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Two Cases of Total Arch Replacement for Ruptured Type B Intramural Hematoma
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（Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan, and Gifu Prefectural General Medical Center*, Gifu, Japan）
| Shinnosuke Goto |
Masafumi Matsui |
Norikazu Kawai* |
| Hideaki Manabe |
Hisato Takagi |
Takuya Umemoto |
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Type B intramural hematoma（IMH）is not considered to be a life-threatening condition, and medical treatment is the first treatment choice. We report 2 cases of ruptured type B intramural hematoma. Total arch replacement was performed via median sternotomy, which is not a common surgical strategy for type B dissection. Case 1:a 77-year-old woman was transferred to our hospital with chest and back pain. CT revealed type B IMH with a large hematoma in the anterior mediastinum. She underwent total arch replacement, but she died of respiratory failure on the 167th postoperative day. Case 2:a 60-year-old man was transferred to our hospital with chest and back pain. CT revealed a type B IMH with a large hematoma on the anterior side of the arch. He underwent total arch replacement, but died of sepsis on the 13th postoperative day. We had 2 rare cases of ruptured type B IMH. In both cases, postoperative courses were problematic. However, median sternotomy could be an approach for ruptured type B dissection in some cases.
Jpn. J. Cardiovasc. Surg. 39:195-198（2010）
Keywords：type B thrombosed type acute aortic dissection, rupture, median sternotomy, intramural hematoma
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