A Case of Partial Remodeling for Type A Aortic Dissection Requiring Aortic Root Reconstruction

Yoshimasa Furuichi＊	Tatsuhiko Komiya＊	Takeshi Shimamoto＊
Michihito Nonaka＊	Takehiko Nonaka＊	Junya Kitaura＊
Taiyo Jinno＊	Atsushi Sugaya＊

（Department of Cardiovascular Surgery, Kurashiki Central Hospital＊, Kurashiki, Japan）

A 48-year-old woman was admitted to our hospital with exertional dyspnea and lower leg edema since 2 months previously. Echocardiogram presented dilation of Valsalva sinus, severe AR（aortic regurgitation）and a supra-annular flap. Enhanced cardiac cycle-gated computed tomography revealed Stanford type A aortic dissection. Primary entry was found just above the aortic valve, the right coronary artery branched from the false lumen, and the commissure between the right and non-coronary cusps was detached. The left coronary artery branched from the true lumen. The false lumen was all patent to the bilateral bifurcations of the common iliac artery. We performed valve sparing partial root remodeling, right coronary artery bypass and total arch replacement after the heart failure management. The operation, cardiopulmonary bypass, aortic cross clamp and selective cerebral perfusion times were 402, 234, 167 and 109 min, respectively. The postoperative course was uneventful, and the patient was discharged 12 days after the operation without any complication. Postoperative CT revealed a well-shaped Valsalva and complete thrombosis of the false lumen on the thoracic aorta. Aortic regurgitation completely disappeared according to a postoperative echocardiogram.

 

Jpn. J. Cardiovasc. Surg. 49:133-137（2020）

Keywords：aortic dissection;valve sparing;partial remodeling;total arch replacement