A 67-year-old man was hospitalized due to congestive heart failure. The blood pressure was 180/72mmHg in the right arm and 100/70mmHg in the right leg. Aortography revealed that the aortic arch was completely interrupted just distal to the origin of the left subclavian artery and the descending aorta was clearly outlined by contrast medium coming from well-developed collateral vessels. There was no congenital anomaly such as PDA or VSD except for the interruption of the aortic arch. The final diagnosis was solitary interruption of the aortic arch (type A). An extra-anatomical bypass using a 16mm woven Dacron graft was placed from the ascending aorta to the descending aorta at the level of the diaphragm with cardiopulmonary bypass. The pressure gradient across the interruption disappeared immediately after opening the graft. Although he had perioperative myocardial infarction in the area of the right coronary artery, he recovered fully and when discharged he was in NYHA class 1 condition.

Three-channeled aortic dissection of the ascending aorta is rare. A 38-year-old man was given a diagnosis of DeBakey type I aortic dissection with three-channel at the ascending aorta on a chest CT scan. Right axillar and left femoral artery and two-stage right atrial cannulas were used to institute cardiopulmonary bypass. Hemiarch replacement was performed. The open proximal anastomosis technique was used under deep hypothermic circulatory arrest and selective cerebral perfusion. This three-channeled aortic dissection was thought to be produced by DeBakey type II dissection first followed by a retrograde dissection of DeBakey type III b. Since obstruction of the brachiocephalic artery due to the expansion of the pseudolumen was found during rewarming, reconstruction of the brachiocephalic artery was necessary. The present case was treated successfully by right axillary artery perfusion and subsequent reconstruction of the brachiocephalic artery.