Ruptured type B acute aortic dissection (AAD) is a life-threatening condition, in which surgical treatment most often yields unsatisfactory results. We report a case of a ruptured type B AAD in a 67-year-old man detected on computed tomography that required a partial aortic arch replacement with reconstruction of the left subclavian artery with adjunct deep hypothermic circulatory arrest (DHCA). Although the patient had a postoperative stroke, he recovered markedly with rehabilitation. DHCA and open proximal anastomosis are useful for the surgical treatment of type B AAD, however, an elaborate strategy to prevent an intraoperative cerebral embolism is especially important.

Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic Fowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.