在马方综合征患者的大动脉根修复后的心血管事件
Tirone E David1, Joy Park1, Mark Tatangelo1
1Division of Cardiovascular Surgery of Toronto General Hospital, Peter Munk Cardiac Centre at University Health Network and University of Toronto, Toronto, Ontario, Canada.
Journal of the American College of Cardiology
|September 6, 2023
概括
马尔凡综合征患者的大动脉节约手术显示了稳定的门功能20年. 然而,大动脉解剖仍然是一个重大问题,重塑与重新植入相比,风险更高.
科学领域:
- 心血管外科心血管外科
- 遗传学 是一个遗传学.
- 大动脉疾病 大动脉疾病
背景情况:
- 大动脉节约手术对于马尔凡综合征 (MS) 患者的大动脉根动脉瘤的疗效仍在争论中.
- 马方综合征是一种影响结合组织的遗传性疾病,通常导致大动脉根扩张和动脉瘤.
研究的目的:
- 为了评估在门保护性大动脉根置换后,在马方综合征患者中心血管事件的发生率.
- 为了比较主动脉再植入和主动脉根改造技术之间的结果.
主要方法:
- 对189名接受大动脉节省手术的马方综合征患者 (1988-2019) 的前性随访.
- 数据收集包括临床,心声,CT和MRI成像.
- 分析的重点是死亡率,大动脉衰竭,重复手术和新剖析,均为14年.
主要成果:
- 在20年后,死亡率为21.5%. 晚年和手术前剖析增加了死亡风险.
- 20年后的累积发病率:14.5%中度/重度大动脉衰竭,7.5%大动脉重复手术,19.9%新的远端大动脉切割.
- 与再植入相比,大动脉根改造与较高的大动脉衰竭和重新手术率有关.
结论:
- 在马方综合征患者的前20年里,大动脉节约手术保持了稳定的门功能,并发症很少.
- 大动脉剖析在这个人群中仍然是一个重大挑战.
- 大动脉根改造和再植入之间的选择可能会影响长期的门结果.
相关概念视频
Aortic Regurgitation III: Medical Management
25
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
25
Aneurysm I: Introduction
12
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
12
Aneurysm III: Interprofessional Care
9
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
9
Aneurysm IV: Nursing Management
8
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
8
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
23
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
23
Aneurysm II: Clinical Manifestations and Diagnostic Studies
10
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
10


