Abstract
Ruptured acute type A aortic dissection in a patient with persistent left superior vena cava (PLSVC) and absence of a bridging innominate vein is rare. A 71-year-old woman presented with a pain in the right side of the neck and nausea. Ruptured acute type A aortic dissection was diagnosed. CT scan revealed a persistent left superior vena cava and absence of a bridging innominate vein. Emergency hemi-arch replacement was performed. After CPB was established with right femoral artery return and right SVC (RSVC), IVC venous drainage was placed. An L-shaped venous cannula was directly placed into the LSVC. After core cooling, the ascending aorta was clamped and the right atrium was incised for retrograde cardioplegia. At a rectal temperature of 28°C, circulatory arrest was started and retrograde cerebral perfusion was performed through right and left SVC. Her postoperative course was uneventful. In cases of ruptured acute type A aortic dissection in a patient with persistent left superior vena cava (PLSVC) and absence of a bridging innominate vein, standard hemiarch replacement can be performed with direct venous cannulation of LSVC for reliable retrograde cardioplagia and retrograde cerebral perfusion.
