Total Aortic Replacement for Type B Aortic Dissection after Aortic Root Replacement and Repair of a True Aneurysm of the Right Subclavian Artery in a Patient with Marfan Syndrome

iDepartment of Thoracic and Cardiovascular Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japanj

Masami Inaoka , Akira Fujii
A 34-year-old woman with Marfan syndrome was admitted to our department in June, 2006 for surgical treatment of the dilated aortic arch and aneurysm of the right subclavian artery. The aortic root and ascending aorta had been replaced because of AAE, severe AR and ascending aortic aneurysm in 1999. The infrarenal abdominal aorta had been replaced for lower limb ischemia due to acute type B aortic dissection in 2001. The descending aorta and thoracoabdominal aorta had been replaced in 2002 and in 2005 respectively for diffuse and extensive dilatation of the false lumen. The remaining dilated entire aortic arch was replaced and right subclavian artery aneurysm was managed by arterial reconstruction in 2006. The whole aorta was replaced in 5 consecutive operations over 7 years. The patient recovered uneventfully and returned her job after discharge. Total aortic replacement for aortic dissection after aortic root replacement is rare and true aneurysm of the subclavian artery is also rare in patients with Marfan syndrome. Staged aortic replacement for treatment of extensive aortic disease is safe with satisfactory result. Regular follow up is important even if total aortic replacement has been completed.
  Jpn. J. Cardiovasc. Surg. 38:40-43i2009j