瓣膜手術患者術中發生主動脈剝離——病例報告

Iatrogenic Aortic Dissection during Mitral Valve Replacement Surgery — A Case Report

手術中的主動脈剝離在心臟手術是一種少見卻致命的併發症。及早發現並及積極治療可以有效的降低死亡率。其中經食道超音波可以提供有效快速的診斷。我們提出一個擬接受瓣膜手術的病人，建立主動脈導管的時候發生主動脈剝離，經食道超音波確定診斷，並馬上經由股動脈進行動脈插管，隨後在體外循環及低溫麻醉下進行主動脈人工血管置換術。在經過二尖瓣置換及三尖瓣成型術以及主動脈人工血管置換後，轉往加護病房照護且成功脫離呼吸器，病人平安出院並固定在門診追蹤。在一些研究中，提到經食道超音波在心臟手術中已經扮演著越來越重要的角色，而且操作醫師的技術純熟與否，應列入手術中主動脈剝離的危險因子之一。在此我們報告一位心臟手術病人術中發生主動脈剝離之併發症，經由早期診斷與治療，成功地避免了可能的致命傷害。

Intraoperative aortic dissection is one of the complications of aortic cannulation, which is potentially lethal with an incidence of about 0.16%.1 Early diagnosis and treatment can lower the mortality rate effectively. We report a 68 y/o female patient sustaining an acute type A aortic dissection in consequence of aortic cannulation for mitral valve replacement surgery. Induction of general anesthesia and endotracheal intubation were performed smoothly. Transesophageal echocardiography (TEE) has proven itself as an important tool to offer definite diagnosis of aortic dissection. Iatrogenic intraoperative aortic dissection is rare but is potentially a fatal complication. Early diagnosis and prompt treatment are important for survival.