A Case of an Elderly Patient Suffering from Acute Type A Aortic Dissection Who Received Conservative Treatment 3 Years after Aortic Valve Replacement

(Department of Cardiovascular Surgery, Saitama Municipal Hospital, Saitama, Japan)

Kenichi Hashizume Satoru Suzuki Yoshiyuki Haga
An 87-year-old man who had a history of aortic valve replacement (Carbomedics n23) due to severe aortic valve regurgitation 3years previously was admitted to our hospital suffering from syncope. The ascending aorta was 40mm in diameter at the time. At the time of admission, the patientfs ECG showed elevation of the ST segments in leads V1-V3 and depression in leads V5, V6, II, III and aVF. Emergency coronary angiography performed for suspected acute myocardial infarction showed a type A acute aortic dissection extending to the ostium of the left coronary artery. However, because of his age and stable condition without cardiac tamponade, we treated this patient with conservative therapy including antihypertensive medication. He experienced no major complication and was discharged 31 days after admission. It is concluded that the occurrence of acute aortic dissection after aortic valve replacement is not common, but for a patient with a dilated aortic root at the time of aortic valve replacement, strict postoperative care is necessary. An operation is the first choice of treatment for acute type A aortic dissection, but in this case the patientfs overall condition had to be considered.
@Jpn. J. Cardiovasc. Surg. 34: 374-377 (2005)