CAJ | 학술논문

目的总结妊娠合并急性A型主动脉夹层的治疗经验.方法 2007年1月至2012年2月,6例妊娠合并急性A型主动脉夹层的患者接受治疗,年龄24～37岁,平均31岁.妊娠12～38周,平均24.5周.4例马方综合征,2例妊娠期高血压.主动脉夹层病理分型A3S1例,A2C2例,A3C3例.5例手术治疗,1例药物保守治疗.手术在低温体外循环或深低温停循环选择性脑灌注下完成.其中Bentall手术1例,Bentall加孙氏手术2例,升主动脉替换加孙氏手术2例,术后母亲和活体胎儿均接受随访.结果接受药物治疗患者治疗9天后因为主动脉夹层破裂母体及胎儿死亡.5例接受外科手术患者母体均生存,胎儿成活3例,死亡2例.体外循环75～210min,平均167min;主动脉阻断83～145min,平均98min;停循环19～27min,平均23.5min.随访1.0～3.5年,平均2.2年,5例均生存.CT示手术部位形态、结构、血流无异常,支架远端的自体血管无扩张;3例婴儿生长发育好,智力正常.结论妊娠合并急性A型主动脉夹层患者应及时手术治疗,药物治疗风险高、夹层破裂可导致母体及胎儿死亡的不良后果.术前应在多学科会诊下综合考虑主动脉病理改变、妊娠周龄来决定灌注部位、体外循环方法,选择恰当的胎儿处理方式及手术方式,从而最有效的保证母婴的安全.
목적 총결임신합병급성A형주동맥협층적치료경험.방법 2007년1월지2012년2월,6례임신합병급성A형주동맥협층적환자접수치료,년령24～37세,평균31세.임신12～38주,평균24.5주.4례마방종합정,2례임신기고혈압.주동맥협층병리분형A3S1례,A2C2례,A3C3례.5례수술치료,1례약물보수치료.수술재저온체외순배혹심저온정순배선택성뇌관주하완성.기중Bentall수술1례,Bentall가손씨수술2례,승주동맥체환가손씨수술2례,술후모친화활체태인균접수수방.결과 접수약물치료환자치료9천후인위주동맥협층파렬모체급태인사망.5례접수외과수술환자모체균생존,태인성활3례,사망2례.체외순배75～210min,평균167min;주동맥조단83～145min,평균98min;정순배19～27min,평균23.5min.수방1.0～3.5년,평균2.2년,5례균생존.CT시수술부위형태、결구、혈류무이상,지가원단적자체혈관무확장;3례영인생장발육호,지력정상.결론 임신합병급성A형주동맥협층환자응급시수술치료,약물치료풍험고、협층파렬가도치모체급태인사망적불량후과.술전응재다학과회진하종합고필주동맥병리개변、임신주령래결정관주부위、체외순배방법,선택흡당적태인처리방식급수술방식,종이최유효적보증모영적안전.
Objective Acute type A aortic dissection associated pregnancy severely threatens the lives of both the mother and her ferus.We retrospectively reviewed our clinical experience with this life-threatening condition in six cases.Methods Between January 2007 and February 2012,6 women with acute type A aotic dissection associated pregnancy were treated by our group,with an average of 3 1 years (range 24 -37 weeks)and a mean gestation weeks of 24.5 (range,12 -38 weeks ).The etiology was Marfan syndrome in 4 cases and gestational hypertension in 2.The pathology was the modified Stanford type A3S in I case,A2C in 2 and A3C in 3.- Five patients were treated surgically and 1 medically.Surgical operations were performed under hypothermic cardiopulmonary bypass or deep hypothermic circulatory arrest,including Bentall procedure in 1case,Bentall + Sun's procedure in 2,ascending aortic replacement + Sun's procedure in 2.Results The woman treated medically and her fetus died from aortic rupture 9 days after admission.The cardiopulmonary bypass and cross clamp time and circulatory arrest time averaged 167 rninites(range,75 -210 minites) and 98 minites(range,83 - 145 minites) and 23.5minites(range,19 -27 minutes),respectively.Five patients treaed surgically survived the operation.Three fetuses survived rand two fetuses died.After a mean follow-up of 2.2 years (range,1 - 3.5 years ),5 patients were doing well.CT angiogram detected nonmal aortic and valvular structures,with no signs of distal dilation.Three babies were normal in development and neurocognitive functios.Conclusion Palients with aortic dissection associated with pregnancy should be operated on ugently and medical treatment carries high risks of aortic rupture and maternal and fetal death.Methods of surgical repair,peffusion techniques and delivery should be chosen based on the underlying aortic pathology and gestational age,so as to maximize the safety of the mother and her baby.