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房、室间隔“双活瓣”治疗双向分流型室间隔缺损伴重度肺动脉高压一例

分期杂交手术治疗胸腹主动脉夹层

目的总结腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层的经验。方法自 2018 年 1 月至 2019 年 6 月，南京鼓楼医院采用腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层 12 例，男 10 例、女 2 例，年龄 36～63（50±9）岁。结果随访 6～24 个月，全组无死亡，1 例术后左下肢单瘫，1 例出现肾功能不全。随访期间 1 例患者术后 1 个月出现主动脉支架近端逆撕，行全主动脉弓置换术后痊愈。2 例患者出现腹腔干动脉近端内漏，予以弹簧圈栓塞后痊愈，其余患者 CT 血管造影（CTA）检查未见吻合口造影剂渗漏及人工血管扭曲、闭塞。结论腹主动脉去分支化手术联合主动脉腔内隔绝术治疗胸腹主动脉夹层可取得良好近期疗效，中远期疗效仍有待进一步观察随访。

Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions

ObjectiveTo explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. MethodsA retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. ResultsA total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. ConclusionFor proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.

Stanford B 型主动脉夹层腔内修复术后并发 A 型夹层的外科治疗

目的总结 Stanford B 型主动脉夹层胸主动脉腔内修复术（TEVAR）后并发 A 型夹层的临床特点及外科治疗经验。方法自 2013 年 11 月至 2018 年 3 月，南京鼓楼医院外科治疗 Stanford B 型主动脉夹层 TEVAR 术后并发的 A 型夹层患者 14 例，其中男 13 例 、女 1 例，年龄 24～66（52±3）岁，合并高血压 13 例，糖尿病 2 例，马方综合征 1 例。所有患者在深低温停循环选择性脑灌注下施行手术，近心端 13 例行升主动脉置换术，1 例行 Bentall 术。共实施全弓置换加象鼻手术 13 例，弓部开窗支架植入术 1 例。结果全组无死亡，1 例术后右上肢单瘫，1 例术后血行感染，1 例出现右侧偏瘫及肾功能不全行肾脏替代治疗。随访 6～45 个月，随访期间 1 例患者术后 1 个月因原介入支架远端胸降主动脉发生新的夹层再次行 TEVAR，其余患者 CT 血管造影检查未见吻合口造影剂渗漏及人工血管扭曲。结论B 型主动脉夹层 TEVAR 术后并发 A 型夹层及时给予外科手术治疗可取得良好疗效。