A Surgical Case of Stanford Type A Acute Aortic Dissection Concomitant with Paraplegia

Hiroshi Furukawa＊	Taishi Tamura＊	Takeshi Honda＊
Noriaki Kuwada＊	Takahiko Yamasawa＊	Yoshiko Watanabe＊
Yasuhiro Yunoki＊	Atsushi Tabuchi＊	Yuji Kanaoka＊
Kazuo Tanemoto＊

（Department of Cardiovascular Surgery, Kawasaki Medical School＊, Kurashiki, Japan）

A 76-year-old man who suffered from consistent back pain was admitted for anti-hypertensive therapy to strictly manage the early thrombosed acute type A aortic dissection（AAAD). On admission, his blood pressure could not be controlled well;soon he complained of recurrent severe back pain. The second thoracoabdominal enhanced computed tomography revealed the progression of AAAD from DeBakey type II to type I with thrombosed pseudolumen at the descending thoracic aorta;therefore, emergent surgical intervention by primary central repair was conducted. Paraplegia was diagnosed eight hours after surgery, then cerebrospinal fluid drainage and intravenous administration of Naloxone were started immediately followed by keeping the systemic blood pressure more than 120 mmHg. However, paraplegia had never improved and been persistent with neurological deficit of the lower extremities. We herein report a complicated surgical case of an AAAD patient with paraplegia and review the complex clinical settings.

 

Jpn. J. Cardiovasc. Surg. 48:419-424（2019）

Keywords：acute type A aortic dissection;paraplegia;early thrombosed pseudolumen;cerebrospinal fluid drainage;naloxone