[Reoperation for postoperative pseudoaneurysm after repair for acute aortic dissection associated with disseminated intravascular coagulation and chronic renal failure].
We report a very high risk case of reoperation for pseudoaneurysm after ascending aortic replacement for acute aortic dissection in a 78-year-old man with chronic renal failure and disseminated intravascular coagulation (DIC). Computed tomography 5 years after the 1st operation showed huge pseudoaneurysm originated from the distal anastomosis and the angiogram showed moderate aortic regurgitation. Hemodialysis and congestive heart failure associated with DIC complicated his general condition. Preoperative DIC score was 7 with D-dimer of 39.8 microg/ml. The patient underwent reoperation through night anterior thoracotomy. At 20 degrees C of urinary bladder temperature, we started re-median sternotomy and ablated the adhesion. When the pseudoaneurysm ruptured, we started hypothermic circulatory arrest with selective cerebral perfusion immediately. And Bentall operation and hemi-arch replacement were performed. Postoperative recovery required long period and he was transferred to another hospital at 3 months after the surgery. Postoperative data showed reduction of DIC score to 3.
Fuchigami
T
T
Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Koide
M
M
Kunii
Y
Y
Umehara
N
N
Watanabe
K
K
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017541:Aneurysm, False / Q000209:etiology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation