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[Successful surgical treatment of intraoperative aortic dissection complicating aortic valve replacement].

Authors
  • Ozaki, S
  • Toyama, M
  • Kawase, I
  • Horimi, H
Type
Published Article
Journal
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
Publication Date
Jul 01, 1996
Volume
44
Issue
7
Pages
1022–1026
Identifiers
PMID: 8741569
Source
Medline
License
Unknown

Abstract

A 74-year-old man underwent standard aortic valve replacement. The aortotomy was closed by use of strips of Teflon felt because of somewhat friable thin aortic wall. After the termination of cardiopulmonary bypass, aortic cannulation site was carefully sutured enforcing with a piece of pericardium, since some bleeding persisted. The intraoperative diagnosis of acute aortic dissection (Stanford type A) was made with transesophageal echocardiography. Since extension of the dissection toward the aortic root was hardly possible due to the Teflon felt enforced aortotomy closure, further surgical intervention was not considered at this time. Thiry-two hours later after admission to CCU, sudden bleeding through the mediastinal tube prompted the patient back to OR for exploration Bleeding was noted from the posterior wall of the ascending aorta. Ascending aorta and transverse arch were significantly enlarged with notable discoloration. With the aid of extracorporeal circulation and selective cerebral perfusion, the total graft replacement of the ascending aorta and aortic arch was performed. The intimal tear located at the aortic cannulation site. The postoperative course was uneventful. Prompt recognition and appropriate surgical management are necessary to improve patient outcome.

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