在胸主動脈剝離手術中運用經食道心臟超音波來診斷在體外心肺循環下發生主動脈真腔漸被壓迫的病例報告

Diagnosis of Progressive Compression of the Aortic True Lumen with Intraoperative Transesophageal Echocardiography during Repair of Dissection of Thoracic Aorta-- A Case Report

本病例為一在甲型胸主動脈剝離的急診手術中，利用經食道心臟超音波來監控，而發生主動脈真腔逐漸被心肺循環所灌注的血壓迫的報告。病人在經全身麻醉及經股動脈插管實行體外心肺循環後，經由食道心臟超音波的監控下，發現在降主動脈的假腔逐漸脹大，在幾分鐘內幾乎把主動脈真腔完全壓扁；我們分析其可能的機轉，主要與體外心肺循環所灌注的血進入主動脈假腔有關，在經食道心臟超音波偵測下，可清楚發現主動脈真腔塌陷的現象。在此病例中，我們可發現在心肺循環下，利用術中經食道心臟超音波可有效的監控主動脈灌注的情況及真腔被壓迫的狀況。在胸主動脈剝離的手術及心肺循環下，利用經食道心臟超音波可快速地診斷及可有效地提供主動脈灌注的情況。

We report an incident of progressive compression of the true lumen of aorta which happened immediately after cardiopulmonary bypass (CPB) and was diagnosed with intraoperative transesophageal echocardiography (TEE) in a patient undergoing an emergent repair of type A aortic dissection under femoral perfusion. During the CPB period, intraoperative TEE revealed gradual expansion of the false lumen which nearly obstructed the true lumen of the dissected aorta. The possible mechanism was related with distension of the false lumen by a dominant flow from retrograde femoral perfusion of CPB. With the application of intraoperative TEE, we could easily detect the hemodynamic changes of thoracic aorta and find the real causes so as to solve the perfusion abnormalities.