Controlled earlier reperfusion for brain ischemia caused by acute type A aortic dissection.
Brain malperfusion caused by acute type A aortic dissection is a life threatening situation that should be relieved as early as possible with minimal reperfusion injury prior to aortic repair. The patient was 72-year-old woman with acute type A aortic dissection. She was referred to us 2.5 hours after onset of chest pain, and she was unconscious with a complete left paralysis. The true lumen of internal carotid artery was severely stenosed. A simple bypass circuit was installed from the femoral artery to the true lumen of the right common carotid artery, which consisted with a roller pump and cold bath for blood cooling. Regional oxygen saturation of the right frontal brain was immediately raised after initiation of the bypass, and she underwent emergency ascending hemi-arch replacement. The postoperative course was complicated with a right brain stroke; however, brain computed tomography and magnetic resonance imaging disclosed minimum brain edema. She was discharged on foot on the 35th postoperative day, and she was walking with a stick after 7 months.
Munakata
Hiroshi
H
Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. h-munakata@k7.dion.ne.jp
Okada
Kenji
K
Kano
Hiroya
H
Izumi
Sou
S
Hino
Yutaka
Y
Matsumori
Masamichi
M
Okita
Yutaka
Y