A Case of DeBakey Type II Aortic Dissection with Respiratory Tract Compression 30 Years after Open Aortic Commissurotomy
10.4326/jjcvs.33.344
- VernacularTitle:先天性二尖弁大動脈弁狭窄症交連切開術後３０年目に発症し，気道圧迫を合併したＤｅＢａｋｅｙ ＩＩ型解離性大動脈りゅうの１手術例
- Author:
Osamu Namura
;
Hisanaga Moro
;
Yuko Tosaka
;
Masakazu Sogawa
;
Jun-ichi Hayashi
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2004;33(5):344-347
- CountryJapan
- Language:Japanese
-
Abstract:
A 43-year-old man visited another hospital because of dry cough and dyspnea in a supine position after having experienced chest pain about 1 month prior to his visit. He had undergone open aortic commissurotomy and ligation of the ductus arteriosus due to congenital bicuspid valve aortic stenosis and patent ductus arteriosus at age 13. CT scan showed a dissected giant aortic aneurysm (12.0cm in diameter) of the DeBakey Type II which compressed surrounding organs, such as his trachea, bilateral main bronchus, superior vena cava, and right main pulmonary artery. Echocardiograms revealed severe aortic stenosis and a dissecting ascending aortic aneurysm. The patient was admitted to our hospital and an urgent operation was performed. Under cardiopulmonary bypass with selective cerebral perfusion, a replacement of the aortic root and the ascending-arch aorta with the inclusion technique was performed. Postoperatively, the patient suffered from ventilatory disturbance under mechanical ventilation. CT scan showed a giant aneurysmal sac containing a hematoma in the perigraft space and the false lumen of the aneurysmal wall and remaining tracheobronchial compression. A reoperation was performed for removal of the hematoma and placation of the aneurysmal sac. The subsequent postoperative course was good. The patient was weaned from mechanical ventilation at 12 days and discharged at 67 days after the initial operation. Histologically, the resected aortic wall showed cystic medial necrosis.
