Abstract
We have experienced 2 cases of proximal pseudoaneurysmal formation and re-dissection after replacement of ascending aorta or aortic arch for acute aortic dissection. The GRF glue was used at first operation in both cases. The first case was 61-year-old man who had undergone total aortic arch replacement 7 years ago due to acute Type A aortic dissection. He came to our outward claiming chest discomfort. A new dissection at Sinus of Valsalva was detected and the ascending aorta had enlarged to 63 mm. Ultrasound cardiogram revealed severe aortic valve insufficiency. Aortic re-implantation using Valsalva graft and CABG to RCA was performed. New intimal tear was found proximally at former suture line, two aortic valve commissures were detached from aortic wall. The second case was a 78-year-old man who had previously undergone replacement of ascending aorta using GRF glue for acute aortic dissection 4 years ago. A follow up computed tomography showed an aortic root pseudo-aneurysm. Also moderate aortic insufficiency was found on ultrasound cardiogram. Aortic root replacement was performed. In the pathological examination, the necrotic change of smooth muscle cells in the aortic media was revealed in both cases. Higher rate of long term complication especially re-dissection or pseudoaneurysm formation provided by the usage of GRF glue for repairing dissected aorta was described in previous reports. The toxic effect of excess formalin is known to be the cause of those complication. We have to observe the patients carefully who has been used GRF glue.
