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The Journal of Cardiovascular Surgery 2001 December;42(6):809-11

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

A case of intraoperative acute aortic dissection caused by cannulation into an axillary artery

Miyatake T., Matsui Y., Suto Y., Imamura M., Shiiya N., Mura-shita T., Yasuda K.

From the Department of Cardiovascular Surgery Hokkaido University School of Medicine, Sapporo, Japan


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Severe ath­e­ros­cle­rot­ic dis­ease of the ascend­ing aor­ta is one of the ­risk fac­tors of dis­sec­tion of the ascend­ing aor­ta and cere­bral embo­lism dur­ing car­diac oper­a­tions ­with car­di­o­pul­mo­nary ­bypass. Aortic dis­sec­tion is ­rare, but ­once it hap­pens, the mor­tal­ity ­rate is ­high. For the ­patient ­with severe­ly ath­e­ros­cle­rot­ic or strong­ly cal­ci­fied aor­ta, we ­should ­avoid can­nu­la­tion ­into the aor­ta or clamp­ing of it. In ­this ­case, we expe­ri­enced aor­tic dis­sec­tion ­although we ­chose the arte­ri­al can­nu­la­tions ­into the axil­lary arter­ies ­because of the ­strong cal­cifi­ca­tion of the ascend­ing aor­ta and the abdom­i­nal aor­ta. The dis­sec­tion was ­caused by the can­nu­la­tion ­into the axil­lary ­artery. Transesophageal ech­o­car­di­og­ra­phy (TEE) ­showed the dis­sec­tion dur­ing the oper­a­tion and the ascend­ing aor­ta was ­replaced ­soon. Early diag­no­sis and treat­ment ­saved the ­patient. This ­case ­showed the fol­low­ing ­points: 1) cannulation ­into an axil­lary ­artery is not ­always ­safe; 2) TEE is ­very use­ful to ­detect the com­pli­cat­ed dis­sec­tion dur­ing oper­a­tion; 3) replacement of the ascend­ing aor­ta ­alone can be one of the choic­es for the treat­ment of aor­tic dis­sec­tion ­caused by can­nu­la­tion ­into an axil­lary ­artery.

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