A Case of Acute Type A Aortic Dissection Complicated with Cerebral Malperfusion

(Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan, Department of Cardiovascular Surgery, Sumitomo Hospital*, Osaka, Japan, and Department of Cardiovascular Surgery, Takatsuki Hospital**, Osaka, Japan)

Atsushi Omura Keiji Ataka* Kazuhiro Mizoguchi*
Nobuhiro Tanimura**
A 59-year-old man with a history of hypertension who suddenly developed back pain and apoplexy was transferred to our hospital 20 min after the clinical onset. Physical examination showed right conjugate deviation of the eyes and left paralysis, suggesting disorder of the right cerebral hemisphere. Enhance computed tomography showed an aortic dissection from the ascending aorta to bilateral iliac arteries, and the right common cranial artery was compressed by a false lumen. Acute type A aortic dissection complicated with cerebral malperfusion was diagnosed, and an emergency operation was performed 2.5h after the onset. Cardiopulmonary bypass was established with right femoral artery inflow and bicaval venous drainage. We found the dissection entry at the ascending aorta using the distal open technique, and performed hemiarch graft replacement with selective cerebral perfusion. The postoperative course was uneventful without deterioration of neurological function. Postoperative computed tomography showed no evidence of cerebral bleeding. He was given on ambulatory discharge on the 22nd postoperative day.
  Jpn. J. Cardiovasc. Surg. 42:71-75(2013)

Keywords:acute aortic dissection, malperfusion, stroke