Stanford A型主动脉夹层的外科治疗

目的 总结A型主动脉夹层外科治疗经验,探讨治疗A型主动脉夹层安全有效的术式和方法.方法 我院2008年1月至2013年11月对40例A型主动脉夹层患者予以外科治疗.Bentall（带瓣人造血管替代升主动脉根部和主动脉瓣膜,并移植左右冠状动脉）手术17例,其中10例同期行主动脉弓部替换＋降主动脉象鼻支架置入术;单纯升主动脉人工血管置换术8例;窦部成形＋主动脉瓣交界悬吊术6例,窦部替换＋主动脉瓣成形＋升主动脉半弓替换5例;升主动脉人工血管置换术＋主动脉全弓替换4例.采用深低温停循环技术（DHCA）12例,其余为浅中低温体外循环.采用冷血心脏停搏液灌注12例,组氨酸-色氨酸-酮戊二酸（HTK）停搏液灌注7例,冷晶体心脏停搏液21例.采用改良超滤技术19例.结果 手术死亡1例,围术期死亡4例,死亡率12.5％（5/40）,余均痊愈出院.结论 细化A型主动脉夹层的分型有利于制订个体化手术方案.术中止血彻底及心肌、脑保护确切可提高手术成功率.     

胸主动脉置换并血管内支架植入治疗主动脉夹层

目的总结主动脉夹层行人造血管置换同时植入血管内支架的外科经验。方法急性DeBakeyⅠ型主动脉夹层1例,破口在升主动脉,行升主动脉并全弓置换同时,术中于降主动脉置入血管内支架;慢性DeBakeyⅢ型主动脉夹层2例,均为介入无法完成者,破口均在降主动脉起始部、左锁骨下动脉下方,行近段降主动脉置换同时术中于远段降主动脉置入血管内支架。术后2周及3个月复查主动脉螺旋CT,了解胸腹主动脉、人造血管及血管内支架情况。结果所有病人手术成功,体外循环时间98(38～207)min。Ⅰ型夹层阻断升主动脉136min,选择性脑灌注33min,Ⅲ型夹层阻断主动脉23min、下半身停循环时间22～28min。术后恢复顺利,痊愈出院。术后2周及3个月复查CT示人造血管血流通畅,血管内支架无内瘘及移位,支架远端主动脉真腔扩大、假腔明显缩小。结论对于病变广泛、多发破口的复杂主动脉夹层,行近端动脉夹层切除、人造血管置换同时在远端植入血管内支架,是一种安全、有效、经济的手术方法。     

经皮主动脉内覆膜支架技术治疗DeBakeyⅢ型主动脉夹层

目的：探讨经皮主动脉内覆膜支架技术治疗DeBakeyⅢ型主动脉夹层的疗效。方法：回顾性分析采用经皮主动脉内覆膜支架技术治疗DeBakeyⅢ型主动脉夹层患者64例的临床资料。结果：64例手术均成功。术后48h内,1例出现TIA1次,1例出现上消化道出血,2例出现脑梗死,1例出现肾功能损害并于10d后恢复。术后追踪随访6～12个月,无截瘫发生,胸背剧痛等症状均消失。结论：经皮主动脉内覆膜支架技术治疗DeBakeylⅢ型主动脉夹层近期效果满意,但需合理选择适应证,术前、后应合理控制血压。     

主动脉夹层的治疗进展

近年来主动脉夹层的治疗取得了长足的进展,特别是介入治疗的进展尤其明显。药物治疗的目标:使心率控制在60~80次/min,收缩压控制在100~120mm Hg的理想水平,以预防主动脉夹层破裂及其他并发症。     

主动脉夹层的治疗进展

主动脉夹层( aortic dissection,AD)是指主动脉腔内的血液从主动脉内膜撕裂口进入主动脉中膜,使中膜分离,并沿主动脉长轴方向扩展,从而造成主动脉真假两腔分离的一种病理改变[1].本病最早于1761年经Morgagni首次报道,1820年被laennec命名为主动脉夹层动脉瘤.上世纪70年代后,人们认为主动脉夹层更能反映该病的本质.据报道,该病每年发病率在50～100/10万,男女比例为2～5:1,并呈逐年上升的趋势.     

