Acute Aortic Dissection Occurring on the Day after Coronary Artery Bypass Operation

(Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Matsudo, Japan)

Koki Nakamura Yuji Suda Yosuke Saito
Mikiko Murakami Tomohiro Asai Hiroki Yamaguchi
A 73-year-old woman was referred to our hospital for angina pectoris due to triple-vessel-disease. She underwent off-pump coronary artery bypass grafting ~3 (RITA-LAD, LITA-OM, SV-PDA). Her vital signs were stable during the operation and the postoperative status was steady in the ICU. However, on the next day, she suddenly had severe back pain with markedly elevated blood pressure. Urine output immediately shut down and respiratory failure progressed with time. An enhanced CT scan revealed aortic dissection (DeBakey type I and Stanford type A). An emergency operation was performed via re-sternotomy. Cardiopulmonary bypass was initiated and the body was cooled down to 20. Under circulatory arrest with isolated cerebral perfusion, the ascending aorta was replaced using a one-branched Hemashield graft (26mm in diameter). The entry of the dissection was located at the proximal anastomosis site of the vein graft. The postoperative course was uneventful and she was discharged on the 24th postoperative day.
@Jpn. J. Cardiovasc. Surg. 36: 215-217 (2007)