最新主动脉夹层动脉瘤 3D重建图PL-药学医学精品资料.ppt

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1、最新主动脉夹层动脉瘤3D重建图PL-药学医学精品资料History1555–Vesaliusdiagnosedapulsatingtumornearthevertebraeinapatient’sbackandcalledit“adilatationoftheaorta”18261826–Laennecintroducedthetermdissectinganeurysm1800’s–surgerywasperformedontheentitybyJohnHunter,AstleyCooperandoth

2、ersevenbeforetheeraofgeneralanesthesiaEarlyoperationsweredesignedtoproducedistalinternalfenestrationtocausedownstreamdecompressionoftheaorta.History1951LamandAramintroducedhomograftsforrepairofdescendingthoracicaneurysms1953CooleyandDeBakeyusedartificialg

3、raftsforrepair1953Bahnsonintroducedaneurysmorrhaphy1957cardiopulmonarybypassbecameavailableDefinitionAorticdissection–Suddencatastrophiceventinwhichatearintheintimaallowsbloodtoescapefromthetruelumenoftheaortarapidlyseparatingtheinnerfromtheouterlayerofth

4、emediaColumnofbloodisdrivenbytheforceoftheleftventricularsystolicpressurewhichstripstheintimafromtheadventitiaDefinitionAcute–lessthan14daysoldChickenortheegg?–Hemorrhageinthemediacausesruptureoftheintimaordissectinghematomainanintimaltear.CausesofAneurys

5、mMedialdegenerationandlocaldilatationAtherosclerosisSyphilis(ascendingonly)Bacterialinfections(mycotic)CongenitalabnormalitiesTraumaAnnuloaorticectasiaCausesofDissectionInherentweaknessoftheaorticwallHypertension–70-90%PregnancyIatrogenicBicuspidaorticval

6、veandcoarctationClosedchesttraumaPathophysiologyLawofLaplace:Asasphereincreasesinsize,thewalltensionofthesphereincreasesWeakenedwallDilatationExpansionwithpressure-relatedsymptomsRuptureNaturalHistoryNotwelldocumentedSigns,symptomsandprognosisrelatedtothe

7、sizeoftheaneurysmThoracicaneurysmslargerthan6cmaremorepronetorupturethanthesmallerones5yearsurvivalforsymptomaticaneurysmsis27%whereas58%withasymptomaticonessurvivedthesameperiodoftime.RuptureisthemostcommoncauseofdeathNaturalHistoryManypatientswithdissec

8、tiondieacutelyduetocardiactamponadeordissectionoftheLAD8%ofascendingrupturessurvivewithouttreatment75%survivedescendingdissectionClassificationTypeI-BeginsattheaorticvalveandmayproceedtoandincludetheabdominalaortaTy