Document Detail

Innovative hybrid procedure for dissection thoracic aorta in a patient with a previous bentall operation.
MedLine Citation:
PMID:  19212026     Owner:  NLM     Status:  MEDLINE    
AIMS AND OBJECTIVES: In dissection aorta involving the whole aorta from the left subclavian artery surgical repair may be a high risk procedure while an endovascular procedure would not be feasible by itself in view of the absence of a safe landing zone and the risk of blocking the brain and arm circulation. A hybrid procedure is presented to tackle such a problem. METHODS: A 42-year-old Marfan, with a previous history of a Bentall procedure 10 years back, presented with acute thoracic aortic dissection. Investigations revealed a large dissection starting from the left subclavian to the right renal artery. Since a safe landing zone was required which would block off the arch vessels, first a redo sternotomy was performed and under femoro-femoral cardio-pulmonary bypass (CPB), a short segment of Dacron graft was interposed between the previous Bentall graft and the arch of aorta. On to this graft, 2 additional grafts were anastomosed. A 14 X 9 bifurcated graft to go to the right brachiocephalic and the left common carotid, and a 9 mm side arm to facilitate the positioning of the endograft. After coming off CPB, a guide wire was manipulated from the femoral artery into the side graft with a snare and the endograft was inserted. RESULTS: The false lumen was successfully obliterated. The patient made a complete recovery with no neurological deficit. CONCLUSIONS: A hybrid procedure with an innovative technique of preserving the brain and arm circulation and a new technique of facilitating proper positioning of the endostent with a side arm conduit is presented.
Harinder Singh Bedi; Bhupender Singh Sengar; Rahul Sheth
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Indian heart journal     Volume:  60     ISSN:  0019-4832     ISO Abbreviation:  Indian Heart J     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2009-02-12     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374675     Medline TA:  Indian Heart J     Country:  India    
Other Details:
Languages:  eng     Pagination:  61-3     Citation Subset:  IM    
Ludhiana Mediciti, Ferozpur Road, Ludhiana, Punjab, India.
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MeSH Terms
Angioplasty / methods*
Aorta, Thoracic*
Aortic Rupture / etiology,  surgery*
Blood Vessel Prosthesis Implantation / methods*
Marfan Syndrome / complications,  surgery

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