急性Standford A型主动脉夹层合并肺动脉壁内血肿CT血管成像表现与预后

目的 观察急性Standford A型主动脉夹层(AD)合并肺动脉壁内血肿(PAIH)CT血管成像(CTA)表现,分析其与预后的关系。方法 回顾性分析55例急性Standford A型AD合并PAIH患者(PAIH组)及55例无PAIH的急性Standford A型AD患者(对照组)资料,对比2组主动脉及冠状动脉CTA表现,观察PAIH组术后15天血肿吸收情况,根据2组出院后1年内主动脉不良事件发生情况分析急性Standford A型AD患者预后的独立影响因素。结果 PAIH组升主动脉最宽径大于对照组, 主动脉瓣、窦管结合部、右冠窦、无冠窦及右冠状动脉更易受累,且更易出现心包积液和胸腔积液(P均＜0.05)。PAIH组42例接受手术治疗,13例因病情危重未能接受手术治疗而死亡;术后15天其中36例血肿范围较前缩小。对103例完成随访,其中63例预后良好、40例预后不良。年龄及合并PAIH是急性Standford A型AD患者预后不良的独立影响因素(OR=1.07、4.71)。结论 急性Standford A型AD合并PAIH的CTA表现具有一定特征性,有助于预测预后不良。

CT angiography manifestations and prognosis of acute Standford type A aortic dissection complicated with pulmonary artery intramural hematoma

Objective To investigate CT angiography (CTA) manifestations of acute Standford type A aortic dissection (AD) complicated with pulmonary artery intramural hematoma (PAIH), and to explore correlations with prognosis. Methods Data of 55 patients with acute Standford type A AD complicated with PAIH (PAIH group), as well as 55 acute Standford type A AD patients without PAIH (control group) were retrospectively analyzed. Aortal and coronary CTA manifestations groups were compared between groups, and hematoma absorption in PAIH group 15 days after treatment was observed. Aortic adverse events were also compared between groups within 1 year after discharge, and the patients were divided into those with good prognosis or with poor prognosis, the impact factors of prognosis were screened. Results The maximum width of ascending aorta in PAIH group was larger than that in control group ([5.22±0.57] cm vs. [4.54±0.45]cm, t=6.963, P＜0.001). PAIH was likely to involve aortic valve, sinus canal junction, right and noncoronary sinus and right coronary artery, and patients in PAIH group were likely to occur pericardial and pleural effusion (all P＜0.05). In PAIH group, 42 cases received surgical treatment, 13 cases did not receive surgical treatment for critical condition and then died. Fifteen days after surgery, 36 of 42 cases had reduced scope of hematoma. Totally 103 cases were followed up, 63 were found with good prognosis while and 40 with poor prognosis. Age and complicated with PAIH were both independent predictors of poor prognosis in acute Standford type A AD patients (OR=1.07, 4.71). Conclusion CTA manifestations of acute Standford type A AD complicated with PAIH had certain characteristics, which might be helpful for predicting prognosis.