A 20-year-old woman had intermittent fever frequently since dental therapy one year previously. Two months previously Takayasu's arteritis had been diagnosed and she had been given 30mg/day prednisolone. She then developed subarachnoid hemorrhage, left arm pain/cataplexy, purpura, sight disturbance, and sepsis caused by Serratia. Finally she felt chest pain and a left Subclavian artery pseudoaneurysm was detected out. Therefore she was transferred to our service for emergency surgery. Preoperative angiography demonstrated post-stenosis aneurysm in the right common carotid artery, left common carotid artery aneurysm, and saccular pseudoaneurysm in the left subclavian artery that suggested impending rupture. The operation was performed through a left upper partial sternotomy extended to the left supraclavicular space. The left subclavian artery was ligated proximal to the aneurysm and distal portion was also ligated through a subclavicular approach. The postoperative course was uneventful. No ischemic sign has been seen in her left arm one year after operation and left/right brachial artery pressure index has improved to 0.80. The patient currently takes steroids and remains healthy without signs of expansion of bilateral carotid artery aneurysms.

Aortic dissection is a rare but potentially fatal complication of cardiac surgery. We report 3 cases of acute aortic dissection complicating open heart surgery. The incidence of complications was 0.18% of cardiac operation during 10 years at our institute (3/1, 647). The dissection is most frequently observed to originate in the ascending aorta, and can occur during operation. In our series, however, two of the three had their dissection entry in the descending aorta and another in the left subclavian artery. Their dissection mainly extended to the distal site of the aorta. Two of the cases were found by postoperative examinations (CT, US) and had had no symptoms or complications, and they were treated conservatively with antihypertensive therapy. One case died due to intrathoracic bleeding and a cerebrovascular event just after the onset of the complication on the 10 postoperative-day. We have to pay attention to this as one of the possible complications after open heart surgery, and intraoperative transesophageal echocardiography or postoperative examinations such as CT were useful for detecting them. We should also take care of hypertension after cardiac surgery in cases in which this is a potential factor such as Marfan's syndrome.