title: [Stanford type a acute aortic dissection with pectus excavatum].
abstract: Pectus excavatum is generally an isolated abnormality of the chest wall. However, some patients have a concomitant pectus deformity and cardiac & aortic disease. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. We report 2 patients with acute Stanford type A aortic dissection and pectus excavatum who underwent emergency operation. In case 1, median sternotomy is an unsuitable approach for open heart surgery, since the heart and great vessels are displace into the left hemithorax. But combined sternotomy and left anterior thoracotomy provided excellent surgical exposure. In case 2, we proceeded with a leftsided costotomy of four ribs and place a normal chest retractor providing as excellent exposure as combined sternotomy and left anterior thoracotomy. A left-sided costotomy of four ribs can be performed safely, eliminating the risks of median sternotomy in acute stanford type A aortic dissection with pectus excavatum.
authors.affiliation: Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kuwata
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Fukuda
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshitatsu
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamada
authors.forename: Ikuko
authors.initials: I
authors.lastname: Shibasaki
authors.forename: Yuho
authors.initials: Y
authors.lastname: Inoue
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hori
authors.forename: Hironaga
authors.initials: H
authors.lastname: Ogawa
authors.forename: Go
authors.initials: G
authors.lastname: Tsuchiya
authors.forename: Riha
authors.initials: R
authors.lastname: Shimizu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takei
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D005660:Funnel Chest / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019616:Thoracic Surgical Procedures / Q000379:methods