title: Emergent total arch replacement for acute type A aortic dissection with aberrant right subclavian artery in a systemic lupus erythematosus patient.
abstract: A 50-year-old man with a history of systemic lupus erythematosus and hemodialysis developed acute type A aortic dissection. Computed tomography demonstrated acute type A aortic dissection with chronic distal arch aneurysm and aberrant right subclavian artery that arose from the proximal descending aorta and ran in a retro-esophageal track. Emergent total arch replacement was performed using antegrade cerebral perfusion with circulatory arrest. Both common carotid arteries and the left subclavian artery were chosen as selective cerebral perfusion sites. The right subclavian artery was snared during cerebral perfusion. The right subclavian artery was reconstructed with the right common carotid artery in an end-to-side fashion in the anterior mediastinum. The patient's postoperative course was uneventful, and computed tomography showed excellent blood flow to all four branches. The case description is followed by a discussion of cerebral protection, reconstruction route of the right aberrant subclavian artery and steroids for systemic lupus erythematosus.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan. kitamura@heart-center.or.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
authors.forename: Arishige
authors.initials: A
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fukaya
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Okawa
authors.affiliation: Department of Cardiovascular Surgery, Kansai Heart Center, Takanohara Central Hospital, Ukyo 1-3-3, Nara, Nara, 631-0805, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Komeda
mesh_terms: D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D018376:Cardiovascular Abnormalities / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003680:Deglutition Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Aberrant right subclavian artery; Acute aortic dissection; Systemic lupus erythematosus