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【文摘发布】胸主动脉上部夹层的假腔越大预后
Jong-Min Song, MD, PhD*,*, Sung-Doo Kim, MD*, Jeong-Hoon Kim, MD*, Mi-Jeong Kim, MD*, Duk-Hyun Kang, MD, PhD*, Joon Beom Seo, MD, PhD, Tae-Hwan Lim, MD, PhD, Jae Won Lee, MD, PhD, Meong-Gun Song, MD, PhD and Jae-Kwan Song, MD, PhD, FACC*
* Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Objectives: We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change.
Background: Aneurysmal dilation of the aorta is a critical late complication in AD patients.
Methods: Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending aorta surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 ± 26 months, and CT was repeated for 31 ± 27 months.
Results: Aneurysm (diameter 60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic aorta (UT), mid descending thoracic aorta (MT), lower descending thoracic aorta (LT) and abdominal aorta (AA), respectively. Of 53 patients in whom CT was repeated for 2 years, the rates of aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 ± 3.66 mm/year, 3.21 ± 2.70 mm/year, 2.62 ± 2.19 mm/year, and 1.93 ± 3.13 mm/year, respectively (p < 0.01), and aneurysm developed in 15 (28%). The initial false lumen diameter at the UT, the aorta diameter at the MT, and Marfan syndrome were independent predictors of late aneurysm. A 22-mm initial false lumen diameter at the UT predicted late aneurysm with a sensitivity of 100% and a specificity of 76%. The patients with initial UT false lumen diameter 22-mm (n = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001).
Conclusions: The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.
J Am Coll Cardiol, 2007; 50:799-804 Long-Term Predictors of Descending Aorta Aneurysmal Change in Patients With Aortic Dissection
主动脉夹层患者远期降主动脉变化的预测因素
Objectives: We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change.
目的：我们旨在证明急性主动脉夹层形成（AD）后降主动脉扩张的长期自然发展过程，识别晚期动脉瘤改变的早期预测因素。
Background: Aneurysmal dilation of the aorta is a critical late complication in AD patients.
背景：主动脉瘤扩张是AD患者严重的晚期并发症。
Methods: Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending aorta surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 ± 26 months, and CT was repeated for 31 ± 27 months.
方法：100名AD患者在急性期进行对比增强CT检查，其中51名1型主动脉夹层患者接受了升主动脉外科手术，另外49名为3型AD。临床观察53±26 月，在31 ± 27
月重复CT检查。
Results: Aneurysm (diameter 60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic aorta (UT), mid descending thoracic aorta (MT), lower descending thoracic aorta (LT) and abdominal aorta (AA), respectively. Of 53 patients in whom CT was repeated for 2 years, the rates of aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 ± 3.66 mm/year, 3.21 ± 2.70 mm/year, 2.62 ± 2.19 mm/year, and 1.93 ± 3.13 mm/year, respectively (p < 0.01), and aneurysm developed in 15 (28%). The initial false lumen diameter at the UT, the aorta diameter at the MT, and Marfan syndrome were independent predictors of late aneurysm. A 22-mm initial false lumen diameter at the UT predicted late aneurysm with a sensitivity of 100% and a specificity of 76%. The patients with initial UT false lumen diameter 22-mm (n = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001).
结果：胸降主动脉上部(UT)、中部(MT)、下部(LT)和腹主动脉(AA)动脉瘤（直径60 mm）的发生率分别为14.4%, 8.2%, 4.1%和3.1% 。53名患者CT随访2年，主动脉直径扩张率在UT、MT、LT和AA分别是3.43 ± 3.66 mm/年、3.21 ± 2.70 mm/年、2.62 ± 2.19 mm/年和1.93 ± 3.13 mm/年(p < 0.01),其中15名患者发生动脉瘤（28%）。最初UT假腔直径、MT直径和 Marfan 综合征是晚期动脉瘤的独立预测因素。最初UT假腔直径22mm预测晚期动脉瘤发生的敏感度为100%，特异度为76%。最初UT假腔22mm的患者(n = 42)与其他患者(n = 58) 相比，动脉瘤或死亡的事件发生率更高(p < 0.001).
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作者:admin@医学,生命科学 2011-03-10 17:11
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