Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie.
Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie.
复制标题
主动脉弓移动性血栓，无主动脉碎片。经食管超声心动图发现与不明原因的动脉栓塞相关。
作者：
Thierry Laperche;Claude Laurian;Raymond Roudaut;Steg Pg
背景
主动脉弓的动脉粥样硬化病变是动脉栓塞的潜在来源。最近有报道称，没有弥漫性动脉粥样硬化的年轻患者主动脉弓内出现移动性血栓，但此类病例仍然是例外。我们描述了一系列患有不明原因动脉栓塞的年轻患者，经食管超声心动图检测到移动性主动脉弓血栓。
方法和结果
对 1991 年至 1995 年间在法国学术心脏病中心收集的经食管超声心动图文件进行了审查，以确定符合以下标准的患者：(1) 之前几周发生过动脉栓塞事件； (2) 移动性带蒂主动脉弓血栓，定义为突出到主动脉腔内并插入主动脉弓上的回声肿块； (3)经食管超声心动图未见明显的弥漫性主动脉粥样硬化或主动脉碎片。从 27 855 次检查中发现了 23 例病例。血栓位于水平主动脉（n = 4）、左锁骨下动脉口附近（n = 5）或主动脉弓后段凹处（峡部）（n = 14）。 21 名患者的插入部位是一个小的动脉粥样硬化斑块。剩余的主动脉壁总是表现正常或轻度动脉粥样硬化。患者的平均年龄为 45 +/- 8.4 岁（范围为 26 至 61 岁）。所有患者在诊断主动脉弓血栓后均接受静脉肝素治疗，其中10例组织学检查证实血栓插入部位有动脉粥样硬化过程的患者进行了手术切除血栓。预后主要受栓塞事件的影响。
结论
主动脉弓血栓似乎是与年轻患者动脉栓塞相关的主动脉粥样硬化性疾病的一种变异形式。
BACKGROUND
Atherosclerotic lesions of the aortic arch are potential sources of arterial embolism. Mobile thrombi in the aortic arch in young patients without diffuse atherosclerosis have been reported recently, but such cases remain exceptional. We describe a series of young patients with unexplained arterial embolism in whom transesophageal echocardiography detected mobile aortic arch thromboses.
METHODS AND RESULTS
Transesophageal echocardiography files collected between 1991 and 1995 in French academic cardiology centers were reviewed to identify patients who fulfilled the following criteria: (1) an arterial embolic event in the preceding weeks; (2) a mobile pedunculated aortic arch thrombosis, defined as an echogenic mass protruding into the lumen of the aorta and inserted on the aortic arch; and (3) absence of obvious diffuse aortic atherosclerosis or of aortic debris on transesophageal echocardiography. Twenty-three cases were identified from 27 855 examinations. Thromboses were located on the horizontal aorta (n = 4), near the ostium of the left subclavian artery (n = 5), or on the concavity of the posterior segment of the aortic arch (in the isthmus) (n = 14). The insertion site was a small atherosclerotic plaque in 21 patients. The remaining aortic wall always appeared normal or mildly atherosclerotic. The mean age of the patients was 45 +/- 8.4 years (range, 26 to 61 years). All patients were treated with intravenous heparin after the diagnosis of aortic arch thrombosis, and surgical removal of the thrombosis was performed in 10 patients in whom histological examination confirmed an atherosclerotic process at the site of insertion of the thrombosis. The prognosis was mainly influenced by embolic events.
CONCLUSIONS
Thromboses of the aortic arch appear to be a variant form of aortic atherosclerotic disease associated with arterial embolism in young patients.
DOI：
10.1016/0735-1097(94)90657-2
发表时间：
1994-06-01
影响因子：
24
作者：
FERNANDEZORTIZ, A;BADIMON, JJ;BADIMON, L
通讯作者：
BADIMON, L