[HSF] Aortic Dissection early after AVR with CABG

[Tohru Asai]

The operation literally took 5 hours. The right femoral a and v are ready 
prior to sternal reentry. The most nasty adhesion was between left lung and 
left hemisternum. Care was taken to dissect adhesion step by step. After a 
part of right atrium exposed, I went on CPB with femoral arterial cannula 
and femoral v and SVC via right appendage. Performed rest of dissection 
around the ascending aorta on pump. Cooled down to 20C followed by circ 
arrest. To open aorta, I found transverse intemal tear posteriorly 
initiating from heel bite of PDA saphenous vein graft. Aortotomy closure 
line, which I always do very low, appeared intact.

As usual, open distal anastomosis with felt reinforced distal aortic stamp 
and Gelweave graft was performed at the level just below the innominate 
take-off. GRF was used to obliterate remained distal pseudolumen. The 
proximal aorta was anastomosed in the same manner, but without touching 
previous aortotomy closure line. Lastly saphenous vein was anastomosed to 
the graft.

I am cautiously optimistic that he will do well.
(BTW Michael, those CT pictures were obtained by 16 slice (not 64). It is 
still good with nice preparation! Great to see you in NY.)
ciao
----
Tohru Asai
PS. I upload serial pictures.
op1: at the first operation before AVR with CABG
op2: at the first operation after AVR with CABG
op3: at the second operation before circ arrest
op4: at the second operation inside the aorta
op5: at the second operation after completing procedure 
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