Descending Thoracic Aortic Aneurysm: Case Presentation and Review

This section is reserved for commentaries and brief essays dealing with matters of interest to physicians. Material for consideration should not exceed five double-spaced typewritten pages. An honorarium of $75 is offered at the time of publication. Submissions should be addressed to: Editor, POSTGRADUATE MEDICINE, 4530 W 77th St, Minneapolis, MN 55435.     

彩色多普勒超声在急诊主动脉夹层动脉瘤中的应用

目的：评价彩色多普勒超声诊断急性主动脉夹层动脉瘤的临床价值。方法：对2000年8月～2002年2月间应用彩色多普勒超声技术诊断的6例急性主动脉夹层动脉瘤患者进行总结分析。结果：除1例超声诊断为Debakey Ⅰ型的患者在未能做其它检查前死亡外，另外5例Debakey Ⅲ乙型经血管造影证实，行支架型人工血管置入术治疗，1例Debakey Ⅲ乙型经增强CT扫描证实。结果：彩色多普勒超声检查对急性主动脉夹层动脉瘤的诊断及治疗方案选择具有重要的临床价值。     

Focused Cardiac Ultrasound Diagnosis of Thoracic Aortic Aneurysm: Two Cases

Background

Thoracic aortic aneurysms (TAAs) are less prevalent than abdominal aortic aneurysms. Symptomatic TAAs need to be identified quickly by the emergency physician (EP) since mortality rates increase dramatically once complications such as rupture or dissection occur. Compared with validated EP-performed ultrasound of the abdominal aorta, EP-performed focused cardiac ultrasound that includes evaluation of the thoracic aorta is relatively unreported.

Objective

Two cases illustrate EP-performed focused cardiac ultrasound and evaluation of the thoracic aorta for aneurysmal dilation.

Case Reports

(1) A 60-year-old man presented to the emergency department (ED) after a blunt traumatic injury to his back while at work. During the focused cardiac ultrasound examination, the aortic outflow tract distal to the aortic valve appeared enlarged and the aortic root measured 5.49 cm. (2) An 82-year-old man with hypertension presented to the ED with 1 month of chest pain radiating to the back. The focused cardiac ultrasound examination demonstrated enlargement of the descending thoracic aorta at 4.82 cm.

Conclusion

EPs performing focused cardiac ultrasound can visualize regions of the thoracic aorta that may reveal an aneurysm, particularly in the parasternal long axis view.     

A Cause of Sudden Death: Rupture of Thoracic Aortic Aneurysm

Sudden death occurred during antihypertcnsive therapy of a Stanford type A dissecting aortic aneurysw. Hemodynamic and electrocardiograpbic events were recorded including deterioration of ventricular fibrillation 4 minutes after rupture.     

Prognostic Factors in Acute Renal Failure Following Aortic Aneurysm Surgery

This study analyses the prognostic factors associated with survivalin 70 patients who developed acute renal failure following surgeryfor an aortic aneurysra. Forty-nine patients (70 per cent) hadsurgery for a ruptured aortic aneurysm and 21 patients (30 percent) had an elective procedure. Fifty-nine patients receivedhaemodialysis. Thirty-three patients (47 per cent) survied theepisode of acute renal failure. Six of these thirty-three patientsdied within three months of recovering from acute renal failure,giving an overall survival of 27/70 (39 per cent). A stepwiselogistic regression analysis showed that the following factorssignificantly adversely affected survival: a need for inotropicsupport, ventilation for more than three days and age over 65years. A model developed using these variables provided a basisfor predicting outcome.     

食管超声心动图在胸主动脉瘤诊断中的应用价值──与CT、磁共振显像及血管造影对比研究

对照ＣＴ、磁共振显像（ＭＲＩ）及胸部大动脉Ｘ线血管造影（ＴＡＧ），分析１６例食管超声心动图结果，评估其诊断胸主动脉瘤的价值。１５例诊断正确，１例真性动脉瘤诊断为夹层动脉瘤ＤｅＢａｋｅｙⅢ型并血栓形成。同时检出主动脉瓣关闭不全６例、左室扩大５例。食管超声检出胸主动脉瘤的能力与ＣＴ、ＭＲＩ及ＴＡＧ相同，并能检出合并的主动脉瓣关闭不全、左室扩大及左室功能不全。     

Rupture of an Ascending and Descending Thoracic Aortic Aneurysm Causing Tension Hemothorax: A Case Report

Background: A ruptured thoracic aortic aneurysm is a life-threatening condition and can lead to a tension hemothorax. Objectives: To describe the presentation and management of a case of a tension hemothorax. Case Report: An 84-year-old woman presented in respiratory distress and was found to have a tension hemothorax. The cause was the rupture of an ascending and descending thoracic aortic aneurysm. She was managed with intubation, mechanical ventilation, and chest tube placement with stabilization. Definitive operative repair was deferred due to the patient's comorbidities and wishes of the family. Conclusions/Summary: A tension hemothorax can result from an ascending and descending thoracic aneurysm, as this case describes. Emergent therapy is necessary as this is a life-threatening condition.     

