主动脉夹层过早死亡的研究进展

正"过早死亡"即没有达到人均寿命就死亡,国内外一致定义为70岁以前的死亡~[1],心血管疾病是导致全球过早死亡的4种主要非传染性疾病之一。主动脉夹层(aortic dissection,AD)是血液从主动脉撕裂口由主动脉内膜进入主动脉中层或中层滋养动脉破裂导致内膜撕裂所致。起病急、进展快、首发症状多样、漏诊误诊率高,是导致高死亡率的重要因素。由AD等疾病导致的过早死亡对家庭、社会造成沉     

孙氏A2型主动脉夹层的细化分型及其应用

目的: 探讨孙氏 A2型主动脉夹层的细化分型及其应用,观察并分析疗效。方法: 选择2013年1月至2018年9月, 我院经外科治疗的孙氏A2型主动脉夹层患者408例,根据主动脉窦、冠状动脉开口受累程度及主动脉瓣膜交界剥离程度再细化分为三种类型,其中轻型180例,中型188例,重型40例。主动脉根部手术方式根据窦部受累情况选择以保留主动脉瓣的根部重建术为主的手术方式。主动脉弓部根据病情采用半弓置换、全弓置换及支架象鼻术。观察死亡率、严重并发症发生率、保留自体主动脉瓣膜比例及随访期间主动脉根部再次干预情况。结果:住院病死率5.4%,并发症发生率21.3%。三组保留自体主动脉瓣膜比例分别为100.0%、88.3%、62.5%,差异有统计学意义（P＜0.05）。随访6个月~6年,重型组有2例于术后6个月及2年出现重度主动脉瓣关闭不全,再次行主动脉瓣置换治愈;有12例（3.3%）出现中度主动脉瓣关闭不全,无临床症状,随访中;余患者无中量及以上主动脉瓣关闭不全及再次主动脉根部干预。结论: 对孙氏A2型主动脉夹层进一步细化分型更有助于临床医师制定手术策略,个体化采用以保留主动脉瓣的根部重建术为主的手术方式是可行的。     

New classification of aortic dissection with reference to a case report.

The authors present a case report of a patient who was diagnosed with aortic dissection during a hemodynamic exam following acute myocardial infarction. With reference to this case, the European Society of Cardiology's latest classification of aortic dissection, published in 2001, is also presented. The patient had the usual risk factors described for aortic dissection, which are simultaneously those for coronary disease. The patient reported an isolated episode in the past of retrosternal pain, radiating to the back, which may have been caused by the aortic dissection. Since then he had been asymptomatic. Four years later, the patient was admitted to hospital following an anteroseptal acute myocardial infarction; fibrinolysis was contraindicated due to recent episodes of rectal bleeding and the patient underwent hemodynamic study (coronary angiography). Due to difficulties in manipulating the guide wire during this exam, aortography was performed, which showed aneurysm and Stanford type B aortic dissection of the thoracic aorta. During hospitalization, a thoracic-abdominal CT scan was performed, which confirmed chronic type B aortic dissection (with intraluminal thrombi). The authors present their reasons for considering this case to be Class 4 according to the new sub-types/classes of aortic dissection of the European Society of Cardiology (ESC): Class 1--Classical aortic dissection Class 2--Intramural hematoma/hemorrhage Class 3--Subtle/discrete aortic dissection Class 4--Plaque rupture/ulceration Class 5--Iatrogenic/traumatic aortic dissection. The authors consider this case to be of interest because of its rarity, the risk that fibrinolysis could have represented, and its categorization according to the latest classification of aortic dissection by the ESC.     

经胸超声心动图在急性主动脉夹层DeBakey分型诊断中的应用价值

目的 探讨经胸超声心动图在急性主动脉夹层DeBakey分型诊断中的应用价值.方法 回顾性分析2015年6月至2020年6月广西壮族自治区人民医院收治的71例急性主动脉夹层患者的临床资料,分析急诊经胸超声心动图检查与术中诊断对主动脉夹层DeBakey分型诊断的一致性情况.结果 Kappa一致性检验结果显示,急诊经胸超声心...     

Update in aortic dissection

New concepts regarding the diagnosis, classification, and treatment of aortic dissection have been recently developed. The aim of this paper is to describe the current state of knowledge on this subject and discuss any controversies surrounding it. Novel findings in the patho mechanisms of aortic dissection have evolved focusing on the indications for preventive surgery, biomarkers, and four-dimensional (4D)-flow magnetic resonance imaging. New classifications of aortic dissections have been proposed (TEM, STS/SVS). Finally, recent treatment improvements in aortic dissection treatment options have been presented, i.e., the frozen elephant trunk approach, thoracic endovascular repair, and the endo-Bentall concept as a future option.     

