Hybrid Procedure for Thoracic Aortic Disease / 华中科技大学学报（医学）（英德文版）

Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach: hybrid procedure. Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest. Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients. All of them were discharged soon after operation without postoperative complications or death. The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.

Utility of Emergency Transesophageal Echocardiography in the Diagnosis of Thoracic Aortic Disease

BACKGROUND: Early recognition of thoracic aortic disease is critical for managing the patients to reduce morbidity and mortality. In emergency department(ED), transesophageal echocadiography(TEE) has recently challenged traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram(CT) scan, aortography and magnetic resonance imaging(MRI) because of it's safety, rapid acquisition time, high sensitivity and portability. The purpose of this study was to evaluate the diagnostic role of TEE as the first imaging modality in nontraumatic and traumatic thoracic aortic disease in emergency department. METHODS: From May 1993 to Feburary 1995, twenty six patients(nontrauma : 13 cases, trauma : 13 cases) who were suspicious of thoracic aortic disease and received tee as the first diagnostic tool in emergency department were enrolledd. Indications of emergency TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. RESULTS: Of the 26 patients undergoing TE, CT scan were performed sequentially in patients(except 4 patients who died immediately in ED). Aortic pathology was detected in 18 patients (65%). Aortic pathology of nontraumatic patients were as followings : DeBakey type I dissction was in 4 cases(36%), type II dissection in 3 cases (28%), and type III dissection in 4 cases(36%). Six of 13 traumatic patients (46%) had thoracic aortic injury. Findings of aortic injury were aortic tear(2 cases), aortic aneurysm and aortic dissection in each. Of six traumatic thoracic aortic lesions which were detected by TEE, 4 lesions (2 aortic tear, subintimal hematoma, and aortic aneurysm) were not detected dby CT scan. Only 4 cases(15%) underwent emergency operation after TEE. There was no significant hemodynamic deterioration or procedure-related dddeath during TEE. CONCLUSION: In emergency department, TEE may be considered as the first diagnostic tool in detecting acute thoracic aortic disease. In considering of it's high sensitivity, no contrast injection, short procedure time and portability at bedside, TEE should be prefered in patients with suspected thoracic aortic disease from trauma.