Three Operations Following Conservative Therapy in Patients with Stanford A Type Acute Thrombosed Aortic Dissection / 日本心臓血管外科学会雑誌

ABSTRACT

We performed 3 operations for Stanford A type aortic dissections which were confirmed as acute thrombosed type by contrast chest CT. Initially conservative therapy was chosen in all patients. In case 1, a 64-year-old woman received ascending aortic replacement with a Hemashield^® vascular prosthesis 3 days after admission, because of increasing diameter of the ascending aorta and sustained back pain. In case 2, a 54-year-old woman, we replaced the total aortic arch with Hemashield^® graft, on an emergency basis since recanalization of the false lumen was revealed by contrast CT and D.S.A. 3 days after admission. In case 3, a 52-year-old woman, cardiac tamponade occured on the 30th admission day even though anti-hypertensive treatment had been effectively performed immediately after onset. Emergency D.S.A. revealed an“ulcer like projection” in the ascending aorta, so following pericardiocentesis, we resected and directly anastomosed the ascending aorta at the entry site 34 days after onset. Generally, acute thrombosed aortic dissections should be treated conservatively. Here we reported 3 operations for acute thrombosed Stanford A type aortic dissections even under good B.P. control, suggesting the importance of careful and long term observation for acute thrombosed aortic dissections.