Ann Thorac Surg 1995;59:1626-1627
© 1995 The Society of Thoracic Surgeons
Correspondence
Dissection With Double Arch
Takaaki Sugita, MD,
Ryuzabro Yasuda, MD,
Tatsuo Magara, MD,
Tadao Nishikawa, MD,
Kazuhiko Katsuyama, MD,
Takehisa Nojima, MD,
Atsushi Katsura, MD
Department of Cardiovascular Surgery, Shiga Seijinbyo Hospital, Moriyama, Second Department of Surgery, Shiga University of Medical Science, Seta Ohtsu, Shiga 520-21, Japan
To the Editor:
We read with particular interest the report of ``Aortic Dissection Involving a Double Aortic Arch With a Right Descending Aorta'' by Midulla and associates [1]. The patient they described was treated successfully using deep hypothermic circulatory arrest. Although we agree that deep hypothermic circulatory arrest is the preferred technique for aneurysms involving the right descending aorta, the right-sided approach and the graft replacement can be difficult in some cases. We previously reported a patient with a ruptured dissecting aneurysm involving a right descending aorta [2]. A 64-year-old man was admitted complaining of sudden-onset severe back pain. Aortography and computed tomography demonstrated a ruptured dissecting aortic aneurysm involving a Shuford type-3 right-sided aortic arch [3] (Figs 1, 2
). Emergency operation was performed and the patient was explored through a left thoracotomy, so the entry was positioned on the left side of the aortic arch, and the hematoma was located in the left thorax. The descending aorta was partially apparent in the left thorax. Thus graft interposition of the aneurysm was impossible. Closure of the entry was performed. The aortic clamp was placed 2 to 3 cm proximal to the aberrant left subclavian artery, and the thoracic aorta was transected just distal to the aberrant left subclavian artery. The entry that was located proximal to the aberrant subclavian artery was closed by two U stay sutures with Teflon felt. The false lumen was obliterated as demonstrated by computed tomography on the 36th postoperative day. The patient is now doing well.
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Fig 1. . Aortogram showing aortic dissection and the entry around the orifice of the left subclavian artery. (LCCA = left common carotid artery; LSA = left subclavian artery; RCCA = right common carotid artery; RSA = right subclavian artery.)
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References
- Midulla PS, Dapunt OE, Sadeghi AM, Quintana CS, Griepp RB. Aortic dissection involving a double aortic arch with a right descending aorta. Ann Thorac Surg 1994;58:874–5.[Abstract]
- Sugita T, Yasuda R, Magara T, et al. Surgical therapy of a ruptured aortic aneurysm involving a Shuford type-3 right-sided aortic arch. J Jpn Assoc Thorac Surg 1990;38:122–5.
- Shuford WH, Sybers RG, Gordon IJ, et al. Circumflex retroesophageal right aortic arch simulating mediastinal tumor of dissecting aneurysm. AJR 1986;146:491–6.[Abstract/Free Full Text]
