Surgical Treatment for Aortic Dissection Manifesting as Pure Aortic Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANGYi ,  XIONGHui , WANGWei , XUJian-ping , CHANGQian , YUCun-tao , WANGShui-yun , WANGXiao-qi

State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding?author：

XIONGHui, Email: dr.xionghui@gmail.com

Keywords：

Aortic dissection; Aortic regurgitation; Surgery

DOI：

10.7507/1007-4848.20140020

Video：

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Objective To explore clinical features and surgical strategies for patients with aortic dissection (AD) manifesting as pure aortic regurgitation (AR), avoid preoperative misdiagnosis, and provide reference for clinical diagnosis and treatment. Methods Clinical data of 5 AD patients who were preoperatively diagnosed as pure AR in Beijing Fu Wai Hospital from January 2005 to May 2012 were retrospectively analyzed. There were 4 male and 1 female patients with their median age of 41 (34-53) years. All the 5 patients were diagnosed as AD during the operation. One patient received aortic valvuloplasty, 1 patient received Wheat procedure, and 3 patients received Bentall procedure. Clinical manifestations, accessory examinations, intraoperative findings, surgical strategies and follow-up results were summarized. Results No postoperative death or complication occurred in this study. Echocardiogram of patient 1 before discharge showed that transverse diameters of the ascending aorta and aortic sinus decreased with satisfactory closure of aortic valves but no AR. Echocardiogram and CT all showed normal function in mechanical valves and patent blood vessel prosthesis in the other 4 patients. All the 5 patients were followed up for 4 (1-5) years and were alive during follow-up. Echocardiogram showed normal function in mechanical valves and patent blood vessel prosthesis without paravalvular leak in 4 patients and mild AR in 1 patient. Conclusion AD manifesting as pure AR is rare and easily misdiagnosed preoperatively. Careful analysis of medical history and accessory examinations can reduce the risk of misdiagnosis. Appropriate surgical strategies should be chosen according to intraoperative findings of intimal tears and aortic sinus damage of AD.

Citation： CHANGYi, XIONGHui, WANGWei, XUJian-ping, CHANGQian, YUCun-tao, WANGShui-yun, WANGXiao-qi. Surgical Treatment for Aortic Dissection Manifesting as Pure Aortic Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 75-79. doi: 10.7507/1007-4848.20140020 Copy

1.	朱曉東, 張寶仁.心臟外科學.北京:人民衛生出版社, 2007.1077-1098.
2.	易定華, 段維勛.中國主動脈夾層診療現狀與展望.中國循環雜志, 2013, 28 (1):1-2.
3.	黃文軍, 葉君明, 鄭澤琪.320例主動脈夾層誤診分析.實用臨床醫學, 2011, 12 (5):8-10.
4.	明廣華, 張宇輝, 吳海英, 等.179例主動脈夾層患者的臨床資料分析.中國循環雜志, 2004, 19 (5):363-366.
5.	吳輝, 楊俊, 丁家望, 等.癥狀不典型主動脈夾層誤診為主動脈瓣關閉不全一例.中國心血管雜志, 2010, 15 (2):156.
6.	劉江茹, 蘇宇芳, 潘延平.不典型主動脈夾層22例誤診分析.臨床醫藥實踐, 2010, 19 (1):70-71.
7.	孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):1171-1176.
8.	Sommer T, Fehske W, Holzknecht N, et al.Aortic dissection:a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and Mr imaging.Radiology, 1996, 199 (2):347-352.
9.	劉琦, 陳德基, 譚理連, 等.320排CT血管造影診斷主動脈夾層.中國醫學影像技術, 2012, 28 (1):113-116.
10.	郭榮利, 梁松年, 黃崑, 等.彩色多普勒超聲在主動脈夾層診斷中的臨床價值.中國醫科大學學報, 2011, 40 (3):272-273, 279.
11.	朱振輝, 劉延玲.主動脈夾層的超聲心動圖診斷及與其他影像診斷的比較.中華超聲影像學雜志, 2000, 9 (9):26-28.
12.	王海林, 黃達德, 王劭晟, 等.主動脈夾層的螺旋CT和彩色多普勒超聲評價.中國臨床醫學影像雜志, 2000, 11 (3):173-175.
13.	耿進朝, 喬華, 王榮峰, 等.彩色多普勒超聲與多層螺旋CT在急診主動脈夾層動脈瘤診斷中的應用.中華超聲影像學雜志, 2006, 15 (7):495-497.
14.	DeSanctis RW, Doroghazi RM, Austen WG, et al.Aortic dissection N Engl J Med, 1987, 317 (17):1060-1067.
15.	Bauer M, Pasic M, Schaffarzyk R, et al.Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve.Ann Thorac Surg, 2002, 73 (3):720-723.
16.	Urbanski PP, Wagner M, Zacher M, et al.Aortic root replacement versus aortic valve rep lacement.Ann Thorac Surg, 2001, 72 (1):28-32.
17.	Mazzucotelli JP, Deleuze PH, Baufreton C, et al.Preservation of the aortic valve in acute aortic dissection:long-term echocardiographic assessment and clinical outcome.Ann Thorac Surg, 1993, 55 (6):1513-1517.
18.	Mastroroberto P, di Virgilio A, Onorati F, et al.Valve preservation in acute type A aortic dissection:13-year experience.J Cardiovasc Surg (Torino), 2008, 49 (5):685-689.
19.	Valo J, Jokinen JJ, Kaarne M, et al.Expanding indications for valve-sparing aortic root Reconstruction:early and midterm results.Ann Thorac Surg, 2013, 95 (2):579-585.
20.	Subramanian S, Leontyev S, Borger MA, et al.Valve-sparing root reconstruction does not compromise survival in acute Type A aortic dissection.Ann Thorac Surg, 2012, 94 (4):1230-1234.
21.	陳偉丹, 常謙, 李守軍, 等.保留主動脈瓣主動脈根部置換術治療主動脈根部瘤的療效分析.中國胸心血管外科臨床雜志, 2012, 19 (5):498-501.
22.	姚建民, 趙向東.支架"象鼻子"技術和主動脈瓣成形治療DeBakeyⅠ型夾層主動脈瘤合并主動脈瓣關閉不全.中國急救醫學, 2008, 28 (6):489-491.
23.	蒙煒, 張爾永, 楊建, 等.主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2009, 16 (1):40-42.
24.	陳俞宏, 李富驪.David-Ⅰ手術治療主動脈夾層合并主動脈瓣反流.臨床心血管病雜志, 2012, 28 (2):157-158.
25.	唐楊烽, 徐激斌, 徐志云, 等.Stanford A型主動脈夾層的根部處理策略及療效分析.中華外科雜志, 2012, 50 (11):991-994.

