RESUMO
We successfully performed aortic root replacement in an asymptomatic 52 year-old man with dilatation of the Valsalva sinuses (75 mm). The patient had previously undergone a radical operation for the tetralogy of Fallot at 13 years of age and AVR at 46 years of age. Massive bleeding occurred in the lungs after weaning from CPB. Emergency bronchoscopy revealed that the bleeding came from the right middle and lower lobes. The bleeding was stopped conservatively on POD 3 ; however, V-V ECMO was started on POD 5 because of severe hypoxia. ECMO was successfully weaned on POD 11 and he discharged on POD 59. The presence of developed bronchial collaterals and barotrauma during the operation were speculated the causes of the bleeding from the right lung.
RESUMO
We report a case of type A dissecting aneurysm occurring after aortic valve replacement (AVR). The patient was a 67-year-old man with a history of AVR 4 years previously. Preoperative CT scan revealed a type A dissecting aneurysm 10cm in diameter, close to the sternum. Under preparation for selective cerebral perfusion (SCP), re-do median sternotomy was safely performed using partial extracorporeal circulation (ECC) via a femoral artery and vein. Because of severe adhesion in the upper part of the ascending aorta and aortic arch, a graft replacement of the ascending aorta was impossible. Under SCP via bilateral common carotid arteries exposed in the neck, the entry of the dissection, which was located in the previous aortotomy line, was closed with an ePTFE patch. SCP via bilateral common carotid arteries exposed in the neck appeared to be very useful and safe for such patients at risk for injury to the aorta during re-do median sternotomy and with severe adhesion, which made it difficult to establish SCP via the usual operative field. Although graft replacement is the standard operation for the treatment of the ascending aortic dissection, patch closure of the entry should be considered as a second-choice method in some case.