Ann Thorac Surg 2008;85:1105. doi:10.1016/j.athoracsur.2007.07.004
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Triple Aortic Lumen With Complex Visceral Organs Perfusion After Acute Redissection of the Aorta
Pasquale Totaro, MDa,*,
Giuseppe De Cicco, MDa,
Roberto Lorusso, MD, PhDa,
Roberto Maroldi, MDb,
Rapheel De Geest, MDa
a Cardiac Surgery Unit, Civic Hospital, Brescia, Italy
b Radiology, Civic Hospital, Brescia, Italy
* Address correspondence to Dr Totaro, Cardiac Surgery Unit, Civic Hospital-Brescia, Piazza Spedali Civili 1, Brescia, 25125, Italy (Email: ptotaro{at}yahoo.com).
A 49-year-old man with a complex medical history presented at Civic Hospital, Brescia, Italy, hospital complaining of back pain and paresthesia of the inferior limbs. The patient had undergone several aortic surgical procedures, including ascending aorta replacement for acute type A aortic dissection in 1995 and a Bentall procedure for dilatation of distal portion of ascending aorta in 2000.
In November 2006, 1 month before the admission, a routine thoracoabdominal computed tomography (CT) scan showed a chronic distal dissection of the thoracoabdominal aorta with a persistence of the false lumen (Fig 1A/b
and Fig 2A/b), without thrombosis. A smaller true lumen was also seen (Fig 1A/a and Fig 2A/a). A routine check-up was planned after 12 months; however, 1 month later he returned to the hospital because of a sudden onset of back pain.
An urgent CT scan showed a new posterior dissection of the thoracic and abdominal aorta. The aorta, in fact, presented with three lumens, with a virtual true lumen in the thoracic tract of aorta (Fig 1B/a and Fig 2B/a), the previous false lumen (Fig 1B/b and Fig 2B/b), and at its posterior side, the new false lumen (Fig 1B/c and Fig 2B/c). This created a complex situation for visceral organ perfusion: right kidney perfusion ensured through the old true lumen (Fig 1Ba), with left kidney perfusion ensured by both old and new false lumens (Fig 1B/b, c).
The patient underwent thoracoabdominal aorta replacement in circulatory support and deep hypothermia. At operation, the presence of the three aortic lumens was confirmed (Fig 2C). The patient survived the operation, had an uneventful postoperative recovery, and was discharged home after 2 weeks.