床旁经胸超声心动图在急性主动脉夹层Stanford细化分型中的应用价值

目的:本文旨在评价床旁经胸超声心动图在急性主动脉夹层(aortic dissection,AD)Stan-ford细化分型中的应用价值。方法:回顾分析经手术证实的52例急性主动脉夹层患者,男性35例,女性17例;年龄18～71岁,平均(52±11)岁的手术结果和经胸超声心动图表现及主动脉夹层采用Stanford细化分型方法。超声心动图分析的内容包括:内膜片、破口、主动脉瓣反流程度、冠状动脉、主动脉弓部3血管分支及窦管交界形态,主动脉窦部、弓部及胸腹主动脉内径。结果:52例AD Stanford细化分型如下:A1S型2例,A1C型1例,A2S型2例;A2C型9例,A3S型2例,A3C型14例,B1S型3例,B2S型5例,B2C型2例,B3S型10例,B3C型2例。经胸超声心动图结果:除3例漏诊外其余49例分型如下:A1S型4例,A1C型1例,A2S型1例;A2C型4例,A3S型5例,A3C型15例,B1S型3例,B1C型1例,B2S型4例,B2C型1例,B3S型8例,B3C型2例。结论:经胸超声心动图有助于诊断AD Stanford细化分型,具有重要的临床应用价值。     

Acute aortic dissection

The treatment of patients with acute aortic dissection must begin as soon as the diagnosis is first suspected. Aggressive measures to lower the systemic blood pressure and its rate of increase (dP/dt), usually with intravenous beta-blockade in combination with sodium nitroprusside, should be instituted immediately, even before confirmatory imaging studies are performed. Patients with type A dissection are best managed with emergency surgery, whereas patients with type B dissection should be treated medically unless complications intervene. There is a growing experience with catheter-based techniques, including fenestration, stenting, and endoluminal graft insertion, for the management of selected patients with acute dissection. Regardless of the initial treatment strategy adopted, hospital survivors should continue strict antihypertensive therapy, and a schedule of surveillance imaging studies should be established.     

Acute aortic dissection

We summarise advances in the epidemiology, presentation, pathogenesis, diagnosis, and management of acute aortic dissection. Improved understanding of this problem has been assisted not only by establishment of an international registry but also by progress in molecular biology and genetics of connective-tissue diseases. Advances in endovascular products and techniques have provided new treatment options. Open surgical repair remains the main treatment for dissection in the ascending aorta, whereas endovascular treatment is increasingly being used in dissection that is limited to other parts of the aorta.     

Intraoperative aortic dissection

Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication.     

Acute aortic dissection

Acute aortic dissection is the most lethal complication affecting the aorta. The use of two-dimensional echocardiography and computed tomography has greatly expanded the physician's ability to establish this diagnosis through noninvasive techniques. Surgery is the definitive treatment for type I and II dissection, whereas medical management with drugs that reduce cardiac output remains the treatment of choice in type III dissection. With improvements in surgical techniques, including cardiopulmonary bypass and composite grafting, immediate and long-term morbidity and mortality have been significantly reduced.     

False echocardiographic diagnosis of aortic root dissection in case of abdominal aortic dissection.

A patient with strong clinical and radiological indications of dissection involving the ascending aorta had this "confirmed" on an echocardiogram which showed a typical pattern of double lumen. At necropsy there was dissection of the abdominal aorta but the heavily calcified thoracic aorta was free of dissection. Echocardiography may be useful but not entirely reliable in the diagnosis of dissection even in the presence of a typical clinical picture.     

主动脉夹层的诊断

主动脉夹层(aoitic dissection,AD)又称为主动脉夹层动脉瘤.是指在动脉粥样硬化、炎症、先天性发育不良、外伤等基础上,由于血压急剧升高所导致的主动脉血管壁内膜撕裂,血液进人动脉壁内形成血肿,也就是假腔.主动脉腔内隔绝术能显著改善AD病人预后.因此早期正确诊断已成为影响AD病人预后的重要因素.     

主动脉夹层的发病机制研究进展

主动脉瘤和主动脉夹层的高死亡率及高致残率,已引起国内外学者对发病机制的深入研究,以期能寻找到解决问题的突破口.本文对引起主动脉夹层和各种先天性和后天性因素作一综述.