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.	朱晓东, 张宝仁.心脏外科学.北京:人民卫生出版社, 2007.1077-1098.
2.	易定华, 段维勋.中国主动脉夹层诊疗现状与展望.中国循环杂志, 2013, 28 (1):1-2.
3.	黄文军, 叶君明, 郑泽琪.320例主动脉夹层误诊分析.实用临床医学, 2011, 12 (5):8-10.
4.	明广华, 张宇辉, 吴海英, 等.179例主动脉夹层患者的临床资料分析.中国循环杂志, 2004, 19 (5):363-366.
5.	吴辉, 杨俊, 丁家望, 等.症状不典型主动脉夹层误诊为主动脉瓣关闭不全一例.中国心血管杂志, 2010, 15 (2):156.
6.	刘江茹, 苏宇芳, 潘延平.不典型主动脉夹层22例误诊分析.临床医药实践, 2010, 19 (1):70-71.
7.	孙立忠, 刘宁宁, 常谦, 等.主动脉夹层的细化分型及其应用.中华外科杂志, 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.	刘琦, 陈德基, 谭理连, 等.320排CT血管造影诊断主动脉夹层.中国医学影像技术, 2012, 28 (1):113-116.
10.	郭荣利, 梁松年, 黄崑, 等.彩色多普勒超声在主动脉夹层诊断中的临床价值.中国医科大学学报, 2011, 40 (3):272-273, 279.
11.	朱振辉, 刘延玲.主动脉夹层的超声心动图诊断及与其他影像诊断的比较.中华超声影像学杂志, 2000, 9 (9):26-28.
12.	王海林, 黄达德, 王劭晟, 等.主动脉夹层的螺旋CT和彩色多普勒超声评价.中国临床医学影像杂志, 2000, 11 (3):173-175.
13.	耿进朝, 乔华, 王荣峰, 等.彩色多普勒超声与多层螺旋CT在急诊主动脉夹层动脉瘤诊断中的应用.中华超声影像学杂志, 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.	陈伟丹, 常谦, 李守军, 等.保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析.中国胸心血管外科临床杂志, 2012, 19 (5):498-501.
22.	姚建民, 赵向东.支架"象鼻子"技术和主动脉瓣成形治疗DeBakeyⅠ型夹层主动脉瘤合并主动脉瓣关闭不全.中国急救医学, 2008, 28 (6):489-491.
23.	蒙炜, 张尔永, 杨建, 等.主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2009, 16 (1):40-42.
24.	陈俞宏, 李富骊.David-Ⅰ手术治疗主动脉夹层合并主动脉瓣反流.临床心血管病杂志, 2012, 28 (2):157-158.
25.	唐杨烽, 徐激斌, 徐志云, 等.Stanford A型主动脉夹层的根部处理策略及疗效分析.中华外科杂志, 2012, 50 (11):991-994.

1. 朱晓东, 张宝仁.心脏外科学.北京:人民卫生出版社, 2007.1077-1098.
2. 易定华, 段维勋.中国主动脉夹层诊疗现状与展望.中国循环杂志, 2013, 28 (1):1-2.
3. 黄文军, 叶君明, 郑泽琪.320例主动脉夹层误诊分析.实用临床医学, 2011, 12 (5):8-10.
4. 明广华, 张宇辉, 吴海英, 等.179例主动脉夹层患者的临床资料分析.中国循环杂志, 2004, 19 (5):363-366.
5. 吴辉, 杨俊, 丁家望, 等.症状不典型主动脉夹层误诊为主动脉瓣关闭不全一例.中国心血管杂志, 2010, 15 (2):156.
6. 刘江茹, 苏宇芳, 潘延平.不典型主动脉夹层22例误诊分析.临床医药实践, 2010, 19 (1):70-71.
7. 孙立忠, 刘宁宁, 常谦, 等.主动脉夹层的细化分型及其应用.中华外科杂志, 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. 刘琦, 陈德基, 谭理连, 等.320排CT血管造影诊断主动脉夹层.中国医学影像技术, 2012, 28 (1):113-116.
10. 郭荣利, 梁松年, 黄崑, 等.彩色多普勒超声在主动脉夹层诊断中的临床价值.中国医科大学学报, 2011, 40 (3):272-273, 279.
11. 朱振辉, 刘延玲.主动脉夹层的超声心动图诊断及与其他影像诊断的比较.中华超声影像学杂志, 2000, 9 (9):26-28.
12. 王海林, 黄达德, 王劭晟, 等.主动脉夹层的螺旋CT和彩色多普勒超声评价.中国临床医学影像杂志, 2000, 11 (3):173-175.
13. 耿进朝, 乔华, 王荣峰, 等.彩色多普勒超声与多层螺旋CT在急诊主动脉夹层动脉瘤诊断中的应用.中华超声影像学杂志, 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. 陈伟丹, 常谦, 李守军, 等.保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析.中国胸心血管外科临床杂志, 2012, 19 (5):498-501.
22. 姚建民, 赵向东.支架"象鼻子"技术和主动脉瓣成形治疗DeBakeyⅠ型夹层主动脉瘤合并主动脉瓣关闭不全.中国急救医学, 2008, 28 (6):489-491.
23. 蒙炜, 张尔永, 杨建, 等.主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2009, 16 (1):40-42.
24. 陈俞宏, 李富骊.David-Ⅰ手术治疗主动脉夹层合并主动脉瓣反流.临床心血管病杂志, 2012, 28 (2):157-158.
25. 唐杨烽, 徐激斌, 徐志云, 等.Stanford A型主动脉夹层的根部处理策略及疗效分析.中华外科杂志, 2012, 50 (11):991-994.

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