背景:成人双主动脉弓(DAA)合并降主动脉弓夹层(DAAD)是一种罕见的主动脉血管疾病。由于双弓和弓血管的解剖结构异常,临床症状和手术方法与典型主动脉夹层不同。
方法:本研究是对涉及三名患者(平均年龄,47.3年),从2010年9月至2019年6月,DAA联合DAAD进行了全弓置换或混合主动脉修复。病人的人口统计学,最初的症状,合并症,外科手术,并对结果进行了总结。
结果:对2例患者进行深低温停循环下的全足弓置换加冷冻支架植入术,其中1例术后出现弥散性血管内凝血和多器官功能衰竭。病例3接受了左锁骨下动脉血运重建和胸主动脉腔内修复的混合手术。随访期间声音嘶哑、吞咽困难症状明显改善。
结论:除了典型的突发胸痛和背痛,DAA和DAAD患者可出现声音嘶哑和吞咽困难.基于DAA的发展,全弓置换或杂交手术可能是一种可选的治疗方法。
BACKGROUND: Double aortic arch (DAA) combined with descending aortic arch dissection (DAAD) in adults is a rare aorta vascular disease. Due to the abnormal anatomy of the double arch and arch vessels, the clinical symptoms and surgical methods differ from those of typical aortic dissection.
METHODS: This study was retrospective analysis of a
case series involving three patients (mean age, 47.3 years) with DAA combined DAAD underwent total arch replacement or hybrid aortic repair from September 2010 to June 2019. The patients\' demographics, initial symptoms, comorbidities, surgical procedures, and outcomes are summarized.
RESULTS: Total arch replacement plus frozen stent implantation under deep hypothermic circulatory arrest was performed for 2 patients, one of them developed disseminated intravascular coagulation and multiple organ failure postoperatively.
Case 3 underwent a hybrid procedure with left subclavian artery revascularization and thoracic endovascular aortic repair. The symptoms of hoarseness and dysphagia were obviously improved during the follow up.
CONCLUSIONS: In addition to typical sudden chest and back pain, patients with DAA and DAAD may have hoarseness and dysphagia. Based on the development of DAA, total arch replacement or hybrid surgery may be is an optional treatment.