| A Case of Aortic Replacement
for a Patient with Bilateral Internal Carotid Stenoses |
(Department of Cardiovascular Surgery, The Heart
Institute of Japan, Tokyo Women' s Medical University, Tokyo,
Japan)
| Akira Yamazaki |
Shigeyuki Aomi |
Masaki Nonoyama |
| Hideyuki Tomioka |
Kenji Yamazaki |
Akihiko Kawai |
| Hiroshi Nishida |
Masahiro Endo |
Hiromi Kurosawa |
|
A 71-year-old man was given a diagnosis
of saccular aneurysm of the aortic arch (maximum 48mm in diameter)
at the age of 68. When he was 69 years old, he began to take
steroids for autoimmune hepatitis (AIH). The following year,
the aneurysm was enlarged to 52mm. Further examinations showed
the aneurysm to extend to the ostium of the left subclavian artery.
Since he had transient ischemic attacks, ultrasonography of the
carotid arteries was performed. Bilateral internal carotid stenoses
were detected, however, cold Xe CT showed an almost normal pattern
of cerebral blood flow. We decided that operation was feasible
using retrograde cerebral perfusion (RCP). Liver dysfunction
due to AIH improved, and his steroid dosage was tapered. Using
RCP, the no-touch technique and the elephant trunk procedure,
he underwent the replacement of ascending aorta and aortic arch
and was discharged without major complications. RCP and the no-touch
technique might enable safer operations on patients with carotid
stenoses.
Jpn. J. Cardiovasc. Surg. 32: 307 -310 (2003) |
|
