Pulmonary Artery Occlusion Due to Abrupt Pinhole Rupture of Aortic Arch Aneurysm
Pulmonary Artery Occlusion Due to Abrupt Pinhole Rupture of Aortic Arch Aneurysm
复制标题
主动脉弓动脉瘤突然针孔破裂导致肺动脉闭塞
DOI：
10.1016/j.jcin.2020.11.028
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Akashi Y
中科院分区：
文献类型：
--
作者：
Warisawa T;Kotoku A;Miyauchi R;Kobayashi T;Yamada T;Matsuda H;Akashi Y
一名83岁的男性，已知主动脉弓动脉瘤直径为60 mm，由于心肺骤停而被转移。在体外膜氧合支持下恢复自主循环后，患者接受了心脏导管插入术，随后进行了普通计算机断层扫描，以排除明显的动脉瘤破裂和主动脉夹层。冠状动脉造影显示无阻塞性疾病。随后，由于怀疑肺栓塞，进行了肺血管造影。右心室流出道的肺血管造影显示主肺动脉（PA）狭窄样结果和左PA模糊可见（图1A，视频1）。对比增强的计算机断层扫描显示，右心室流出道放置了静脉导管和Berman导管，结果显示，肺动脉小弯处的小孔破裂导致肺动脉夹层，随后出现腔内血肿，似乎闭塞了肺动脉的真腔（图1B和1C，视频2）。不幸的是，患者死亡，尽管计划进行手术修复。
An 83-year-old man with a known aortic arch aneurysm of 60 mm in diameter was transferred due to cardiopulmonary arrest. After achieving return of spontaneous circulation supported by extracorporeal membrane oxygenation, the patient underwent heart catheterization followed by plain computed tomography to exclude evident aneurysm rupture and aortic dissection. Coronary angiogram revealed no obstructive disease. Subsequently, with a suspicion of pulmonary embolism, pulmonary angiogram was performed. Pulmonary angiogram from the right ventricular outflow tract demonstrated stenosis-like findings in the main pulmonary artery (PA) and faint visualization of the left PA (Figure 1A, Video 1). Contrastenhanced computed tomography with an intravenous line and a Berman catheter placed at the right ventricular outflow tract indicated that the pinhole rupture of the arch on the minor curvature into the PA caused the dissection of PA and following intraluminal hematoma, which seemed to occlude the true lumen of the PA (Figures 1B and 1C, Video 2). Unfortunately, the patient died, although surgical repair was planned.