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[Acute aortic dissection complicating coronary artery bypass surgery]
1Department of Cardiology, Toranomon Hospital.
Insights
Aortic dissection can occur at cardioplegia injection sites during bypass surgery. Prompt surgical repair involving aortic transection and anastomosis led to successful patient recovery.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac procedure.
- Aortic dissection is a serious complication affecting the aorta.
- Calcification of the ascending aorta increases surgical risk.
Observation:
- A 70-year-old female patient presented with calcification of the posterior ascending aorta.
- Acute ascending aortic dissection developed at the cardioplegia injection site post-CABG.
- The dissection occurred after aortic cross-clamp removal.
Findings:
- The surgical team performed aortic transection due to the dissection.
- Internal and external application of Teflon felt was utilized.
- An end-to-end anastomosis of the aorta was successfully reconstructed.
Implications:
- This case highlights a rare complication of CABG: iatrogenic aortic dissection.
- Successful surgical management of this complication is feasible.
- Careful technique during cardioplegia administration in patients with aortic calcification is crucial.
Abstract:
We experienced a patient in whom acute ascending aortic dissection appeared to develop at the site of injection of the cardioplegic solution during coronary artery bypass surgery. The patient was a woman aged 70, who was demonstrated to have calcification of the posterior wall of the ascending aorta by preoperative CT scanning. When dissection developed at the cardioplegia injection site after removal of the aortic cross clamp, the aorta was transected and teflon felt was applied to the aorta internally and externally before end-to-end anastomosis was performed. Postoperative CT scanning revealed closure of the dissecting lumen, and the patient was discharged from hospital on the 33rd postoperative day.