Graft Replacement with Partial Extra-corporeal Circulation of Descending Thoracic and Abdominal Aortic Aneurysms in Marfan Syndrome Combined with Severe Left Ventricular Dysfunction and Mitral Regurgitation
- VernacularTitle:Graft Replacement with Partial Extra-corporeal Circulation of Descending Thoracic and Abdominal Aortic Aneurysms in Marfan Syndrome Combined with Severe Left Ventricular Dysfunction and Mitral Regurgitation
- Author:
Kayo SUGIYAMA
1
;
Katsuhiko MATSUYAMA
2
;
Nobusato KOIZUMI
1
;
Keita MARUNO
1
;
Yukio MUROMACHI
1
;
Akinari IWAHORI
1
;
Satoshi TAKAHASHI
1
;
Toru IWAHASHI
1
;
Toshiya NISHIBE
1
;
Hitoshi OGINO
1
Author Information
- Keywords: Marfan syndrome; left ventricular dysfunction; aortic aneurysm; partial extra-corporeal circulation; intra-aortic balloon pumping
- From:Japanese Journal of Cardiovascular Surgery 2018;47(2):71-77
- CountryJapan
- Language:Japanese
- Abstract: We report on a rare case of Marfan syndrome with giant dissecting descending thoracic and abdominal aortic aneurysms associated with poor left ventricular function and severe mitral regurgitation. Before the anesthetic induction, a partial extra-corporeal circulation was established to prevent a collapse of the circulation. Descending aortic graft replacement and following abdominal aortic graft replacement were performed safely using the partial extra-corporeal circulation to relief the afterload for the severely deteriorated left ventricle with severe mitral regurgitation. Intra-aortic balloon pumping was also promptly used to assist the poor circulation in the postoperative period. Despite the admission to a specialized institute, he died from irreversible heart failure with a developing renal failure. Even for a difficult patient with Marfan syndrome with severe left ventricular dysfunction and mitral regurgitation, graft replacement was feasible with meticulous perioperative circulatory management using partial extra-corporeal circulation and intra-aortic balloon pumping. However, a prompt registration for heart transplantation and an aortic surgery concomitant with implantation of left ventricular assisted device should have been considered to save the patient.
