胸部钝挫伤后主动脉瓣反流和根部假性动脉瘤:病例报告。

IF 0.7 Q4 SURGERY
Hiroaki Aizawa, Haruo Yamauchi, Masahiko Ando, Minoru Ono
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引用次数: 0

摘要

背景:同时诊断出因交通事故导致的严重主动脉瓣反流和主动脉根部假性动脉瘤极为罕见。本报告介绍了一例因交通事故导致主动脉根部假性动脉瘤和亚急性重度主动脉瓣反流的马凡综合征患者的病例:一名 64 岁的妇女 16 年前被诊断患有马凡综合征,目前正在门诊接受随访。八年前,患者因急性 A 型夹层接受了全弓置换术,并结合 J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan)。发病前五个月,患者在一次交通事故中左侧肋骨骨折,在当地医院接受了保守治疗。患者因呼吸急促和呼吸困难加重来到急诊室。超声心动图显示主动脉瓣严重反流,三尖瓣中度反流。计算机断层扫描显示主动脉根部新发假性动脉瘤。通过改良的 Bentall 手术,使用生物人工瓣膜和三尖瓣瓣环成形术,成功进行了手术修复。术中发现假性动脉瘤伴有右侧瓦尔萨尔瓦窦穿孔。虽然左、右主动脉瓣叶正常,但非冠状动脉瓣叶出现尖裂纤维股破裂,导致急性主动脉瓣反流:本病例报告强调了在交通事故后发生主动脉根部假性动脉瘤和亚急性主动脉瓣反流的罕见情况。对于钝性胸部创伤病例,尤其是马凡氏综合征患者,经常进行检查对于评估创伤后主动脉瓣反流和主动脉损伤的可能性至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Posttraumatic aortic regurgitation and root pseudoaneurysm following blunt chest trauma: a case report.

Background: The simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident.

Case presentation: A 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation.

Conclusions: This case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.

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