A Case of Surgical Treatment for Type A Aortic Dissection in a Patient with Tracheostomy

(Department of Cardiovascular Surgery and Department of Internal Medicine*, Yamanashi Prefectural Central Hospital, Yamanashi, Japan)

Harunobu Matsumoto Koji Tsuchiya Masato Nakajima
Hideki Sasaki Narutoshi Hibino Kimio Yamamoto*
The approach for the heart and proximal aorta in a patient with a tracheostomy poses difficult problems such as mediastinitis and inadequate operative exposure. We report a case of successful surgical treatment for type A aortic dissection in a patient with tracheostomy using a Y shaped skin incision and median full-sternotomy. A 63-year-old woman with a tracheostomy was referred to our hospital because of type A thrombosed aortic dissection and cardiac tamponade. At first we treated the patient conseservatively, but follow-up CT taken on the 20th day after onset revealed that false lumen of the ascending aorta was patent and the size of ascending aorta had increased to 6cm in diameter. We therefore performed hemiarch replacement (24mm Hemashield gold graft) through a Y shaped skin incision and median full-sternotomy. The postoperative course was uneventful and she was discharged on the 19th postoperative day.
@Jpn. J. Cardiovasc. Surg. 32F31-33 (2003)