2024 Volume 53 Issue 5 Pages 294-298
A 77-year-old man suffered sudden chest oppression in driving. The patient had undergone aortic valve replacement with a mechanical valve for unknown valvular heart disease 17 years before. On arrival, the symptom was improved and hemodynamics were stable. Contrast-enhanced CT scans revealed remarkable pear-shaped dilatation of the aortic root (76 mm in maximum diameter), ascending aortic dissection, and extravasation from the posterior wall of the dissecting aorta with mediastinal hematoma compressing the left atrium. Ruptured type A acute aortic dissection with root ectasia (following aortic valve replacement) was diagnosed and urgent root and ascending aortic replacement was performed preserving the replaced mechanical valve. Initially, surgery not under hypothermic circulatory arrest but under normothermic aortic cross clamp was planned. Although sudden massive bleeding from the rupture site (dorsal to the ascending aorta) occurred during exposure of the ascending aorta (just proximal to the origin of the brachiocephalic artery), the procedure could be continued under bleeding control by the surgeon's fingers. The patient underwent re-sternotomy for hemostasis and undertook rehabilitation for discharge on the postoperative day 30. Mortality of ruptured type A acute aortic dissection is extremely high, and no surgical surviving case has been reported in the Japanese language.
