Ann Thorac Surg 2009;87:e27-e28. doi:10.1016/j.athoracsur.2008.11.041
© 2009 The Society of Thoracic Surgeons
Case Reports
Controlled Earlier Reperfusion for Brain Ischemia Caused by Acute Type A Aortic Dissection
Hiroshi Munakata, MD*,
Kenji Okada, MD, PhD,
Hiroya Kano, MT,
Sou Izumi, MD,
Yutaka Hino, MD,
Masamichi Matsumori, MD, PhD,
Yutaka Okita, MD, PhD
Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
Accepted for publication November 17, 2008.
* Address correspondence to Dr Munakata, Department of Surgery, Division of Cardiovascular Surgery Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan (Email: h-munakata{at}k7.dion.ne.jp).
Brain malperfusion caused by acute type A aortic dissection is a life threatening situation that should be relieved as early as possible with minimal reperfusion injury prior to aortic repair. The patient was 72-year-old woman with acute type A aortic dissection. She was referred to us 2.5 hours after onset of chest pain, and she was unconscious with a complete left paralysis. The true lumen of internal carotid artery was severely stenosed. A simple bypass circuit was installed from the femoral artery to the true lumen of the right common carotid artery, which consisted with a roller pump and cold bath for blood cooling. Regional oxygen saturation of the right frontal brain was immediately raised after initiation of the bypass, and she underwent emergency ascending hemi-arch replacement. The postoperative course was complicated with a right brain stroke; however, brain computed tomography and magnetic resonance imaging disclosed minimum brain edema. She was discharged on foot on the 35th postoperative day, and she was walking with a stick after 7 months.
Copyright © 2009 by The Society of Thoracic Surgeons.
