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Ruptured Acute Type A Aortic Dissection with Persistent Left Superior Vena Cava and Absence of a Bridging Innominate Vein
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（Department of Cardiovascular Surgery, Shinko Kakogawa Hospital, Kakogawa, Japan）
| Tomoaki Iwasaki |
Hidefumi Obo |
Hidetaka Wakiyama |
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Ruptured acute type A aortic dissection in a patient with persistent left superior vena cava（PLSVC）and absence of a bridging innominate vein is rare. A 71-year-old woman presented with a pain in the right side of the neck and nausea. Ruptured acute type A aortic dissection was diagnosed. CT scan revealed a persistent left superior vena cava and absence of a bridging innominate vein. Emergency hemi-arch replacement was performed. After CPB was established with right femoral artery return and right SVC（RSVC), IVC venous drainage was placed. An L-shaped venous cannula was directly placed into the LSVC. After core cooling, the ascending aorta was clamped and the right atrium was incised for retrograde cardioplegia. At a rectal temperature of 28℃, circulatory arrest was started and retrograde cerebral perfusion was performed through right and left SVC. Her postoperative course was uneventful. In cases of ruptured acute type A aortic dissection in a patient with persistent left superior vena cava（PLSVC）and absence of a bridging innominate vein, standard hemiarch replacement can be performed with direct venous cannulation of LSVC for reliable retrograde cardioplagia and retrograde cerebral perfusion.
Jpn. J. Cardiovasc. Surg. 38:135-137（2009）
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