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导管相关的医源性主动脉夹层及主动脉壁间血肿临床治疗经验 被引量:6

Clinical experience of transcatheter iatrogenic aortic dissection and aortic hematoma
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摘要 目的:导管相关的医源性主动脉夹层及主动脉壁间血肿发生率较低且相关报道有限,介绍和探讨我中心对此种并发症的临床治疗经验以及其临床效果。方法:在2016年5月至2018年1月期间,安贞医院共有8例因导管检查和治疗导致医源性主动脉夹层及主动脉壁间血肿患者,1例发生在心脏电生理检查和射频消融操作过程中,7例发生在冠状动脉造影检查及冠状动脉介入支架治疗操作过程中。3例为A型主动脉壁间血肿,1例为右冠状动脉窦局限性夹层,4例为A型主动脉夹层。4例(3例A型主动脉壁间血肿、1例局限性夹层)行保守治疗,4例A型主动脉夹层行急诊手术治疗。对8 例患者均行定期随访及主动脉CTA复查。结果:1例保守治疗的A型主动脉壁间血肿患者1个月后再发胸痛,主动脉弓新发主动脉溃疡,行手术治疗。8例患者无住院死亡,且均无脑梗死、截瘫、心力衰竭等严重发症,远期随访结果均存活且恢复良好。结论:导管相关的医源性主动脉夹层及主动脉壁间血肿是一种发生率较低的并发症,但是出现此并发症可以导致严重的后果,通过对病情的综合判断采用合理的保守治疗和外科治疗方法都可以得到较理想的临床效果。 Objective : Transcather iatrogenic aortic dissection and aortic hematoma is rare and the lit-erature is limited. We aimed to present and probe the clinical experience at anagement of this complication. Methods: From May 2015 to January 2018, 8 consecutive patients were diagnosed as transcather iatrogenic aor-tic dissection or aortic hematoma. I case occurred during electrophysiological examination and radiofrequency ablation. 7 cases occurred during percutaneous coronary angiography or percutaneous coronary intervention. Complications included: type A aortic hematoma in 3 patients, local aortic dissection in I patient and type A aortic dissection in 4 patients. Management included : conservative treatment in 4 patients which were 3 type A aortic hematoma patients and I local aortic dissection patients, surgical treatment in 4 type A aortic dissection. Follow-up and CT angiography were implemented in 8 patients. Results : I type A aortic hematoma patients un-derwent recurrence of chest pain and surgical treatment at I month after conservative treatment. There was no early mortality and severe cardiovascular complication including cerebral infaiction, paralysis, heart failure and so on. Good result was obtained in long-term outcome. Conclusions : Transcather iatrogenic aortic dissection and aortic hematoma is rare but life-threatening. Comprehensive, feasible and effective strategy including conservative and surgical treatment could obtain ideal clinical effect.
作者 王龙飞 刘宁宁 李宇 周子凡 王珺 潘旭东 刘永民 朱俊明 孙立忠 WANG Longfei;LIU Ninging;LI Yu;ZHOU Zifan;WANG Jun;PAN Xudong;LIU Yongmin;ZHU Junming;SUN Lizhong(Department of Cardiovascular Surgery, Beijing Anzhen Hospitaly Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处 《心肺血管病杂志》 2019年第4期391-394,共4页 Journal of Cardiovascular and Pulmonary Diseases
基金 “使命”人才计划(SML20150601)
关键词 主动脉夹层 主动脉壁间血肿 医源性 导管 Aortic dissection Aortic hematoma Iatrogenic Transcather
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