Abstract：
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
摘要：
一名72岁男性，多年前曾有三血管冠状动脉旁路移植术史，出现DeBakey2型主动脉夹层和主动脉左心房瘘，并伴有旁路移植术（左乳内动脉和隐静脉移植物）。他出现肺水肿，需要插管。右腋窝动脉插管。将升主动脉和左乳内动脉夹住后,主动脉被横切,在两个隐静脉移植物周围留下主动脉组织，形成两个独立的斑块。在大隐静脉移植物与后降支动脉的近端吻合处附近发现了入口撕裂。瘘管,位于非冠状窦的假腔和左心房的穹顶之间，主要是关闭。因为主动脉夹层导致非冠状窦内的外膜变薄,通过重悬连合进行部分主动脉根部重塑。在中度低温和单侧顺行脑灌注下进行半体修复。全身灌注恢复后，确定了隐静脉移植纽扣的位置。再次交叉夹住上升移植物；使用Carrel补片技术将隐静脉移植物重新植入钝角边缘分支移植物，而将隐静脉移植物植入后降支动脉则需要插入10毫米Dacron移植物以适应长度。
