Document Detail

Spinal cord malperfusion caused by using the segmental clamp technique during descending aortic repair for chronic type B aortic dissection.
MedLine Citation:
PMID:  17913766     Owner:  NLM     Status:  MEDLINE    
Several effective strategies for spinal cord protection have been advocated in descending and thoracoabdominal aortic repairs. The segmental clamp technique has been known as a useful adjunct to shorten the duration of spinal cord ischemia. However, we experienced two cases of spinal cord malperfusion during segmental aortic clamping in descending aortic repair for chronic type B aortic dissection. In these patients, the intercostal arteries including the Adamkiewicz artery had originated from the false lumen. In one patient, spinal cord ischemia was initially detected as decreased motor-evoked potentials. Transesophageal echocardiography simultaneously revealed blood flow congestion in the false lumen during segmental aortic clamping and spinal cord ischemia had developed due to malperfusion of the intercostal arteries branching from the false lumen. Segmental clamping in patients with aortic dissection may not always be useful for shortening the duration of spinal cord ischemia. Transesophageal echocardiography as well as motor-evoked potentials is a useful modality for obtaining the details of intraoperative blood flow in dissecting lumens and malperfusion of the intercostal arteries related to spinal cord injury.
Masashi Kawamura; Hitoshi Ogino; Hiroaki Sasaki; Hitoshi Matsuda; Kenji Minatoya; Hiroshi Tanaka; Soichiro Kitamura
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-10-03
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  7     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-31     Completed Date:  2008-02-14     Revised Date:  2008-02-27    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  146-8     Citation Subset:  IM    
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical / methods
Aneurysm, Dissecting / diagnosis,  surgery*
Aortic Aneurysm, Thoracic / diagnosis,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Chronic Disease
Evoked Potentials, Motor
Follow-Up Studies
Magnetic Resonance Angiography
Spinal Cord Ischemia / diagnosis,  etiology*,  surgery
Suture Techniques / adverse effects*,  instrumentation
Thoracic Arteries / surgery*
Tomography, X-Ray Computed
Comment In:
Interact Cardiovasc Thorac Surg. 2008 Feb;7(1):148   [PMID:  18234780 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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