We present a 78-year-old man who developed Stanford type A aortic dissection seven years after aortic valve replacement. At the previous operation, the diameter of the ascending aorta was 40 mm. Three years later, computed tomography revealed the diameter to have expanded to 50 mm. Four years later, the patient developed aortic dissection with entry at the ascending aorta, and a graft replacement was performed.
A reversed U-shaped skin incision with a lower sternotomy could provide relatively comfortable operative fields for cardiac surgeons, and be cosmetically appealing to female patients who require a repair of simple congenital heart defect.
We reviewed 24 cases of patchplasty for true thoracic aortic aneurysm performed in our hospital up to July 2001. The size of the aneurysm in the ascending aorta was 6.0cm (1 case), and the rate was 12.5% (3 patients out of 24). The causes of death were multiple organ failure, cerebral bleeding and sepsis. In the long-term results, 2 patients had recurrence, but there were no late deaths in relation to the aneurysmal recurrence. We performed open stent operations for severe adhesion and pulmonary dysfunction in the aneurysmal recurrence cases. The postoperative course of these cases was uneventful.The open stent was useful for the treatment of the aneurysmal recurrence in the distal arch.
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