Floating thrombus in the ascending aorta

Floating thrombus in the ascending aorta is an uncommon source of embolism. We report a case of a 61-year-old man who was admitted to our hospital for transient brain ischemic attack. Transesophageal echocardiography showed a floating mass on the sinotubular junction. We started anticoagulation therapy immediately and performed surgical removal of the mass 5 days after the admission. Postoperative course was uneventful. He is now in good health and has no sign of recurrence. The etiology of this case is unclear, and the strategy is difficult to determine in terms of cerebral complications.     

Spontaneous rupture of the ascending aorta

A case of spontaneous non-traumatic rupture of the thoracic aorta in a hypertensive patient is presented. The clinical findings suggested acute aortic dissection, and a large pericardial effusion was detected by echocardiography. The typical angiographic features of aortic dissection were not found. Autopsy revealed a longitudinal intimal tear and a rupture in the postero-lateral aspect of the ascending aorta. No false lumen was seen in the ascending aorta. When acute intrapericardial or intrapleural bleeding develops with no evidence of aortic aneurysm or dissection, spontaneous aortic rupture should be suspected.     

Floating nonocclusive thrombus in the ascending aorta

We report the case of a 55-year-old woman seen with signs of angina pectoris and dyspnea. Transesophageal echocardiography showed a floating thrombus distal to the right coronary ostium. At operation, we found a highly mobile thrombus attached to an atherosclerotic plaque distal to the right coronary ostium. The atherosclerotic lesion and the pedunculated thrombotic mass were removed without resection of the adjacent aortic wall. In our judgment, a floating mass in the ascending aorta represents an emergency and should be removed before major thromboembolic complications occur.     

人主动脉中膜分层方法的建立及其层间剪应力分析

目的在初步建立主动脉中膜分层方法的基础上，对其层间剪应力（ISS）进行分析。方法取人升主动脉、降主动脉近段和降主动脉远段标本，分为腹侧和背侧两部分，在立体显微镜下，将主动脉组织大体均匀分层，并测定相邻两层间的周向和纵向层间剪应力。结果主动脉壁至少可分为4层。同一层间剪应力在不同部位相比较：降主动脉近段中间两层间的剪应力显著低于升主动脉（P〈0．05），内侧和外侧各层间剪应力在各部位差异无统计学意义（P〉0．05）；降主动脉近段中间两层间剪应力在腹、背侧间差异无统计学意义（P〉0．05）。同一主动脉段不同层间剪应力相比较：降主动脉近段腹侧和背侧中间两层间剪应力均显著低于内侧和外侧（P〈0．05）；降主动脉近段中间两层间剪应力在腹侧不同方向上差异无统计学意义（P〉0．05），但在背侧周向显著高于纵向，差异有统计学意义（P〈0．05）。结论人主动脉中膜可以进一步分层研究。降主动脉近段腹侧中层和背侧中层纵向均是潜在的夹层间隙容易形成的部位。     

Flow impeding fungal thrombus in the ascending aorta

Mycotic endoaortitis is a rarely occurring infectious entity with an extremely high mortality rate. We report an uncommon case of Phialemonium endoaortits with its management. This large fungal thrombus in the ascending aorta caused significant impediment to the blood flow.     

Giant thrombus in the ascending aorta that caused systemic embolism

Although an ascending aortic thrombus is a rare finding, it may cause major embolic complications. We report a case of a 58-year-old male who suffered from cerebral and left renal infarctions due to emboli from a giant thrombus in the ascending aorta. The thrombus was demonstrated by computed tomography and transesophageal echocardiography. Ten days after the initiation of anticoagulation therapy, surgery was performed. After a median sternotomy was performed and cardiopulmonary bypass was initiated, the ascending aorta was replaced with a synthetic graft under hypothermic circulatory arrest and retrograde cerebral perfusion. The excised specimen revealed a 3.5×3.0×3.0-cm pedunculated thrombus. The patient's postoperative recovery was uneventful, and there was no recurrence of aortic thrombosis during one year of postoperative follow-up. The patient had no coagulation disorders, and the etiology of this giant thrombus remains unclear. We believe that initial treatment for an ascending aortic thrombus should be emergency surgery before it leads to major embolic events. However, the treatment strategy for a thrombus causing cerebral infarction is sometimes difficult to develop.     

升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变

目的 总结升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变的经验与体会.方法 回顾性分析2002年1月至2013年6月在中山大学附属第一医院血管外科接受升主动脉-颈动脉旁路联合腔内修复术治疗的10例主动脉弓部病变高危患者的临床资料.其中男性9例,女性1例,年龄34 ～71岁,平均年龄(54±14)岁.原发病包括主动脉夹层8例,胸主动脉瘤2例.行正中开胸行升主动脉-无名动脉-左颈总动脉旁路7例,升主动脉-左颈总动脉-左锁骨下动脉旁路3例,同期(5例)或二期[5例,平均间隔(7±4)d]经股动脉植入覆膜支架修复主动脉弓病变.结果 全部手术取得技术成功.术后30 d死亡3例,1例死于脑干梗死,1例死于循环衰竭,1例死于主动脉气管瘘.术后发生Ⅱ型内漏1例.随访1 ～ 132个月,中位随访时间24个月(四分位数间距14个月),术后1个月、3个月、1年及其后每年复查CT,随访期间7例患者均健康存活、人工血管旁路通畅,除1例Ⅱ型内漏继续存在外,其余支架均无移位和内漏.结论 升主动脉-颈动脉旁路联合腔内修复术可用于治疗一般情况差、难以耐受主动脉置换的主动脉弓部疾病高危患者.     

