초록접수 현황
| 20F-015 | 구연 발표 |
Diameter change of completely remodeled proximal descending aorta after acute type I dissection repair: implications for estimating the pre-dissection size
Joon Chul Jung, Bongyeon Sohn, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim, and Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
Purpose : Pre-dissection diameter of the proximal descending thoracic aorta (p-DTA), if available, would be the reference for determining the size of stent-graft or elephant trunk. It has been reported that acute type B dissection resulted in p-DTA diameter increase by 23% (Rylski factor) on the average. We aimed to investigate the accuracy of estimating the post-remodeling diameter of p-DTA based on post-dissection morphological parameters in acute type I dissection.
Methods : In sixty patients with acute type I dissection who showed complete remodeling of p-DTA false lumen after surgical repair, preoperative and post-remodeling computed tomography scan images were reviewed. Several parameters including area-derived aortic diameter (AoD) and true lumen maximal diameter (TLDmax) were measured at p-DTA.
Results : After complete remodeling, p-DTA diameter decreased significantly by 4.1 mm (P<0.001). Assuming that the post-remodeling diameter is identical with the pre-dissection diameter, the equivalent to Rylski factor was 15%. Both TLDmax and AoD divided by 1.23 frequently showed ≥ 2 mm discrepancy from post-remodeling aortic diameter; 38.3% and 46.7%, respectively. If coincided, the two numbers better estimated post-remodeling diameter. With wider circumferential dissection (>66% of total circumference), TLDmax showed a significant tendency to underestimate post-remodeling diameter (P<0.001).
Conclusion : Prediction of post-remodeling aortic diameter relying on a single morphologic parameter carries a substantial risk of both overestimation and underestimation. Considering together the size and geometric change of the true lumen, the extent of circumferential dissection and total aortic diameter may give a better estimation, which leads to adequate sizing of the elephant trunk if needed.
Methods : In sixty patients with acute type I dissection who showed complete remodeling of p-DTA false lumen after surgical repair, preoperative and post-remodeling computed tomography scan images were reviewed. Several parameters including area-derived aortic diameter (AoD) and true lumen maximal diameter (TLDmax) were measured at p-DTA.
Results : After complete remodeling, p-DTA diameter decreased significantly by 4.1 mm (P<0.001). Assuming that the post-remodeling diameter is identical with the pre-dissection diameter, the equivalent to Rylski factor was 15%. Both TLDmax and AoD divided by 1.23 frequently showed ≥ 2 mm discrepancy from post-remodeling aortic diameter; 38.3% and 46.7%, respectively. If coincided, the two numbers better estimated post-remodeling diameter. With wider circumferential dissection (>66% of total circumference), TLDmax showed a significant tendency to underestimate post-remodeling diameter (P<0.001).
Conclusion : Prediction of post-remodeling aortic diameter relying on a single morphologic parameter carries a substantial risk of both overestimation and underestimation. Considering together the size and geometric change of the true lumen, the extent of circumferential dissection and total aortic diameter may give a better estimation, which leads to adequate sizing of the elephant trunk if needed.
책임저자: Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
발표자: Joon Chul Jung, E-mail : junbare3@hanmail.net