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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
[Three-channeled aortic dissection: selection of surgery based on the images]
T Yamada1, T Imazeki, M Yokoyama
1Dokkyo University Koshigaya Hospital, Japan.
Insights
Three-channeled aortic dissection poses rupture risks and prevents cardiopulmonary bypass. Fenestration aids visceral recovery and enables successful total aortic repair in complex cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease
Background:
- Three-channeled dissection presents unique anatomical challenges, including enlarged false lumens compressing the true lumen and visceral arteries originating from the false lumen.
- This specific anatomy complicates surgical repair by preventing the use of cardiopulmonary bypass (CPB) and leading to visceral malperfusion.
Observation:
- The peculiar anatomy of three-channeled dissection increases the risk of rupture.
- Visceral malperfusion due to false lumen origin arteries is a significant complication.
Findings:
- Fenestration of the aorta can restore functional recovery of malperfused viscera.
- Fenestration facilitates the use of cardiopulmonary bypass, enabling complete repair of thoraco-abdominal aortic dissections.
- Two patients successfully underwent fenestration followed by total thoraco-abdominal aortic repair; a third patient is under surveillance after fenestration.
Implications:
- Fenestration is a viable strategy for managing complex three-channeled aortic dissections.
- This approach allows for necessary total aortic repair in high-risk patients.
- Further monitoring is crucial for patients managed with fenestration alone.
Abstract:
Three patients with 3-channeled dissection were operated upon. Images of the dissection were enlargement of the false lumens, compression of the true lumen by enlarged false lumens and visceral arteries of false lumen origin. These prevent the use of cardiopulmonary bypass (CPB) and cause malperfusion of the viscera. Three-channeled dissecion is easy to rupture for its peculiar anatomy and total repair of the thoraco-abdominal aorta is mandatory. Fenestration brings functional recovery of malperfused viscera and enables the patients to be placed on CPB for total repair. Two patients underwent infrarenal and descending aorta fenestration followed by the total repair of thoraco-abdominal aorta successfully. A third patient has been placed on the strict CT follow-up following the infrarenal fenestration.