Successful removal of a floating thrombus in ascending aorta

Free-floating thrombus in ascending aorta is a rare cause of peripheral embolism with potentially fatal consequences. We report the case of a young patient with syncope and sudden lumbar pain. Computed tomographic scan revealed a large pedunculated floating mass attached to the posterior wall of the ascending aorta, probably responsible of renal embolic infarction; transthoracic echocardiography confirmed the diagnosis. Surgery was urgently performed. The thrombus was excised, and was not related to atherosclerotic disease of the aortic wall. We conclude that once diagnosis is clear, urgent surgery must be considered to avoid any further embolic complications.     

‘Ganglions’

The ganglion cyst is the commonest soft-tissue swelling in the hand and wrist. It is a fibrous swelling that arises near a joint or tendon sheath, and contains clear mucinous fluid. The exact pathogenesis of the ganglion is unknown, although various theories quote anatomical and physiological evidence to support them. Ganglia can occur near any joint in the body, although they are encountered most commonly in the wrist and hand. They can present in a diverse number of ways. In cases of diagnostic uncertainty, they can be investigated by imaging techniques. If a ganglion is symptomatic, it should be treated by conservative means initially including aspiration. Steroids have no place in their management. If this strategy fails, then excision is required, it should be radical to minimise the risk of recurrence. Further research into the pathophysiology may allow improvement in treatment.     

Chronic dissection of the ascending aorta: surgical results during a 20-year period (previous surgery excluded)

Objective: We study here the surgical results of chronic dissection involving the ascending aorta over the last 20 years. Patients with previous cardiac surgery, or proximal aortic repair, were excluded. The patients survived an acute dissection, undiagnosed as pauci- or asymptomatic. The aorta was normal or pathological (atheromatous aneurysm in 15 cases, Marfan's disease in 12 cases, and annuloectasic disease in 18 cases). Two patients had a bicuspid aortic valve. Methods: Between January 1981 and December 2001, 77 patients (mean age 48 ± 15) underwent surgery for chronic dissection of the ascending aorta; 60 patients had severe aortic regurgitation, 12 had Marfan syndrome, and 18 had annuloaortic ectasia. Only the ascending aorta was dissected in 37 patients, the ascending aorta and arch in 26, and the whole aorta in 14. Coronary artery disease occurred in five patients. Statistical analysis was performed using SAS software. Different surgical procedures were used. The aortic arch was repaired in 40 cases; selective antegrade cerebral perfusion and partial circulatory arrest were used. Total aortic replacement was performed on four patients. Results: In-hospital mortality was 10%. The only risk factor was the extent of the dissection. The rate of neurologic stroke was 2.5%. Late survival rate was 42 ± 7.5% at 12 years for all the patients; it was 71 ± 10% when only the ascending aorta was dissected, 44 ± 11% when the ascending aorta and arch were dissected, and 33 ± 15% when the whole aorta was dissected (p = 0.0329). The extent of the dissection was the only risk factor for late mortality. Reoperation was required for one proximal and five distal problems. Conclusion: In chronic aortic dissection, in-hospital and late mortality were related to the extent of the dissection; in-hospital mortality remained unchanged during the operative period.     

‘STAB AND SPLIT’: A ‘BLOODLESS’ AND ‘SCARLESS’ SKIN INCISION TECHNIQUE FOR MINOR SURGERY

The ‘stab and split’ skin incision technique was applied to children requiring minor surgery. A small stab incision was made on a skin crease and split open with mosquito forceps. After the surgical procedure was completed, the wound was closed in layers with a subcuticular suture to the skin. In all cases, splitting caused virtually no blood loss because subcutaneous veins were left intact, and the wounds healed well, especially in infants. ‘Stab and split’ is an effective alternative incision technique for minor surgery in younger children.     

血糖及血脂与腹主动脉瘤腔内血栓的关系

目的:探讨血糖、血脂及其他临床因素与腹主动脉瘤(AAA)腔内血栓(ILT)的关系。方法:回顾性分析中国医科大学附属第一医院血管外科2014年7月—2017年10月收治的151例AAA患者资料,运用统计学方法分析与AAA中ILT的相关因素。结果:151例AAA患者中,有ILT者132例,无ILT者19例。与非ILT组比较,ILT组的男性患者比例及周围动脉疾病患者比例增高,以及甘油三酯(TG)、肌酐(Cr)、D-二聚体(D-D)水平明显升高(均P0.05)。ILT厚度方面,男性患者ILT厚度明显高于女性,有糖尿病(DM)患者ILT厚度小于无DM患者(均P0.05);按ILT厚度分组比较显示,薄ILT组AAA瘤径明显小于厚ILT组,DM患者比例及空腹血糖(FBG)浓度高于厚ILT组,而总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、D-D水平则低于厚ILT组(均P0.05)。相关分析提示,ILT厚度与TC(r=0.206,P=0.018)及LDL-C(r=0.227,P=0.009)均呈正相关。结论:血脂是ILT产生和发展的重要因素,血糖及DM对ILT的影响仍然需要进一步探索。     

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目的 开展带膜支架腔内植入升主动脉治疗DeBakey Ⅰ型主动脉夹层的临床研究。方法 报告采用带膜支架腔内植入治愈DeBakey Ⅰ型主动脉夹层1例。结果 从左颈总动脉送入导丝和带膜支架至升主动脉封闭撕裂口。此前先建立左锁骨下动脉至左颈总动脉的内转流通道。二枚带膜支架重叠放置成功封闭升主动脉撕裂口，术后复查彩超示胸腹主动脉夹层消失，假腔内血栓形成，病人痊愈出院。结论 带膜支架腔内植入是治疗DeBakey Ⅰ型主动脉夹层的有效方法。通过颈总动脉送入支架和预先建立颈总动脉内转流通道可保证手术的成功进行。