[HSF] Aortic Dissection early after AVR with CABG

[Tohru Asai]

Dear friends
Thanks for many thoughtful comments.

Concerning my case, I can clearify one thing.
At initial surgery, I had constructed the proximal anastomosis of saphenous
vein during the cross clamp. I rarely use the partial occlusion clamp in
such a combined procedure. The extra 5 to 10 minutes of cardioplegic arrest
have never caused additional problem, therefore I always use a single clamp
technique.

With my decision to go back OR, I obtained two precious things.

One is the understanding of the cause of the aortic dissection in the case.
The 2 heel bites of SV to PDA was only holding adventitia, and the very site
was where the intimal tear originated. Again I did not use the partial
occlusion clamp. Aorta was indeed elongated and tortulous, but aortic valve
was 3 cuspid and aortic diameter did not exceed 5 cm.

The other is a smile of the patient. I just got back from making round to
see him walking around after dinner with smiling without anxiety of aortic
rupture.  His recovery following the second operation was fortunately
uneventful. He started to eat regular diet on POD#1 and OOB.

Thank you all.
-- 
Tohru Asai
Shiga University of Medical Science
Otsu, Japan