| Successful Surgical Treatment
of Thoracic Aortic Aneurysm in Two Patients with Old Cerebral
Infarcts and Severely Stenotic Cerebral Vessels |
(Department of Cardiovascular Surgery, Kyoto Prefectural
University of Medicine, Kyoto, Japan)
| Takahisa Okano |
Shinichi Satoh |
Keiichi Kanda |
| Yasuyuki Shimada |
Hitoshi Yaku |
Nobuo Kitamura |
|
Our strategy for treatment of thoracic
aortic aneurysms with severely stenotic or occluded cerebral
vessels is as follows. 1) The status of cerebral vessels and
brain is assessed in detail by a team of neurologists and neurosurgeons,
2) cerebral surgical treatment is performed prior to aortic arch
surgery, and 3) reconstruction of the total arch is performed
using the arch-first technique through a median sternotomy. We
successfully performed artificial graft replacement of the total
aortic arch in two patients with old cerebral infarcts and severely
stenotic cerebral vessels. In both cases, the operation was performed
through median sternotomy under circulatory arrest by feeding
the blood to the ascending aorta and draining it from the right
atrium. Cerebral protection during reconstruction of the aortic
arch was provided by profound hypothermia and retrograde cerebral
perfusion (RCP). Prior to the incision of the aneurysm, cerebral
branches were dissected to avoid escape of debris into cerebral
vessels. The graft replacement was completed in 4 steps: 1) anastomosis
of each of the 3 arch vessels, 2) distal anastomosis of another
graft for the elephant trunk procedure, 3) anastomosis of the
arch graft and the graft for the elephant trunk, and 4) proximal
anastomosis. Just after cerebral branches were anastomosed to
the 3 branches of the graft, the blood was supplied to the brain
through the side branch of the graft instead of RCP. No signs
of neurological deficit occurred postoperatively. The above protocol
provided protection of high-risk patients with old cerebral infarcts
from possible postoperative brain damage.
Jpn. J. Cardiovasc. Surg. 32: 288 -292 (2003) |
|
