Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.
ObjectiveTo explore the reoperation on aortic diseases in patients with previous aortic valve surgery due to rheumatic aortic valve disease, improve the understanding of aortic valve disease secondary to surgery of aortic valve. MethodsWe retrospectively analyzed the data of twenty-seven patients with previous aortic valve replacement due to rheumatic aortic valve disease underwent aortic root or other aortic operation in Fu Wai Cardiovascular Hospital because of new aortic root or aortic diseases between August 2003 and May 2012. All the patients with new aortic diseases were diagnosed by cardiac ultrasound and aortic computed tomography. The new diseases included type A aortic dissection in 13 patients, ascending aortic aneurysm in 6 patients, and aortic root aneurysm in 8 patients. There were 20 males and 7 females with mean age of 50±10 years (ranged 28-69 years). Seven patients underwent aortic root replacement, 6 patients received ascending aorta and total aortic arch replacement combined with stented graft implantation into the descending aorta, 6 patients received aortic root and total aortic arch replacement combined with stented graft, and 8 patients received the ascending aorta replacement. All patients were followed by clinic interview or telephone. ResultsThe interval time for reoperation was 6-110 (57±32) months. No patient died within 30 days after operation. Cardiopulmonary bypass time was 50-274 (143±65) minutes; hospital stay was 13-27 (19±11) days. Four patients had renal insufficiency after operation and all were cured by hemofiltration before departure. Three patients had neurological complications of transient brain dysfunction, and there was no postoperative spinal cord deficits occurred. Four patients had pulmonary complication. The mean follow up time were 4-118 (43.5±32.2) months. Five patients were missed and 4 cases died during the follow-up. The follow-up rate was 81.5%. Three-year survival rate was 85.1%. There was no case received third operation due to aortic disease during the follow-up. ConclusionWe should pay more attention to patients with previous surgery due to rheumatic aortic valve disease, especially to patients combined with enlarged ascending aorta, so that aortic adverse events following to aortic valve operation can be reduced or be avoided in long term.
ObjectiveTo 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. MethodsClinical 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. ResultsNo 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. ConclusionAD 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.