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Case Reports
NUMBER 3-4 YEAR 2011
Replacement of the Ascending Aorta and the Aortic Arch for Acute Type A Aortic Dissection
Clinic of Cardiovascular Surgery, Niculae Stancioiu Heart Institute, Cluj-Napoca

Correspondence to:
Dan Bindea, MD, Clinic of Cardiovascular Surgery, Niculae Stancioiu Heart Institute,
19-21 Motilor Str., Cluj-Napoca, Romania,
Tel. +40-264-591531
Email: bindea_dan_ch@yahoo.com
REZUMAT
Pacienta L.M. in varsta de 53 ani a fost internata de urgenta in Serviciul nostru cu diagnosticul de disectie de aorta (Ao) tip A cu interesarea portiunilor initiale a trunchiului arterial brahiocefalic (TABC) si a arterei carotide comune (ACC) stangi (confirmat prin CT in Spitalul teritorial). Ecografia cardiaca confirma diagnosticul si arata prezenta unei colectii pericardice cu semne de tamponada si a insuficientei aortice severe. În aceste conditii, pacienta este supusa de urgenta unei interventii chirurgicale complexe: protezarea valvei aortice, inlocuirea Ao ascendente si a 2/3 proximale din arcul aortic, reimplantarea arterelor coronare prin interpozitia a doua segmente de proteza scurte si reimplantarea TABC si a ACC stangi, de-asemenea prin intermediul unor segmente de proteza. Pentru refacerea portiunii initiale a aortei s-a utilizat procedeul Bentall si tehnica Mills. Pe perioada arestului cardiocirculator (53 min) perfuzia cerebrala a fost asigurata prin incanularea directa a TABC. Evolutia postoperatorie a fost marcata de prezenta unui sindrom de insuficienta respiratorie acuta (ARDS), care a necesitat ventilatia mecanica prelungita a pacientei. În ziua a 14-a postoperator a fost necesara evacuarea unei colectii pericardice compresive prin abord chirurgical subxifoidian. Ulterior, evolutia a fost fara alte evenimente. Consideram ca, chirurgia arcului aortic ramane o provocare pentru chirurgul cardiac; o tehnica chirurgicala excelenta alaturi de o protectie cerebrala buna asigura premisele unei reusite.

ABSTRACT
A 53-year old female patient was admitted in our Service for acute type A aortic dissection (confirmed on a CT scan made at a local hospital). The cardiac echography confirm the diagnostic and showed cardiac effusion with tamponade and severe aortic regurgitation. The patient underwent emergency surgery: replacement of the aortic valve, replacement of the ascending aorta and of the 2/3 of the aortic arch, associated with reconnection of the coronary arteries, the brachiocephalic trunk and the left common carotid artery to the aortic graft using also prosthetic grafts (For the replacement of the ascending aorta we performed Bentall procedure associated with Mills technique). During the cardio-circulatory arrest (53 min), the cerebral perfusion was made possible by cannulation of the brachiocephalic trunk. Surgery of the aortic arch remains a challenge for the cardiac surgeon. A good surgical technique together with a good cerebral perfusion assure the success of the surgical procedure.


"Victor Babes" Publishing House "Victor Babes" University of Medicine and Pharmacy Romanian Academy of Medical Sciences National Council of Scientific Research in Higher Education (B+) Index Copernicus
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