title: [Obstruction of the true lumen by retrograde perfusion during repair of DeBakey type I aortic dissection: a case report].
abstract: Retrograde femoral perfusion is often used during the repair of DeBakey type I aortic dissections, however, it may cause serious ischemic damage of vital organs even though the arterial cannula is properly placed. A 58-year-old woman with chest pain was admitted to our hospital. She was operated on urgently because chest computed tomograms revealed that she suffered from a DeBakey type I aortic dissection. A ringed graft, 22 mm in diameter, was implanted into the ascending aorta using retrograde perfusion through the right femoral artery. Following the removal of the aortic cross-clamp and rewarming, the prosthetic graft remained flaccid and the heart failed to resume beating. We speculated that retrograde femoral perfusion caused the true lumen obstruction while distending the false lumen. This resulted in blocking reperfusion of the coronary arteries. After antegrade perfusion was initiated through an 8 mm Dacron graft which was anastmosed to the ringed graft, the heart soon resumed beating. During the repair of DeBakey type I aortic dissections, this serious complication should be anticipated. If it occurs, retrograde femoral perfusion must be exchanged for antegrade aortic perfusion before irreversible changes occur.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyorin University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tsuda
authors.forename: T
authors.initials: T
authors.lastname: Koishizawa
authors.forename: Y
authors.initials: Y
authors.lastname: Watanabe
authors.forename: M
authors.initials: M
authors.lastname: Takeshita
authors.forename: J
authors.initials: J
authors.lastname: Kokubo
authors.forename: T
authors.initials: T
authors.lastname: Nonaka
authors.forename: T
authors.initials: T
authors.lastname: Fujiki
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Arimura
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.forename: K
authors.initials: K
authors.lastname: Sudo
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology*; D010477:Perfusion / Q000009:adverse effects* / Q000379:methods