BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic surgery.Direct visualization of the fistula via i...BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic surgery.Direct visualization of the fistula via imaging is rare.AIM To investigate the relationship between computed tomography(CT)findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.METHODS Six patients(mean age 71 years,including 4 men and 2 women)with suspected ABF on CT(air around the graft)at our hospital were included in this retrospective study between January 2004 and September 2022.Chest CT findings included direct confirmation of ABF,peri-graft fluid,ring enhancement,dirty fat sign,atelectasis,pulmonary hemorrhage,and bronchodilation,and the clinical course were retrospectively reviewed.The proportion of each type of CT finding was calculated.RESULTS ABF detection after surgery was found to have a mean and median of 14 and 13 years,respectively.Initial signs and symptoms were asymptomatic in 4 patients,bloody sputum was found in 1 patient,and fever was present in 1 patient.The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients.Of the 6 patients,3 survived,2 died,and 1 was lost to follow-up.The locations of the ABFs were as follows:1 in the ascending aorta;1 in the aortic arch;2 in the aortic arch leading to the descending aorta;and 2 in the descending aorta.ABFs were directly confirmed by CT in 4/6(67%)patients.Peri-graft dirty fat(4/6,67%)and peri-graft ring enhancement(3/6,50%)were associated with graft infection,endoleaks and pseudoaneurysms were associated with hemoptysis(2/6,33%).CONCLUSION Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT.CT is useful for the diagnosis of ABF and its complications.展开更多
Objective: We have occasionally encountered a moderately dilated distal ascending aorta while reconstructing an aortic root. We describe reconstruction of an extended root and ascending aorta using our current strateg...Objective: We have occasionally encountered a moderately dilated distal ascending aorta while reconstructing an aortic root. We describe reconstruction of an extended root and ascending aorta using our current strategy. Patients and Methods: Between March 2011 and December 2012, 15 (11 men;mean age, 70.1 ± 7.3 years) patients underwent root reconstruction with hemi-arch replacement under hypothermic circulatory arrest with antegrade selective cerebral perfusion. The maximum diameter of the aortic root was 52.5 ± 4.4 mm. The distal ascending aorta just below innominate artery was moderately dilated to 41.7 ± 1.4 mm in diameter. Results: Operative outcomes excluding the diameter of the distal ascending aorta did not significantly differ from those of patients who had undergone root reconstruction under distal ascending aortic clamping during the same period. Postoperative computed tomography confirmed complete resection of the dilated ascending aorta in the patients, and did not develop neurological dysfunction or stroke. Conclusion: Postoperative computed tomography confirmed complete resection of dilated ascending aortae. We considered that complete resection under hypothermic circulatory arrest and selective cerebral perfusion might help to avoid repeated surgery to treat dilation of the distal ascending aorta over the long-term.展开更多
文摘BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic surgery.Direct visualization of the fistula via imaging is rare.AIM To investigate the relationship between computed tomography(CT)findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.METHODS Six patients(mean age 71 years,including 4 men and 2 women)with suspected ABF on CT(air around the graft)at our hospital were included in this retrospective study between January 2004 and September 2022.Chest CT findings included direct confirmation of ABF,peri-graft fluid,ring enhancement,dirty fat sign,atelectasis,pulmonary hemorrhage,and bronchodilation,and the clinical course were retrospectively reviewed.The proportion of each type of CT finding was calculated.RESULTS ABF detection after surgery was found to have a mean and median of 14 and 13 years,respectively.Initial signs and symptoms were asymptomatic in 4 patients,bloody sputum was found in 1 patient,and fever was present in 1 patient.The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients.Of the 6 patients,3 survived,2 died,and 1 was lost to follow-up.The locations of the ABFs were as follows:1 in the ascending aorta;1 in the aortic arch;2 in the aortic arch leading to the descending aorta;and 2 in the descending aorta.ABFs were directly confirmed by CT in 4/6(67%)patients.Peri-graft dirty fat(4/6,67%)and peri-graft ring enhancement(3/6,50%)were associated with graft infection,endoleaks and pseudoaneurysms were associated with hemoptysis(2/6,33%).CONCLUSION Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT.CT is useful for the diagnosis of ABF and its complications.
文摘Objective: We have occasionally encountered a moderately dilated distal ascending aorta while reconstructing an aortic root. We describe reconstruction of an extended root and ascending aorta using our current strategy. Patients and Methods: Between March 2011 and December 2012, 15 (11 men;mean age, 70.1 ± 7.3 years) patients underwent root reconstruction with hemi-arch replacement under hypothermic circulatory arrest with antegrade selective cerebral perfusion. The maximum diameter of the aortic root was 52.5 ± 4.4 mm. The distal ascending aorta just below innominate artery was moderately dilated to 41.7 ± 1.4 mm in diameter. Results: Operative outcomes excluding the diameter of the distal ascending aorta did not significantly differ from those of patients who had undergone root reconstruction under distal ascending aortic clamping during the same period. Postoperative computed tomography confirmed complete resection of the dilated ascending aorta in the patients, and did not develop neurological dysfunction or stroke. Conclusion: Postoperative computed tomography confirmed complete resection of dilated ascending aortae. We considered that complete resection under hypothermic circulatory arrest and selective cerebral perfusion might help to avoid repeated surgery to treat dilation of the distal ascending aorta over the long-term.
