, age, episodes of time, season, vital signs, symptoms (chest pain, chest tightness (CP/CT), abdominal pain, neurological symptoms), Stanford classifications, and outcome. Comparisons are made by gender of AD groups. 85 cases with complete data are strictly enrolled into our study. We used student t test and one way ANOVA for statistical analyses, and significance was set at a P value less than 0.05 (2-tailed).ResultsThere are 64 male and 21 female enrolled into our study with the mean ± standard deviation (SD) of age is (64.1±14.0) years old. In AD patients with female gender are older than male AD patients (71.5 vs. 61.6 years old, P value<0.01). In symptoms of presentation, female AD patients have more neurologic symptoms than male AD patients (38.1% vs. 12.5%, P <0.01). Female AD patients have longer hospital stay and higher mortality rate than male AD patients (16.8 vs. 13.4 d; 38.1% vs. 18.8%, P =0.39; P =0.07).ConclusionFemale AD patients are ten-year older in age than male, and have more common neurologic symptoms in presentations, and female AD patient have 2-fold mortality rate than male AD patients.     

血D-二聚体浓度对主动脉夹层的诊断价值

目的探讨血D-二聚体浓度对主动脉夹层的诊断价值.方法37例经心脏超声、食道超声、CT、MRI或血管造影确诊的主动脉夹层患者,同期住院的35例急性心肌梗死患者作为对照组.所有患者入院当时抽血检测D-二聚体、C反应蛋白(CRP)和肌钙蛋白Ⅰ水平.结果17例主动脉夹层患者为Stanford A型,20例B型.所有主动脉夹层患者D-二聚体水平升高(＞0.3 μr/mL),均值2.0±1.9(0.4～8.4)μg/mL,敏感性100%.自症状发作到D-二聚体测定的时间为1.5 h～14d,D-二聚体升高的程度与病程呈负相关(r=-0.42,P=0.04).病变范围越大,D-二聚体水平越高,死亡组D-二聚体均高于5 μg/mL,提示D-二聚体升高对判断预后有指导价值.与主动脉夹层患者相比,仅4例急性心肌梗死患者血D-二聚体水平轻度升高(＜0.7 μg/mL).结论D-二聚体阴性有助于排除急性主动脉夹层的诊断.D-二聚体升高对判断病变范围和预后有一定的指导价值.     

Acute inferior wall myocardial infarction induced by aortic dissection in a young adult with Marfan syndrome: A case report

BACKGROUNDAortic dissection (AD) is an emergent and life-threatening disorder, and its in-hospital mortality was reported to be as high as 24.4%-27.4%. AD can mimic other more common disorders, especially acute myocardial infarction (AMI), in terms of both symptoms and electrocardiogram changes. Reperfusion for patients with AD may result in catastrophic outcomes. Increased awareness of AD can be helpful for early diagnosis, especially among younger patients.CASE SUMMARYWe report a 28-year-old man with acute left side chest pain without cardiovascular risk factors. He was diagnosed with acute inferior ST-segment elevation myocardial infarction (STEMI), which, based on illness history, physical examination, and intraoperative findings, was eventually determined to be type A AD caused by Marfan syndrome. Emergent coronary angiography revealed the anomalous origin of the right coronary artery as well as eccentric stenosis of the proximal segment. Subsequently, computed tomography angiography (CTA) showed intramural thrombosis of the ascending aorta. Finally, the patient was transferred to the cardiovascular surgery department for a Bentall operation. He was discharged 13 d after the operation, and aortic CTA proved a full recovery at the 2-year follow-up.CONCLUSIONIt is essential and challenging to differentiate AD from AMI. Type A AD should be the primary consideration in younger STEMI patients without cardiovascular risk factors but with outstanding features of Marfan syndrome.