Ruptured giant aneurysm of the ascending aorta caused by chronic aortic dissection.
ABSTRACT A 55-year-old man developed acute chest pain and dyspnea. Computed tomography demonstrated a rupture of a giant aneurysm of the ascending aorta. The lesion was 14 cm in diameter--the largest ever reported-and resulted from chronic aortic dissection. The patient did not have aortic insufficiency or aortic dissection around the coronary ostium. Graft replacement of the ascending aorta was performed successfully under deep hypothermia with right hemisphere perfusion.
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ABSTRACT: Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aortic segments. We present the case of a Marfan patient who successfully underwent repair of a giant ascending aortic pseudoaneurysm and concomitant repair of an abdominal aortic aneurysm. An aggressive surgical strategy followed by life-long cardiovascular monitoring is warranted in order to prolong the survival of these patients.Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2003; 30(3):233-5. · 0.67 Impact Factor
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ABSTRACT: We sought to analyze the postoperative hospital mortality and postoperative neurologic dysfunction in patients who had total arch replacement for atherosclerotic arch aneurysms using our recent refined technique. Between June 1997 and April 2000, 50 consecutive patients underwent total arch replacement with an aortic arch branched graft for atherosclerotic arch aneurysms. Their mean age was 71 +/- 7 years (range, 57-87 years). Forty-eight (96%) patients were operated on electively, and the remaining 2 (4%) were operated on an emergency basis because of rupture of aneurysm. All operations were performed with hypothermic extracorporeal circulation, selective cerebral perfusion for cerebral protection during aortic arch repair, and systemic circulatory arrest during distal graft anastomosis. A total of 19 concomitant procedures were done in 17 patients. Mean selective cerebral perfusion time was 78.1 +/- 16.5 minutes. Overall in-hospital mortality was 2% (95% confidence intervals, 0%-5.9%). On univariable analysis, permanent neurologic dysfunction was the only risk factor for in-hospital mortality. Postoperative temporary and permanent neurologic dysfunctions were 4% (95% confidence intervals, 0%-9.4%) and 4% (95% confidence intervals, 0%-9.4%), respectively. On univariable analysis, cardiopulmonary bypass time was the only risk factor for temporary neurologic dysfunction, and history of cerebrovascular disease was the only risk factor for permanent neurologic dysfunction. There was no significant correlation between selective cerebral perfusion time and temporary and permanent neurologic dysfunction. Integrated cerebral protective effect of antegrade selective cerebral perfusion and total arch replacement with an aortic arch branched graft could substantially reduce in-hospital mortality and postoperative neurologic dysfunction in patients with atherosclerotic arch aneurysms.Journal of Thoracic and Cardiovascular Surgery 04/2001; 121(3):491-9. · 3.53 Impact Factor
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ABSTRACT: Deep hypothermic circulatory arrest (DHCA) without retrograde cerebral perfusion (RCP) has a strict time limit. We modified a surgical technique for anastomosis to shorten the period of DHCA and unilateral cerebral perfusion (UCP). Between March 1993 and August 2001, retrospective analysis was done on 23 consecutive patients, who underwent aortic arch replacement with branches. The patients were divided into two groups: DHCA group and UCP group. The DHCA group, in which DHCA alone and without additional cerebral perfusion was performed, comprised of nine patients. Proximal aortic anastomosis was performed first during systemic cooling; then both the brachiocephalic artery and left carotid artery were reconstructed with the branches of the artificial graft during circulatory arrest; thereafter, cerebral and coronary perfusions were resumed. The UCP group, in which DHCA was not used but right hemisphere perfusion during deep hypothermia was performed when the origin of brachiocephalic artery was safely clamped, consisted of 14 patients. Mean time of DHCA was 18.8+/-4.2 minutes and that of right hemisphere perfusion time was 11.0+/-3.8 minutes, respectively. Twenty-one patients survived the surgery (91.3%), and two (8.7%) died during hospitalization. Transient cerebral complication occurred in four patients in the DHCA group and all recovered. Logistic regression analysis revealed that DHCA was the only parameter to significantly influence temporary neurological dysfunction. There was no other significant difference between the two groups. With our modified and simple surgical technique for aortic arch repair, we were able to successfully shorten the DHCA time and right hemisphere perfusion time. However, because DHCA was the only parameter to significantly influence temporary neurological dysfunction, some form of continuous cerebral perfusion at deep hypothermia may be a safer method to preserve cerebral function.Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 01/2004; 9(6):389-93. · 0.47 Impact Factor