1. 朱曉東, 張寶仁.心臟外科學.北京:人民衛生出版社, 2007.1077-1098.
2. 易定華, 段維勛.中國主動脈夾層診療現狀與展望.中國循環雜志, 2013, 28 (1):1-2.
3. 黃文軍, 葉君明, 鄭澤琪.320例主動脈夾層誤診分析.實用臨床醫學, 2011, 12 (5):8-10.
4. 明廣華, 張宇輝, 吳海英, 等.179例主動脈夾層患者的臨床資料分析.中國循環雜志, 2004, 19 (5):363-366.
5. 吳輝, 楊俊, 丁家望, 等.癥狀不典型主動脈夾層誤診為主動脈瓣關閉不全一例.中國心血管雜志, 2010, 15 (2):156.
6. 劉江茹, 蘇宇芳, 潘延平.不典型主動脈夾層22例誤診分析.臨床醫藥實踐, 2010, 19 (1):70-71.
7. 孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):1171-1176.
8. Sommer T, Fehske W, Holzknecht N, et al.Aortic dissection:a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and Mr imaging.Radiology, 1996, 199 (2):347-352.
9. 劉琦, 陳德基, 譚理連, 等.320排CT血管造影診斷主動脈夾層.中國醫學影像技術, 2012, 28 (1):113-116.
10. 郭榮利, 梁松年, 黃崑, 等.彩色多普勒超聲在主動脈夾層診斷中的臨床價值.中國醫科大學學報, 2011, 40 (3):272-273, 279.
11. 朱振輝, 劉延玲.主動脈夾層的超聲心動圖診斷及與其他影像診斷的比較.中華超聲影像學雜志, 2000, 9 (9):26-28.
12. 王海林, 黃達德, 王劭晟, 等.主動脈夾層的螺旋CT和彩色多普勒超聲評價.中國臨床醫學影像雜志, 2000, 11 (3):173-175.
13. 耿進朝, 喬華, 王榮峰, 等.彩色多普勒超聲與多層螺旋CT在急診主動脈夾層動脈瘤診斷中的應用.中華超聲影像學雜志, 2006, 15 (7):495-497.
14. DeSanctis RW, Doroghazi RM, Austen WG, et al.Aortic dissection N Engl J Med, 1987, 317 (17):1060-1067.
15. Bauer M, Pasic M, Schaffarzyk R, et al.Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve.Ann Thorac Surg, 2002, 73 (3):720-723.
16. Urbanski PP, Wagner M, Zacher M, et al.Aortic root replacement versus aortic valve rep lacement.Ann Thorac Surg, 2001, 72 (1):28-32.
17. Mazzucotelli JP, Deleuze PH, Baufreton C, et al.Preservation of the aortic valve in acute aortic dissection:long-term echocardiographic assessment and clinical outcome.Ann Thorac Surg, 1993, 55 (6):1513-1517.
18. Mastroroberto P, di Virgilio A, Onorati F, et al.Valve preservation in acute type A aortic dissection:13-year experience.J Cardiovasc Surg (Torino), 2008, 49 (5):685-689.
19. Valo J, Jokinen JJ, Kaarne M, et al.Expanding indications for valve-sparing aortic root Reconstruction:early and midterm results.Ann Thorac Surg, 2013, 95 (2):579-585.
20. Subramanian S, Leontyev S, Borger MA, et al.Valve-sparing root reconstruction does not compromise survival in acute Type A aortic dissection.Ann Thorac Surg, 2012, 94 (4):1230-1234.
21. 陳偉丹, 常謙, 李守軍, 等.保留主動脈瓣主動脈根部置換術治療主動脈根部瘤的療效分析.中國胸心血管外科臨床雜志, 2012, 19 (5):498-501.
22. 姚建民, 趙向東.支架"象鼻子"技術和主動脈瓣成形治療DeBakeyⅠ型夾層主動脈瘤合并主動脈瓣關閉不全.中國急救醫學, 2008, 28 (6):489-491.
23. 蒙煒, 張爾永, 楊建, 等.主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2009, 16 (1):40-42.
24. 陳俞宏, 李富驪.David-Ⅰ手術治療主動脈夾層合并主動脈瓣反流.臨床心血管病雜志, 2012, 28 (2):157-158.
25. 唐楊烽, 徐激斌, 徐志云, 等.Stanford A型主動脈夾層的根部處理策略及療效分析.中華外科雜志, 2012, 50 (11):991-994.

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