不典型急性主动脉夹层1例的诊断及文献回顾

Diagnosis and Literature Review of One Case of Atypical Acute Aortic Dissection

摘要: 急性主动脉夹层(Acute Aortic Dissection, AAD)是一种由于血液通过血管内膜破口进而撕裂内膜形成真假腔并延伸剥离的急性致死性疾病。本文报告了1例73岁女性患者以急性心肌梗死为主要表现入院，行经皮冠状动脉介入术(PCI)治疗后患者反复出现胸痛。影像检查结果均提示：1) 主动脉夹层(Debakey IIIa型)，破口位于主动脉弓；2) 主动脉弓、降主动脉胸段壁内血肿(约T3~T9椎体水平)。急行主动脉腔内修复术，植入胸主动脉覆膜血管内支架系统，术后患者心功能恢复良好，无明显不适。

Abstract: Acute aortic dissection (AAD) is an acute fatal disease in which the blood passes through a rupture in the intima-media of a blood vessel and tears the intima-media to form a true-false lumen with extended dissection. In this paper, the authors report a case of a 73-year-old female patient who was admitted to the hospital with acute myocardial infarction as the primary manifestation and had recurrent chest pain after percutaneous coronary intervention (PCI). Imaging results suggested 1) aortic dissection (Debakey type IIIa), with the breach located in the aortic arch; 2) intramural hematoma in the thoracic segment of the aortic arch and descending aorta (about the level of the vertebral body of T3~T9). Emergency endoluminal repair of the aorta was performed. The thoracic aorta was implanted with a membranous endovascular stenting system, and the patient recovered well from the procedure with no noticeable discomfort.