手術中經食道超音波發現心導管併發A型主動脈剝離之病例報告

Cardiac Catheterization-induced Type-A Aortic Dissection Detected by Intra-operative Transesophageal Echocardiography-- A Case Report

對於冠狀動脈疾病，心導管同時是診斷和治療的工具。冠狀動脈剝離是心導管的併發症之一，當冠狀動脈剝離合併循環不足或嚴重狹窄時，緊急的冠狀動脈繞道手術是必要的。我們報告一位因為心導管導致冠狀動脈剝離而進行緊急冠狀動脈繞道手術的病患，手術中經食道超音波發現進行性的A型主動脈剝離，因此，外科醫師改用了和一般冠狀動脈繞道手術不同的人工循環插管位置和手術方式，以同時處理冠狀動脈繞道和主動脈剝離的情況。對於類似的情況，特別是手術前就知道有逆行性冠狀動脈剝離的病患，利用手術中經食道超音波來發現主動脈剝離這種少見但嚴重的心導管併發症是重要的。

Cardiac catheterization is not only a diagnostic tool but also a means of treatment of coronary artery disease. Coronary artery dissection is one of the complications of cardiac catheterization. Emergency coronary artery bypass graft (CABG) surgery is indicated when coronary artery dissection is associated with unstable perfusion or residual severe stenosis. We present a case of progressive type-A aortic dissection as a continity of catheterization-induced dissection of right coronary artery (RCA) with occlusion, disclosed by transesophageal echocardiography (TEE) during the emergent CABG surgery for the iatrogenic injury. Once the aortic dissection has been diagnosed by TEE, the surgical procedure and cannulation site for cardiopulmonary bypass were altered from those used in regular CABG surgery. Therefore, TEE is able and valuable in such situation to detect this rare but severe complication due to catheterization, especially when retrograde coronary artery dissection has been noted preoperatively.