title: [Intra-operative Acute Aortic Dissection during Aortic Root Reimplantation and Mitral Valve Reconstruction Surgery in a Patient with Marfan Syndrome;Report of a Case].
abstract: In patients with Marfan syndrome, cardiovascular complication due to aortic dissection represents the primary cause of death. Iatrogenic acute aortic dissection during cardiac surgery is a rare, but serious adverse event. A 51-year-old woman with Marfan syndrome underwent elective aortic surgery and mitral valve reconstruction surgery for the enlarged aortic root and severe mitral regurgitation. We replaced the aortic root and ascending aorta based on reimplantation technique. During subsequent mitral valve reconstruction, we found the heart pushed up from behind. Trans-esophageal echocardiography revealed a dissecting flap in the thoracic descending aorta. There was just weak signal of blood flow in the pseudolumen. We did not add any additional procedures such as an arch replacement. Cardio-pulmonary bypass was successfully discontinued. After protamine sulfate administration and blood transfusion, blood flow in the pseudolumen disappeared. The patient was successfully discharged from the hospital on 33th postoperative day without significant morbidities.
authors.affiliation: Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Japan.
authors.forename: Chikao
authors.initials: C
authors.lastname: Teramoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Kawaguchi
authors.forename: Yoshimori
authors.initials: Y
authors.lastname: Araki
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Wataru
authors.initials: W
authors.lastname: Uchida
authors.forename: Gennta
authors.initials: G
authors.lastname: Takemura
authors.forename: Naoki
authors.initials: N
authors.lastname: Makino
mesh_terms: D000208:Acute Disease; D001011:Aorta / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications*; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012092:Replantation; D014057:Tomography, X-Ray Computed