Perioperative Acute Aortic Dissection Complicating Open Heart Surgery: Report of Three Cases

(Department of Cardiovascular Surgery, Asahikawa City Hospital, Asahikawa, Japan)

Ko Takigami Hidetoshi Aoki Junichi Oba
Kazuhiro Eya Yasushige Shingu Noriyoshi Ebuoka
Aortic dissection is a rare but potentially fatal complication of cardiac surgery. We report 3 cases of acute aortic dissection complicating open heart surgery. The incidence of complications was 0.18% of cardiac operation during 10 years at our institute (3/1,647). The dissection is most frequently observed to originate in the ascending aorta, and can occur during operation. In our series, however, two of the three had their dissection entry in the descending aorta and another in the left subclavian artery. Their dissection mainly extended to the distal site of the aorta. Two of the cases were found by postoperative examinations (CT, US) and had had no symptoms or complications, and they were treated conservatively with antihypertensive therapy. One case died due to intrathoracic bleeding and a cerebrovascular event just after the onset of the complication on the 10 postoperative-day. We have to pay attention to this as one of the possible complications after open heart surgery, and intraoperative transesophageal echocardiography or postoperative examinations such as CT were useful for detecting them. We should also take care of hypertension after cardiac surgery in cases in which this is a potential factor such as Marfan's syndrome.
@Jpn. J. Cardiovasc. Surg. 34: 295-299 (2005)