急性胸主动脉夹层瘤术后早期并发症及其监护16例

2001年7月-2002年9月，我院最先采用腰骶部骨筋膜室切开减压的方法治疗由腰骶部慢性骨筋膜室综合征所致慢性腰痛患者33例，经术后护理、腰腹肌功能锻炼及有效的出院指导，确保了手术疗效，患者的腰痛症状、步行能力和腰部的前屈、后伸活动度得到了明显改善，现将护理体会报告如下。     

经食管超声心动图在胸主动脉瘤血管内带膜支架置入治疗中应用的初步体会

目的：初步总结经食管超声心动图（TEE）在胸主动脉瘤血管内带膜支架（ESG）置入治疗中的应用价值。方法：3例DeBakeyⅢ型亚急性主动脉夹层动脉瘤和1例假性胸主动脉瘤ESG置入后1年残余漏患者，全麻状态下，采用多平面TEE对整个ESG置入或补漏ESG再置入手术过程连续动态检测。结果：所有4例患者均成功地置入了ESG，在整个手术过程中TEE对主动脉夹层入口或支架置入后残余漏口的定位，血流和分流状态观察，支架释放过程监测，球囊再扩张效果评估及血管造影辅助观察等多方面均起到了重要作用，其中对夹层入口，血流状态，ESG置入后形态与封堵效果的关系等细节的显示有独到之处。结论：TEE在胸主动脉病变的ESG置入治疗中具有重要和独到的应用价值。     

急性主动脉夹层动脉瘤早期诊断问题──附21例病例报告

急性主动脉夹层动脉瘤发病急骤，临床表现复杂，相当多的病例易漏诊、误诊，本文分析21例急性主动脉夹层动脉瘤临床特征和诊断情况，根据经治经验、提出急诊早期对本症的诊断线索，并对各种诊断方法作了初步评价。     

20例主动脉窦瘤破裂的外科治疗

目的：总结主动脉窦瘤破裂的外科治疗经验。方法：主要脉窦瘤破裂20例,合并室间隔缺损11例（55％）,合并主动脉关闭不全5例（25％）,行单纯窦瘤切除修补4例,窦瘤切除加室缺修补11例,窦瘤切除修补加主动脉瓣置换5例。结果：全组无手术死亡,无残余分流。结论：心脏超声对主动脉窦瘤破裂诊断准确率高。窦瘤破裂心功能影响严重,一经确诊,宜尽早手术。窦瘤破口直径≥1．0cm宜有补片修补,缝合或修补窦瘤时进针方向要与主动脉长轴平行。     

主动脉窦瘤破裂的超声心动图诊断

目的评价主动脉窦瘤破裂(rupturedaorticsinusaneurysm,RASA)的超声心动图价值。方法复习文献,回顾性分析经手术证实的9例主动脉窦瘤的超声心动图特征。结果超声心动图可以准确显示窦瘤的形态、部位、破入心腔方向、血流动力学及并发症。结论超声心动图可于手术前及时、准确的诊断本病。     

分期全主动脉置换术治疗主动脉夹层动脉瘤

目的:探讨采用分期全主动脉置换术治疗主动脉夹层动脉瘤的手术方式和治疗效果。方法:对6例马凡氏综合征的患者行分期全主动脉置换术,手术方法为:经左侧胸腹联合切口、腹膜外入路,在体外循环或左心转流下采用分段阻断法完成胸腹主动脉置换及重要分支的重建。其中1例深体温停循环20 min。结果:所有患者均康复出院,平均体外循环或左心转流时间(202.0±54.1)min,呼吸机辅助通气时间10.5～200.0h,患者监护室入住时间3～12 d。术后出现急性肾功能损害2例,声音嘶哑2例,无脊髓损伤病例。1例术后2个月因脓胸病死。结论:分期全主动脉置换术是治疗主动脉夹层动脉瘤的一种安全、有效的方法。     

主动脉夹层动脉瘤猝死患者的临床与尸检病理分析

目的 探讨主动脉夹层动脉瘤患者猝死的原因、临床特点、病理基础，从而早期诊断，有效防治。方法 回顾性分析我院13例主动脉夹层动脉瘤猝死患者的临床尸检病理资料。结果 13例中，老年人11例。Ⅰ型1例；Ⅱ型6例；Ⅲa型和Ⅲb型各3例。死亡原因：急性心包填塞8例，以Ⅰ型和Ⅱ型多见；休克4例；1例引起反射性心跳骤停。结论 主动脉夹层动脉瘤起病隐匿，但其动脉夹层一旦破裂或撕裂，则发病急骤，常导致严重后果。尽早防治动脉粥样硬化，有效控制高血压是预防夹层动脉瘤的根本措施。对于老年人，应定期查体，防治急性事件发生，降低病死率。     

CT of Nontraumatic Thoracic Aortic Emergencies

Computed tomography (CT), especially multidetector row CT (MDCT), is often the preferred imaging test used for evaluation of nontraumatic thoracic aortic abnormalities. Unenhanced images, usually followed by contrast-enhanced arterial imaging, allow for rapid detailed aortic assessment. Understanding the spectrum of acute thoracic aortic conditions which may present similarly (aortic dissection, aneurysm rupture, penetrating atherosclerotic ulcer, intramural hematoma) will ensure that patients are diagnosed and treated appropriately. Familiarity with imaging protocols and potential mimics will prevent confusion of normal anatomy and variants with aortic disease.     

超声诊断胸主动脉瘤和夹层剥离

【目的】为评估多普勒超声检查诊断胸主动脉瘤或夹层剥离的价值。【方法】回顾分析经手术和心血管造影证实的超声资料较完整的胸主动瘤或夹层剥离２０例,结合图像、病理及临床进行探讨。【结果】其中弓、降部真性动脉瘤７例（３５％）,假性动脉瘤１例（５％）,升主动脉瘤７例（３５％）,夹层剥离５例（２５％）;超声误诊１例,诊断符合率９５％。【结论】升主动脉瘤多为Ｍａｒｆａｎ′ｓ综合征,弓、降部主动脉瘤均为动脉粥样硬化所致,在夹层剥离中彩超对判断真假腔、寻找破口有独特的价值