Two Cases of Total Arch Replacement for Ruptured Type B Intramural Hematoma
10.4326/jjcvs.39.195
- VernacularTitle:血栓閉塞型 B 型急性大動脈解離破裂に対する2手術例
- Author:
Shinnosuke Goto
;
Masafumi Matsui
;
Norikazu Kawai
;
Hideaki Manabe
;
Hisato Takagi
;
Takuya Umemoto
- Publication Type:Journal Article
- Keywords:
type B thrombosed type acute aortic dissection;
rupture;
median sternotomy;
intramural hematoma
- From:Japanese Journal of Cardiovascular Surgery
2010;39(4):195-198
- CountryJapan
- Language:Japanese
-
Abstract:
Type B intramural hematoma (IMH) is not considered to be a life-threatening condition, and medical treatment is the first treatment choice. We report 2 cases of ruptured type B intramural hematoma. Total arch replacement was performed via median sternotomy, which is not a common surgical strategy for type B dissection. Case 1 : a 77-year-old woman was transferred to our hospital with chest and back pain. CT revealed type B IMH with a large hematoma in the anterior mediastinum. She underwent total arch replacement, but she died of respiratory failure on the 167th postoperative day. Case 2 : a 60-year-old man was transferred to our hospital with chest and back pain. CT revealed a type B IMH with a large hematoma on the anterior side of the arch. He underwent total arch replacement, but died of sepsis on the 13th postoperative day. We had 2 rare cases of ruptured type B IMH. In both cases, postoperative courses were problematic. However, median sternotomy could be an approach for ruptured type B dissection in some cases.
