We report 2 cases of retrograde DeBakey III type (Stanford A type) closing aortic dissection in a state of shock. At the preoperative assessment, we could not confirm the region of entry in either of them. Consequently, to close the entry, we decided to perform antero-lateral thoracotomy with partial sternotomy (ALPS) and good results were obtained. This method has 3 advantages. 1) The wide field of view enables visualization from the ascending to the descending aorta. 2) Because of the good field of view, we are able to suture without difficulty and minimize the volume of bleeding. 3) We can minimize influence on the lung because the upper sternum is not incised, thus we can handle the lung gently while performing the planned incision.

Twelve cases of ruptured abdominal aortic aneurysm (RAAA) were treated during 5 years. Nine showed severe hypotension (systolic pressure below 70mmHg) and three required cardiac massage prior to operation. At the beginning of this study, direct laparotomy was conducted on 4 cases but mortality was high mortality (75%). Left thoracotomy with antero-lateral incision through the 7th intercostal space was carried out to access the thoracic aorta for clamping before laparotomy, since the major mortality of this disease is due to abrupt bleeding following anesthesia and operation. Left thoracotomy before laparotomy was conducted on 8 cases, half of whom required aortic clamping during operation (clamping time 21min). Operative mortality following thoracotomy decreased (12.5%). The aneurysm size and the time of operation for the groups with or without thoracotomy were the same, though the degree of bleeding significantly differed (3, 925ml in the group with thoracotomy, 7, 193ml in the group without thoracotomy). Left thoracotomy befor laparotomy obtained good results in case of RAAA.