| A Case of Aortitis
Syndrome Associated with Occlusion of All Arch Branches and Atypical
Aortic Coarctation |
(First Department of Surgery, Hiroshima University,
School of Medicine, Hiroshima, Japan)
| Yuji Sugawara |
Taijiro Sueda |
Hiroo Shikata |
| Kazumasa Orihashi |
Masanobu Watari |
Kenji Okada |
| Yuichiro Matsuura |
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A 61-year-old man was admitted with
acute cardiac failure associated with atypical aortic coarctation
and severe left ventricular hypertrophy. Angiography and MRI
showed that all branches from the aortic arch were occluded,
and that cerebral circulation was supplied via collateral flow
from small aortic branches either proximal or distal to the coarctation
and by the right vertebral artery receiving retrograde flow from
the right internal thoracic and right thoracodorsal arteries.
Cerebral CT revealed massive cerebral infarction in the perfusion
area of the right mid-cerebral artery. Aortitis syndrome was
diagnosed from these findings, and ascending-abdominal aortic
bypass grafting with aorto-right subclavian bypass was performed
after successful conservative treatment for cardiac failure.
Because of remarkable increase in the aortic blood pressure on
partial clamping of the ascending aorta, proximal aortic anastomosis
was performed under extracorporeal circulation. Near infrared
spectroscopy (NIRS) was used to monitor the intraoperative cerebral
circulation. The perfusion flow rate was maintained in order
not to reduce the regional brain oxygen saturation below the
critical level. No cerebral complication was encountered postoperatively.
Cases of aortitis syndrome with occlusion of all arch branches
are rare. NIRS was suggested to be useful to evaluate cerebral
circulation during operation in such cases in which cerebral
blood flow can be severely affected.
Jpn. J. Cardiovasc. Surg. 29: 114-117 (2000) |
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