危重症主动脉夹层处理

主动脉夹层是急性主动脉综合征的一种,其发病急剧,病死率高,严重危及着人类生命安全。其临床治疗以 外科手术为主,但手术难度大、风险高、并发症较常见。随着医疗技术的进步,手术方式日趋多样,疗效日益确切。     

主动脉夹层24例临床分析

目的：分析探讨主动脉夹层(AD)的早期诊断及疗效。方法：回顾了近6年来本院收治的24例AD病例，分析探讨其早期诊断及保守治疗。24例病例全部经彩色多普勒二维超声或螺旋CT检查确诊。治疗分紧急治疗阶段和巩固治疗阶段，治疗原则为绝对卧床、镇静镇痛．严格控制血压、心率在理想水平．终身服用降压药和倍他乐克。结果：彩色多普勒二维超声对诊断AD有重要意义。结论：AD病理基础终生存在，在不具备AD手术条件的基层医院．早期诊断终生治疗是降低其病死率的关键。     

主动脉夹层的腔内治疗进展

主动脉夹层( aortic dissection,AD)是一种灾难性疾病,随着诊治水平的提高,手术死亡率已有明显降低,但急诊主动脉夹层手术死亡率仍高达15％～30％[1,2].对于没有并发症的B型夹层患者,以往推荐药物保守治疗,但在长期随访过程中,患者5年死亡率仍达50％,相当一部分存活患者会发生假腔瘤样变,需要进一步治疗.胸主动脉腔内隔绝术作为一种新的治疗方法,因其围手术期死亡率低且易于实施逐渐被作为多种主动脉疾病的一线治疗方法[3].     

主动脉夹层临床分析

目的:评价不同的入院确诊时间和治疗方法对主动脉夹层疗效的影响。方法:对140例主动脉夹层患者进行确诊主动脉夹层时间的分组和分析早期误诊的原因。回顾分析药物、手术及支架植入治疗的疗效。结果:5h内确诊20例(14.3%),5～12h内确诊18例(12.9%),12～24h内确诊14例(10%),24h后确诊的有88例(62.8%)。早期误诊为其他疾病的病例有63例(45%)。药物治疗组92例,住院死亡18例(19.6%);手术治疗组20例,住院死亡7例(35.0%);支架治疗组28例,住院死亡1例(3.6%)。结论:主动脉夹层早期误诊率高,应引起关注。支架置入治疗III型主动脉夹层疗效较好。     

主动脉夹层的外科治疗

主动脉夹层是主动脉疾病中最常见的灾难性病变,预后极差。如未经治疗,24h内死亡约占33%,48h内死亡约占50%,1周内死亡约占80%。约75%死于主动脉破裂。西方主动脉夹层年发病率约0,2％～0．8％。我国主动脉夹层发病率随着人们生活饮食习惯的改变而逐年增高,而主动脉夹层诊断率随医疗条件改善也逐年提高。     

急性主动脉夹层52例临床分析

目的　观察急性主动脉夹层的临床特点 ,评价有关的检查方法及地尔硫注射液 (合贝爽 )对急性主动脉夹层的临床治疗效果。方法　对 5 2例急性主动脉夹层患者分别行超声心动图、CT、MRI确诊 ,比较其确诊率。对其中 9例给予合贝爽注射液治疗 ,评价其治疗效果。结果　超声心动图检查 38例 ,确诊 33例 ( 86 .8%) ,MRI检查 17例 ,确诊 16例 ( 94.1%) ,CT检查 13例 ,确诊 11例 ( 84.6 %)。9例急性主动脉夹层给予合贝爽注射液治疗后 ,血压、心率稳定 ,疗效满意。结论　与超声心动图、CT比较 ,MRI确诊率最高 ,可作为诊断急性主动脉夹层的最重要方法。合贝爽注射液安全有效 ,不良反应少 ,可作为治疗急性主动脉夹层首选药物之一。     

Real-time imaging of dissection of the ascending aorta

We report the case of a 72-year-old woman referred for evaluationof a chest and back pain in whom we documented the dramaticprogression from intramural hematoma to dissection of the ascendingaorta with cardiac tamponade.     

主动脉夹层23例临床分析

目的分析主动脉夹层(AD)的临床、影像学特点及治疗转归,探讨AD的早期诊断和治疗。方法对23例本院收治的AD患者的临床特点、影像学结果进行回顾性分析。结果23例AD病人中大多表现胸腹及腰背部疼痛,常伴有其他系统损害,均通过影像学方法而确诊。结论AD以疼痛为主要表现,可伴有其他系统损害,计算机断层扫描(CT)、磁共振成象(MRI)、X线平片等检查具有极大诊断价值。总结AD的诊断要点,提高AD的诊断意识是早期诊断的关键。     

