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[A case of Cabrol's procedure in which selective cerebral perfusion was necessitated]
Y Terada1, K Sakakibara, S Ohkawa
1Institute of Clinical Medicine, University of Tsukuba, Japan.
Insights
Aortic atheroma can cause cerebral infarction during extracorporeal circulation. Selective cerebral perfusion is recommended to prevent this complication in patients undergoing aortic arch surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Annuloaortic ectasia requires surgical intervention, often involving extracorporeal circulation.
- Atherosclerotic changes in the aorta pose a risk for embolic events during cardiovascular procedures.
- Cerebral infarction is a serious complication associated with aortic surgery.
Observation:
- A 69-year-old male patient presented with annuloaortic ectasia and multiple cerebral infarctions.
- Preoperative CT revealed widespread atherosclerotic disease from the aortic arch to the descending aorta.
- Arterial cannulation was performed via the left subclavian artery to mitigate embolic risk.
Findings:
- Intraoperative findings showed atheromatous and ulcerative changes in the ascending aorta.
- Cerebral infarction in this case was likely caused by retrograde embolism of atheroma from the aortic arch during extracorporeal circulation.
- The chosen cannulation site did not prevent embolism from the aortic arch.
Implications:
- Selective cerebral perfusion should be considered during extracorporeal circulation in patients with extensive aortic atheroma.
- This case highlights the importance of assessing aortic pathology to tailor surgical strategies and minimize neurological complications.
- Optimizing cannulation strategies and perfusion techniques is crucial for preventing stroke in complex aortic surgeries.
Abstract:
A 69-year-old man underwent Cabrol's procedure for annuloaortic ectasia and complicated multiple cerebral infarction. Preoperative CT scan showed atherosclerotic changes from the aortic arch to descending aorta. During extracorporeal circulation, arterial cannulation was made through left subclavian artery to prevent cerebral infarction due to detouched atheroma from the descending aorta. Intraoperatively, the ascending aorta was also atheromatous and ulcerative. In this case, cerebral infarction was most likely due to detouched atheroma from the aortic arch in retrograde blood flow during extracorporeal circulation. To prevent this complication, selective cerebral perfusion during extracorporeal circulation should have been selected.