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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2002 October;43(5):651-4

language: English

Toral aortic arch graft replacement for recurrent aortic aneurysm

Miyahara K., Maeda M., Sakurai H., Nakayama M., Murayama H., Hasegawa H.

Division of Cardiovascular Surgery, Social Insurance Chukyo Hospital, Nagoya, Japan


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We suc­cess­ful­ly per­formed a ­total aor­tic ­arch replace­ment for a recur­rent aor­tic aneu­rysm fol­low­ing ­repair of an aor­tic dis­sec­tion. A 59-­year-old man under­went a ­patch aor­to­plas­ty ­through ­median ster­not­o­my for Stanford ­type B aor­tic dis­sec­tion in oth­er hos­pi­tal. Three ­years and 6 ­months lat­er an aneu­rysm devel­oped. Computed tomog­ra­phy and mag­net­ic res­o­nance imag­ing angio­gra­phy dem­on­strat­ed an enlarge­ment of the aneu­rysm, result­ing in a diag­no­sis of recur­rent dis­tal aor­tic ­arch aneu­rysm. A ­graft replace­ment of the ­total aor­tic ­arch ­with the aid of selec­tive cere­bral per­fu­sion was per­formed ­through a ­median rester­not­o­my and ­left lat­er­al thor­a­cot­o­my. Additional ­left lat­er­al thor­a­cot­o­my ­offered a suf­fi­cient­ly opti­mal oper­at­ing ­field for dis­tal anas­tom­o­sis. However, ­care ­must be tak­en not to over­look the bleed­ing ­from inter­cos­tal arter­ies. Since aor­to­plas­ty may ­lead to sub­se­quent dila­tion and aneu­rys­mal for­ma­tion, ­initial replace­ment of the seg­ment of the aor­ta is rec­om­mend­ed, and care­ful ­long-­term fol­low-up of the ­patient is impor­tant.

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