ABSTRACT
A 34-year-old female with a gestational age of 38 weeks developed acute type A aortic dissection. Appearance of this patient was typical for Marfan's syndrome, and echocardiography revealed annulo-aortic ectasia with mild aortic regurgitation, but pericardial effusion was absent. As her hemodynamic condition was stable, an emergency Caesarean section was carried out first. After careful observation in the ICU for half a day, she successfully underwent aortic valve reimplantation and replacement of the ascending aorta under deep hypothermic circulatory arrest. Intraoperative heparin use minimally impacted uterine bleeding. Both the mother and the neonate were discharged home 16 days later. We believe a two-stage strategy should be adopted whenever possible.
ABSTRACT
A 65-year old unconscious man with left hemiplegia was found to have acute Stanford type A aortic dissection (AAD) and occlusion of the brachiocephalic and right carotid artery. He underwent emergency surgery. Before midline sternotomy, arterial cannulas were inserted into the femoral artery and the true lumen of the right carotid artery and were connected thorough a Y-shaped extracorporeal circulation circuit to restore the cerebral perfusion. During the aortic procedure, both arteries were used as arterial inflow sites.The patient regained consciousness 6 h later and was extubated on the next day. He suffered infarction of the right cerebral hemisphere, but neurologic deficits were totally resolved. He was given an ambulatory discharged 46 days later and has been reinstated in his former job 6 months after the operation. The indications for emergency surgery for AAD complicated by stroke or coma remains controversial. Especially soon after the onset, surgery may be applicable for such AAD patients if neurological deficits are not obviously irreversible.