Obstructive sleep apnea and thoracic aorta dissection

Obstructive sleep apnea syndrome (OSAS) is a process that is associated with the development of arterial hypertension, the main risk factor for aortic dissection and during obstructive episodes of the upper airways with marked increases in transmural pressure of the aorta wall. The aim of this work was to study the association between aortic dissection and OSAS. Nineteen consecutive patients with thoracic aorta dissection and 19 hypertensive patients of similar age, sex, and body mass index were studied by clinical questionnaire and polysomnography. Snoring and nonrefreshing sleep were common in both groups. Thirteen patients (68%) from each group showed an apnea-hypopnea index of more than 5 per hour. However, patients with aortic dissection presented a higher apnea-hypopnea index (28 [30.3] versus 11.1 [10.4], p=0.032). Seven patients with dissection presented an apnea-hypopnea index of more than 30 versus 1 patient in the control group (p=0.042). Patients with thoracic aorta dissection presented a high prevalence of previously undiagnosed and frequently severe OSAS. Further studies, including this diagnosis as a prognostic variable in the follow-up of patients with aortic dissection, are required. Our results suggest that in patients with aortic dissection and symptoms consistent with OSAS, a sleep study should be considered in their clinical management.     

Magnetic resonance imaging in dissection of the aorta

In order to evaluate the usefulness of this new exploratory method in dissection of the aorta, 13 patients (10 men and 3 women, mean age 58 +/- 14 years) were examined by means of an 0.5 Tesla Magniscan 5000 nuclear magnetic resonance machine. Fifteen examinations were performed: 5 in patients with actual aortic dissection (type A 4 including one acute, type B1), 5 in patients previously operated upon for type A dissection and 5 for suspected acute aortic dissection unconfirmed by other examinations. Magnetic resonance imaging (MRI), synchronized with electrocardiography, was carried out using spin-echo techniques with 1 to 3 echoes and multiple contiguous sections along several planes. In the 5 patients with actual dissection the 2 channels separating the membrane could be demonstrated, thus providing a firm diagnosis (MRI proved superior to angiography in 2/5 patients). All 5 patients could be classified as either type A or type B. Extension to the cervical vessels was observed in 3 cases and the portal of entry was seen in one case, but the origin of the coronary arteries was never visualized. In the 5 patients previously operated upon MRI provided detailed analysis of the prosthesis of the supra-coronary ascending aorta implanted in all cases, of the aorta proximal and distal to that segment and of the periaortic mediastinum. By studying the signal from the false channel distal to the prosthesis information was obtained as to the presence in it (2 patients) or absence of circulating blood.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endovascular treatment for dissection of the descending aorta

Surgery for acute ischaemia complicating dissection of the descending aorta is associated with high mortality. We used an endovascular fenestration approach (scissor technique) to treat seven of 12 patients with ischaemic complications of descending aortic dissection; the remaining five patients were treated by stent implantation. Four of the 12 patients died (two in the fenestration group and two in the stenting group) in the days after the procedure. The remaining eight were symptom-free a mean of 9.4 (SD 8) months later. We suggest that the fenestration approach is a promising addition to endovascular treatment for patients with ischaemic complications of descending aortic dissection.     

New imaging technics in dissection of the thoracic aorta

The multiplicity of imaging for investigation of the thoracic aorta requires that the physician choose a strategy adapted to the disorder involved: this is the case, for example with dissection of the aorta. A critical study of the new methods available which include digital angiography; echocardiography; CT scan; magnetic resonance imaging (MRI), should be compared to "the" reference technique of conventional methods: aortography and two-dimensional cineangiography. In addition, the decision must take into account specific characteristics of the disorder: natural history of the disease and anatomopathological form which are useful for the surgeon in case surgery is decided upon. The strategy proposed remains faithful to two-dimensional cineangiography during the first 72 hours of acute dissection because this disorder is a true surgical emergency at this stage if the ascending aorta is involved. Later, or if the ascending aorta does not appear to be involved, MRI has now proven this efficacy as a first-line diagnostic procedure. The judiciousness of preoperative aortography is still the subject of debate.     

Chronic dissection of the aorta after coronary bypass surgery

Dissection of the aorta is a potential complication of all forms of cardiac surgery. It occurs after a variable interval. When observed in the long term, surgery may be complex with greater technical difficulties resulting in increased postoperative morbidity and mortality compared with other types of dissection. These difficulties are all the more marked when the initial surgery is coronary bypass grafting and when the grafts, especially internal mammary artery grafts, remain patent. A surgical strategy has to be elaborated to prevent certain per- and postoperative complications. The authors report the case of a patient who developed a chronic dissection of the aorta 9 months after coronary bypass surgery with patent internal mammary artery grafts. In this situation, a strategy associating anterograde cerebral perfusion before the sternotomy and endovascular control of the internal mammary grafts was proposed.