Descending Aortic Rupture after Frozen Elephant Trunk Technique for Dissected Aortic Arch Aneurysm / 日本心臓血管外科学会雑誌

We report a 41-year-old man who presented with a ruptured dissecting aneurysm of the descending aorta. He had undergone aortic root replacement for an acute aortic dissection (Stanford type A) ; 8 months later, he had undergone total arch replacement with insertion of a frozen elephant trunk (FET) due to enlargement of the chronic dissecting aneurysm of the arch. FET-induced new entry and incomplete thrombosis occurred postoperatively. Three months after FET insertion, he developed an aortic rupture that required emergency replacement of the descending aorta. The patient tolerated the procedure well and was discharged 16 days after the operation.

A Case of Surgical Treatment for Aortic Root Dissection after Full Aortic Root Replacement with Stentless Aortic Valve / 日本心臓血管外科学会雑誌

A 84-year-old woman underwent aortic root replacement with stentless bioprosthesis and coronary artery bypass grafting. Four years later, she presented with dyspnea. Transthoracic echocardiography revealed aortic regurgitation, dilation and dissection of the sinus of Valsalva. A Bentall operation was performed by using prosthetic graft and bioprosthetic valve. Intimal tear caused the aortic wall dissection and aneurysm of the Freestyle valve.

Impact of unilateral and bilateral antegrade selective cerebral perfusion on neurological function in patients undergoing a hybrid approach for DeBakey type Ⅰ aortic dissection A prospective randomized controlled study / 国际脑血管病杂志

Objective To compare the effect of brain unilateral and bilateral antegrade selective cerebral perfusion (ASCP) during a hybrid approach to DeBakey type Ⅰ aortic dissection and to provide the clinical evidence for the selection of cerebral perfusion methods of aortic dissection surgery.Methods Among the 56 patients undergoing a hybrid approach to DeBakey type Ⅰ aortic dissection from January 2009 to June 2011,24 were enrolled in the study.They were randomly divided into a unilateral ASCP group (n =11) and a bilateral ASCP group (n =13).The patients in both groups underwent cognitive ability test,brain CT scan,cerebrovascular and aortic CTA examinations before and after procedure.The general information,intraoperative conditions and neurological function in the patients of both groups were compared.Results There was no difference in the general data between the unilateral and bilateral ASCP groups.There were no significant differences among the intraoperative cardiopulmonary bypass time (125.2 ± 34.4 min vs.132.1 ± 45.4 min; t =- 0.278,P =0.784),aortic cross-clamping time (54.5 ± 23.6 min vs.61.6 ± 27.5 min; t =-0.149,P =0.883),cerebral perfusion time (30.9 ± 13.2 min vs.31.7 ± 14.5 min; t =- 1.283,P =0.213),right radial artery pressure (57.6 ± 15.5 mm Hg vs.60.7 ± 14.3 mm Hg; t =0.758,P =0.457),and arterial oxygen pressure (465.6 ± 62.4 mm Hg vs.488.4 ± 72.5 mm Hg; t =- 1.894,P =0.071 ).There were no surgery and recent death in both groups.There were no significant differences among the mechanical ventilation time (33.5 ± 14.6 h vs.37.8 ± 12.3; t =- 1.009,P =0.162),time awake after surgery (5.2 ± 2.4 h vs.5.5 ± 3.1 h; t =0.876,P =0.195),and intensive care unit stay time (7.5 ± 3.1 d vs.8.2 ± 3.5 d; t =-0.186,P =0.427).There was no new permanent neurological dysfunction in both groups.One patient had transient neurological impairment in each group.The cognitive function scores after surgery in the unilateral ASCP group (50.1 ± 14.8 vs.47.3 ± 15.2; t =1.005,P =0.126) and in the bilateral ASCP group (52.1 ± 13.7 vs.48.6 ± 16.5; t =0.576,P =0.254) were slightly lower than those before procedure,however,there was no significant difference; there was also no significant difference in the unilateral and bilateral ASCP groups before (t =-0.887,P =0.385) and after procedure (t =-0.953,P =0.351).Conclusions Under the circumstance of complete circle of Willis,the brain protective effect of the unilateral and bilateral ASCP in patients undergoing a hybrid approach for DeBakey type Ⅰ aortic dissection had no significant difference,and more simple and convenient unilateral ASCP can be used.

Two Stage Operation for Chronic Dissecting Thoracic Aortic Aneurysm Associated with True Lumen Obstruction of the Abdominal Aorta / 日本心臓血管外科学会雑誌

A 64-year-old man who had chronic aortic dissecting aneurysm with true lumen obstruction of the abdominal aorta was referred to our hospital for surgery. He underwent total aortic arch replacement with the elephant trunk technique using an aortofemoral artery bypass as a first-stage operation. Reconstruction of the thoracic aortic descending aneurysm using the previous elephant trunk graft in a second-stage operation was feasible. His perioperative course was uneventful and he had no neurologic complications.

Four Cases of Dissecting Aortic Aneurysms Diagnosed by Transesophageal Echocardiography

BACKGROUND: The prompt and accurate diagnosis of acute aortic dissection is decisive for the prognosis of the patient, since an effective surgical and medical therapy can improve the high rate of mortality due to this pathology. Among the various diagnostic methods, transesophageal echocardiography can provide a rapid and accurate method of diagnosing and evaluating dissecting aortic aneurysm and permits prompt initiation of appropriate treatment. Thus we performed transesophageal echocardiography in patients supected to dissecting aortic aneurysm, as a preliminary examination, and now we reported the result. METHODS: We have studied 4 case of dissecting aortic aneurysms among the patient received examination of cardiovascular system by transesophageal echocardiography, since January 1991 at Keimyung University hospital. In these 4 cases, 3 cases had CT scan, 2 cases had MRI scan, and all cases had transthoracic echocardiography simultaneously as a adjuvant diagnostic method. RESULTS: All 4 cases could be promptly and accuratoly diagnosed and typed by transesophageal echocardiography. As a consequence, patients could receive the early medical treatment and good clinical results. CONCLUSION: Transesophageal echocardiography is fast, inexpensive and accurate method in diagnosis of dissecting aortic aneurysm. So we recommend transesophageal echocardiography, as a preliminary examination in case of suspecting dissecting aortic aneurysm.