[A case report of successful management of intraoperative aortic dissection during aorta-coronary bypass and aortic valve replacement].

A 70-year-old woman underwent aortic valve replacement and coronary artery bypass surgery with a saphenous vein graft for aortic regurgitation and 99% stenosis in the right coronary artery. During the period of weaning from the cardiopulmonary bypass enlargement of the ascending aorta and bleeding from the suture line were observed. The intraoperative diagnosis of ascending aortic dissection (DeBakey type I) was made with transesophageal and transthoracic echocardiography. Cardiopulmonary bypass was reinstituted and the patients was cooled to 20 degrees C. Under circulatory arrest and continuous retrograde cerebral perfusion through the superior vena cava the intimal tear at the point of infusion cannula was removed and the ascending aorta was reconstructed by direct suture bolstered with Teflon felt strips. Following completion of the repair no further dissection was seen, and the patient was successfully weaned from cardiopulmonary bypass. There were no signs of neurologic complications. Although intraoperative aortic dissection is uncommon, it can be a fatal iatrogenic complication of cardiac operations. Prompt recognition and surgical repair of the injuries are essential to achieve a successful outcome. The combination of transesophageal echocardiography and transthoracic echocardiography permits the immediate diagnosis of aortic dissection. And it is suggested that continuous retrograde cerebral perfusion through the superior vena cava protects the brain for 52 minutes of cerebral circulatory arrest at the lowest nasopharyngeal temperature of 18.7 degrees C. This technique is simple, and required neither special preoperative preparation or special equipment, so that it is suitable especially for intraoperative aortic dissection such as this case.