Preceding Re-entry Closure for Chronic Thoracic Aortic Dissection in a Patient with Marfan Syndrome

Akihiro Yamamoto	Hirono Satokawa	Shinya Takase
Hiroki Wakamatsu	Yoshiyuki Sato	Yuki Seto
Akihito Kagoshima	Tomohiro Takano	Tsuyoshi Fujimiya
Hitoshi Yokoyama

（Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan）

A 42 year-old woman with Marfan syndrome, who had replacement of the ascending aorta for acute aortic dissection several years ago, was found to have distal aortic arch aneurysm. The aneurysm had small entries at cervical arterial branches and large re-entry at the left external iliac artery. It was necessary to perform two-staged operation Bentall procedure with total arch replacement and abdominal aortic replacement with re-entry closure. It was usually performed with a primary entry closure for chronic aortic dissection, but massive invasion was expected. We performed catheter angiography for entry and re-entry, and decided to perform preceding re-entry closure. First, we underwent replacement of the abdominal aorta, and then successfully performed the Bentall procedure with total aortic arch replacement. The catheter angiography was useful for decision-making for medical treatment.

 

Jpn. J. Cardiovasc. Surg. 46:25-28（2017）

Keywords：chronic aortic dissection;Marfan syndrome;re-entry closure;aortic remodeling;catheter angiography