在Marfan患者的选择性门节约性大动脉根置换过程中,我们是否应该更换非动脉瘤大动脉门?
Malakh Shrestha1,2, Tim Kaufeld2, Linda Rudolph2
1Mayo Clinic, Rochester, MN, USA.
概括
对于接受门节约性大动脉根置换的Marfan患者,预防性大动脉门置换是不必要的. 长期跟踪显示未来大动脉门干预的风险非常低,支持孤立的大动脉根修复.
科学领域:
- 心血管外科心血管外科
- 遗传学 遗传学是一种遗传学.
- 胸部外科手术 胸部外科手术
背景情况:
- 门节约性大动脉根置换 (VSARR) 越来越多地用于马尔凡综合征.
- 关于在VSARR期间是否预防性地更换非动脉瘤大动脉门存在争议.
研究的目的:
- 在隔离VSARR后评估马尔凡患者大动脉门的长期状态.
- 确定是否需要同时进行预防性大动脉门置换.
主要方法:
- 在1993年至2021年期间,对67名接受隔离大卫I手术 (VSARR) 的Marfan患者进行了回顾性研究.
- 排除在手术时有大动脉门病理的患者.
- 100%完整的后续检查,以评估大动脉门状况和重新手术率.
主要成果:
- 20年生存率很好 (85%). 在20年 (85%).
- 由于动脉瘤导致的大动脉重置的高自由度 (95%在20年).
- 没有患者需要为动脉瘤置换大动脉;3人接受了B型大动脉剖析的替代.
结论:
- 在Marfan患者中隔离的VSARR产生了优秀的长期结果.
- 隔离VSARR后未来大动脉门干预的风险非常低.
- 预防性大动脉门置换不适用于接受选择性VSARR的非动脉瘤大动脉门的Marfan患者.
相关概念视频
Aneurysm I: Introduction
259
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...
259
Aortic Regurgitation III: Medical Management
359
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...
359
Aneurysm III: Interprofessional Care
233
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...
233
Aneurysm II: Clinical Manifestations and Diagnostic Studies
176
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...
176
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
361
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...
361
Aneurysm IV: Nursing Management
347
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...
347


