ABSTRACT
The purpose of this study was to estimate the postoperative growth of untreated segments of the dissected aorta with non-thrombotic communicating false lumen, and also to evaluate the clinical outcome in relation to the aortic enlargement after surgery. Nineteen patients who underwent surgical treatment of aortic dissection were studied with enhanced CT scans and angiograms during the postoperative follow-up period. In Stanford type A patients, mean aortic dilatation rate calculated at the segment showing maximal dilatation was 5.1mm/year during 13-82 months (average, 41 months) after surgery, as a sequela of enlargement of the false lumen. Differences in the aortic dilatation rates between the different segments of the aorta were observed and these were per annum 4.8mm in the ascending aorta, 5.4mm in the transverse aortic arch, 4.3mm in the proximal descending aorta, 2.7mm in the distal descending aorta and 2.4mm in the abdominal aorta. In all patients, major communications were detected at the perianastomotic sites on angiography. In Stanford type B patients, false lumens with small communications were observed to show gradual thrombotic occlusion, but no significant aortic dilatation was detected during the follow-up period (13-70 months, average: 44 months), except three cases of sudden death who had major communications. Nine late events related to dissection, consisting of 4 sudden deaths suspected to be due to aortic rupture, 2 intestinal necroses and 3 cerebral infarctions, occured in 6 patients (32%), among which three patients had undergone arterial fenestration, one of whom had double barrel anastomosis. In the remaining two, major leakages were recognized at distal aortic anastomotic sites on postoperative angiography. The results of this study, we stress the importance of periodic check-ups using enhanced CT scan and if necessary, angiography after surgery of the patients having communicating false lumen. Early detection of progressive aneurysm formation and timely surgical reintervention can yield a good prognosis.
ABSTRACT
Ten patients after coronary artery bypass grafting had reoperatinons and eight patients underwent postoperative PTCA at Nihon University Hospital from 1970 to July 1991. The difference of age between the reoperation group and the postoperative PTCA group is not significant. Most patients of the reoperation group and all of the PTCA group were male. Symptoms of the patients who required again surgical treatment or PTCA were almost reattack of angina and many cases were complicated by the coronary risk factors, particularly uncontrolled hypercholesterolemia and smoking. The bypass numbers of the reoperation group in the first operation were 2.1 and those of the PTCA group were 3.5. The difference of them was statistically significant (<i>p</i><0.05). The period from the primary operation to the second treatment also showed statistically significant difference between two groups (<i>p</i><0.05) (reoperation group: 81.8 months, PTCA group: 55.7 months). In the reoperation group, there were two operative deaths, two late deaths (not caused by heart disease), and the others remained asymptomatic. In PTCA group, no one had died, but four patients repeated attacks of chest pain after PTCA (mean interval 2.3 months), and two of them underwent re-PTCA. For a symptomatic case whose native coronary arteries or vein grafts show progressive stenosis and who have undergone PTCA, reoperation is recommendable as an effective treatment to relieve the symptom.