At the beginning of the new year, all things come in spring. On February 25, 2021, the Honglang team of Jiangxi Cardiovascular Hospital welcomed a 33-year-old young male patient who complained of repeated chest and back pain and discomfort for more than one month in the local area. The hospital underwent electrocardiogram and chest X-ray examination, and no abnormal findings were found. Chief physician Li Linfeng of the Fourth Department of Cardiology received the patient and performed thoracic-abdominal aorta CTA showing: thoracic and abdominal aortic aneurysm. This is like a "bomb" that may "explode" at any time, hidden in the chest and abdomen of this young patient, while the "bomb disposal expert" is an unexpected cardiologist.
For such young and symptomatic patients with thoracic-abdominal aneurysm , Li Linfeng attaches great importance to fully assessing the patient’s lesions, and invites cardiac surgery and span4span surgery to consult with . Discuss surgical strategy. The tumor in this patient straddled the thoracic-abdominal aorta, and the lower edge of the tumor involved the trunk of the abdominal cavity and the superior mesenteric artery. The surgery required an open chest and abdomen. According to the patient’s wishes, it is proposed to choose minimally invasive interventional stent graft implantation. The technique is difficult to protect the celiac trunk and superior mesenteric artery. The provincial doctor specially invited Shanghai Changhai Hospital Professor Feng Rui of Vascular Surgery Consultation , It is recommended that the stent graft is double-opened in vitro to protect the abdominal trunk and superior mesenteric artery. On February 28, under general anesthesia, the patient underwent external double-window implantation of the thoracic-abdominal aortic aneurysm stent graft and protective abdominal trunk, superior mesenteric artery stent implantation, which was successfully completed within 2 hours This is a difficult operation.
After the operation, the patient's condition was stable and he recovered and was discharged from the hospital on March 6. Due to the poor compliance of the patient in hospital admission, the Baker cognitive therapy was used throughout the hospitalization process to intervene the patient’s negative emotions.It reduces the patient's bad mood, improves the quality of life, and enables it to cooperate well with the treatment.
Postoperative rounds
Li Linfeng suggested that thoracic and abdominal aortic aneurysms are degenerative changes of the elastic fibrosis and expansion of the middle layer of the aortic wall, which are more common in middle-aged and elderly people. If not detected and treated in time, they will develop into tumors. Body rupture, hemorrhagic shock, the mortality rate is nearly 100%, this type of patients are mostly accompanied by long-term hypertension and atherosclerosis. Young people are relatively rare, and the discovery rate is low. At present, with the improvement of living standards and the improvement of medical conditions, more and more patients with aneurysms with pulsating abdominal mass as the primary manifestation have been found through physical examinations. If they are accompanied by chest, back and abdominal pain and discomfort, they should be treated promptly. Improve the CTA examination of the thoracic and abdominal aorta to confirm the diagnosis. Minimally invasive stent graft implantation is an effective and fast method for the treatment of thoracic-abdominal aortic aneurysms. Strong1strong has gradually become the preferred method for patients due to its advantages such as small trauma, fast recovery, and reduced hospitalization days.
The Honglang team of Jiangxi Cardiovascular Hospital has strong interventional technical support and a large number of patients with various types of aortic aneurysms such as abdominal aortic aneurysm, thoracic aortic aneurysm, and transthoracic aortic aneurysm The successful cases can achieve individualized interventional treatment strategies. They are both "bomb disposal experts" and a heart-protecting team. As Dean Hong Lang said: "We are not only a team that can fight, but also a team that can win!"
(Fourth Department of Provincial Cardiovascular Hospital, Chen Liyan, Tu Weiling, and Yu Longhui)
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