主动脉夹层详解.ppt
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1、Fundamentals of Aortic Surgery华中科技大学同济医学院附属协和医院心外科 孙图成Modern Era1955:Debakey/Cooley perform replacement of aorta using homograft.1965:Wheat proposes modern pharmacological anti-impulse therapy(dp/dt)1970:Stanford Classification1975:HCA for aortic arch repair by Griep and colleagues2005 first FDA-app
2、roved TEVAR2022/11/162OverviewPathologies of thoracic aorta Medical managementOpen repair Endovascular repair2022/11/163Pathologies of Thoracic AortaThoracic aorta aneurysm(TAA)Acute and chronic dissectionsAortic transections Penetrating ulcer Intramural hematomaAortoesophageal and aortobronchial fi
3、stulaShaggy AortaCoarctation of the aorta and its aneurysm2022/11/164GuidelinesHiratzka LF et al.,Circulation 20102022/11/165Thoracic Aorta AneurysmAneurysmal dilatation=50%increase over the normal diameter majority w/o symptomsSvensson LG,Crawford ES.Cardiovascular and vasculardisease of the aorta.
4、Philadelphia:WB Saunders,19972022/11/166TAA-Lifetime Rates of rupture,dissection or death34%for ascending thoracic aorta at 6 cm43%for descending thoracic aorta at 7 cm2022/11/167Medical ManagementControl BP and HR(dp/dt)*multiple intravenous medication:B-blocker,calcium-antagonists,etc.Pray!No weig
5、ht lifting,skiing,horseback riding,contact sports,etc.*7th JNC guidelines:Chobanian et al.Hypertension 2003;42(6):1206-52.2022/11/168Indications for operation5.5 cm in ascending aorta(or smaller!)5.5 cm in arch and DTA(or larger)faster growth rateruptureintractable painviscero-renal symptomsconcomit
6、ant operations2022/11/169Aortic dissection发病率10-29/10万,男、女比例3:1急性:14天以内亚急性:14天-2月慢性:2月以上发病凶险,若未及时治疗,48小时死亡率可高达80%2022/11/1610病因主动脉中层变性(Marfans syndrome)主动脉粥样硬化高血压胸部外伤医源性(主动脉插管、AVR、CABG)2022/11/1611病理内膜破口:95%的病人主动脉夹层起自两个部位之一:升主动脉、胸降主动脉起始部(导管韧带附着处)。其中66%为升主动脉破口。假腔形成:主动脉内膜和中层分离。假腔内可有血液流动或血栓形成。可向下撕裂至腹主动
7、脉、髂总动脉。远端可有1个或多个破口,为假腔出口。假腔因高压可使外膜膨出形成动脉瘤,严重者外膜可破裂出血。高压的假腔可压迫真腔或主动脉的各分支血管(如冠状动脉、弓部分支、肾动脉等)2022/11/1612并发症和主要死亡原因主动脉破裂 心包填塞 血胸 急性主动脉瓣关闭不全 充血性心衰灌注不良综合征 急性心梗 卒中(偏瘫等)截瘫 肝、肾、肠 肢体缺血2022/11/1613分型2022/11/1614症状突发的撕裂样疼痛(前胸、颈部、两肩胛骨之间、腰背部甚至腹股沟。一旦假腔形成并稳定,锐痛可转为持续的钝痛。疼痛突然加重提示破裂征象)休克症状(出汗、四肢皮肤湿冷、晕厥)神经系统症状(偏瘫、失语)少
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- 主动脉 夹层 详解
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