Surgical Treatment of Type A Acute Aortic Dissection Complicated with Polycystic Kidney

Masataka Yoda	Kuniki Nakashima	Kazutomo Minami

（Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan＊（Kitakanto Cardiovascular Hospital), Shibukawa, Japan）

Autosomal dominant polycystic kidney disease（ADPKD）is primarily caused by not only renal failure but also systemic diseases, including cysts of other systemic organs, and vascular dissection or aneurysm. To make matters worse, life-threatening aortic diseases are associated with ADPKD in some cases. However, only a few cases were reported ADPKD-associated with aortic dissection in the international literature. A 37-year-old woman was hospitalized due to Stanford type A acute aortic dissection and moderate aortic valve regurgitation. The entry of the aortic dissection was located at the aortic arch. The sinus of Valsalva was dilated to 50 mm. She had a family history, her grandfather suffered ADPKD, and also her mother had ADPKD too. Her mother died of subarachnoid hemorrhage at 44 years old. We performed urgent aortic root replacement, graft replacement of ascending aorta and aortic arch. The blood flow of the right carotid artery reduced after closing the thorax. The echo showed the false lumen pressed the true lumen in the common carotid artery, and we reconstructed the carotid artery. We clamped the common carotid artery simply, we fixed the intimal flap and re-sutured right carotid artery. She did not require dialysis after the procedure, and she was discharged on the 14th postoperative day. Pathological finding of the aortic wall showed the dissection of the media alone. No findings such as aortitis or cystic medial necrosis were recognized.

 

Jpn. J. Cardiovasc. Surg. 46:134-138（2017）

Keywords：autosomal dominant polycystic kidney disease;thoracic aortic dissection;aortic root replacement;total aortic arch replacement;carotid artery reconstruction