阳性A型剖析:从高容量大动脉中心的病例系列和手术管理
Amit Iyengar1,2, John J Kelly1,2, Michael Catalano1,2
1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Annals of thoracic surgery short reports
|January 10, 2025
概括
创致性A型大动脉剖析是心脏手术的罕见但严重的并发症. 手术修复在医院死亡率很高,但特定的修复策略可以确保长期的耐用性.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 干预心脏病学 干预心脏病学
背景情况:
- 创血性A型大动脉剖析是心脏手术的罕见并发症.
- 它与显著的发病率和死亡率有关.
- 了解其发生率和结果对于患者护理至关重要.
研究的目的:
- 为了确定外科手术期间发生的阳性性A型大动脉剖析.
- 描述所采用的手术管理策略.
- 为了评估接受这种疾病修复的患者的结果.
主要方法:
- 对成人心脏手术数据库 (2002-2018) 的回顾性审查.
- 鉴定具有亚原性A型大动脉剖析修复的患者.
- 分析原因和修复策略的操作报告,并对死亡率和重新干预进行后续调查.
主要成果:
- 36名患者被确定为具有亚原性A型大动脉剖析 (发病率为0.1%).
- 剖析发生于开放性手术 (63.9%),PCI (13.9%),TEVAR (13.9%) 和其他内血管手术 (8.3%).
- 住院死亡率为36.1%;长期存活率很好,需要重新干预的需求有限 (11.1%通过血管内治疗).
结论:
- 阳性A型剖析很少发生,但很严重,在手术修复时死亡率高.
- 使用开放的远端解和近端根重建的修复策略提供了持久的结果.
- 这种方法尽量减少了随后的大动脉重新操作的需要.
相关概念视频
Aortic Regurgitation I: Introduction
1.7K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.7K
Aortic Regurgitation III: Medical Management
599
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...
599
Aneurysm I: Introduction
660
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...
660
Aneurysm II: Clinical Manifestations and Diagnostic Studies
593
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...
593
Aneurysm III: Interprofessional Care
479
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...
479
Aneurysm IV: Nursing Management
627
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...
627


