A Case of Open Stent Grafting for Type B Acute Aortic Dissection Complicated with Abdominal Angina / 日本心臓血管外科学会雑誌

Acute aortic dissection is a formidable disease because of complications such as rupture or visceral ischemia. Early diagnosis of these conditions is essential. The patient was a 40-year-old woman with acute type B aortic dissection, suspected to have Marfan syndrome. We first treated her with medical therapy, but 5 days later she suffered from repeated abdominal angina. This was thought to be probably predictive of malperfusion, so we decided to perform an operation. We maintained an elevated blood pressure (about 140mmHg), used heparin and Prostaglandin E₁ for the prevention of angina, until total aortic arch replacement and open stent grafting was performed. She has been doing well since.

A Case of Ruptured Penetrating Atherosclerotic Ulcer of the Thoracic Descending Aorta That Previously Had Asymptomatic Focal Ulceration / 日本心臓血管外科学会雑誌

We encountered a case of ruptured penetrating atherosclerotic ulcer (PAU) that previously had focal ulceration. A 82-year-old man was followed on a diagnosis of distal arch true aneurysm with a diameter of 4.5cm on CT examination. He was admitted with sudden onset of back pain, but he had experienced no previous symptom. CT scan showed a ruptured penetrating atherosclerotic ulcer, therefore we performed emergency replacement of the thoracic descending aorta. The postoperative course was good. CT scan showed the thoracic descending aorta had focal ulceration with a width of 11mm and depth of 7mm at 6 months, however the width was 11mm and the depth was 11mm 1 month before rupture of the PAU. This suggested progression of the focal ulceration caused the PAU rupture.