[A case of total aortic replacement in a patient with Marfan's syndrome]

A 32-year-old male with Marfan's syndrome was admitted to our Department in June, 1989 due to severe back pain that was diagnosed as type III-b dissecting aneurysm. His infrarenal abdominal aorta and bilateral iliac arteries had been replaced in another clinic in 1984 due to true aortic aneurysm. Two years later, Carbrol's operation was performed in our Department for the late development of DeBakey type II dissecting aneurysm. DSA and CT studies indicated the need for total replacement of the entire remaining aorta, since diffuse and extensive dilatation of the false lumen and the presence of an intimal tear at the origin of the left carotid artery were demonstrated. The arch and upper descending thoracic aorta were replaced in June, 1989, and replacement of the total remaining thoracoabdominal aorta was carried out under left heart bypass on September 26, 1989. Abdominal branch arteries and intercostal arteries of the 9th to 11th levels were reattached to the graft as onlay patches. Hoarseness of voice was the only complication. The patient recovered uneventfully and returned to his job after discharge. Although the native aorta had been completely replaced, ambulatory monitoring of the patient's pressure and ECG, performed two months after the operation, showed the normal reflex.