Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Mar;199(3):358–362. doi: 10.1097/00000658-198403000-00018

Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome.

E S Crawford, J L Crawford, C L Stowe, H J Safi
PMCID: PMC1353405  PMID: 6231006

Abstract

Total aortic replacement including aortic valve was performed successfully in the two patients in whom this method of treatment was utilized to correct a chronic dissecting aortic aneurysm. Both patients had moderately severe aortic insufficiency producing increasing heart strain and progressive enlargement of the false lumen of aortic dissection involving the entire aorta despite ideal blood pressure control. In addition, one patient had Marfan's syndrome. The surgical treatment for both patients was performed in two stages. At the first operation, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were employed while the aortic valve and the ascending and transverse aortic arch were replaced and the coronary and brachiocephalic vessels were reattached to the composite valve-graft used for replacement. At the second operation, the entire descending thoracic and abdominal aortic segments were replaced with a graft and the intercostal, lumbar, and visceral arteries reattached thereto. Left vocal cord paralysis occurred in both patients and transient mild paraparesis occurred in only one. Both patients are alive and well, one at 13 months and one at 6 weeks. This experience suggests an additional treatment modality for selected patients with complications of chronic aortic dissection.

Full text

PDF
359

Images in this article

359Fig. 1.
on p.359
360Fig. 2.
on p.360

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anagnostopoulos C. E., Prabhakar M. J., Kittle C. F. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972 Aug;30(3):263–273. doi: 10.1016/0002-9149(72)90070-7. [DOI] [PubMed] [Google Scholar]
  2. Crawford E. S., Cohen E. S. Aortic aneurysm: a multifocal disease. Presidential address. Arch Surg. 1982 Nov;117(11):1393–1400. doi: 10.1001/archsurg.1982.01380350001001. [DOI] [PubMed] [Google Scholar]
  3. Crawford E. S., Saleh S. A. Transverse aortic arch aneurysm: improved results of treatment employing new modifications of aortic reconstruction and hypothermic cerebral circulatory arrest. Ann Surg. 1981 Aug;194(2):180–188. doi: 10.1097/00000658-198108000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crawford E. S., Snyder D. M., Cho G. C., Roehm J. O., Jr Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries. Ann Surg. 1978 Sep;188(3):404–422. doi: 10.1097/00000658-197809000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Crawford E. S., Snyder D. M. Treatment of aneurysms of the aortic arch. A progress report. J Thorac Cardiovasc Surg. 1983 Feb;85(2):237–246. [PubMed] [Google Scholar]
  6. Crawford E. S. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974 May;179(5):763–772. doi: 10.1097/00000658-197405000-00032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DeBakey M. E., McCollum C. H., Crawford E. S., Morris G. C., Jr, Howell J., Noon G. P., Lawrie G. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982 Dec;92(6):1118–1134. [PubMed] [Google Scholar]
  8. Ergin M. A., O'Connor J., Guinto R., Griepp R. B. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg. 1982 Nov;84(5):649–655. [PubMed] [Google Scholar]
  9. HIRST A. E., Jr, JOHNS V. J., Jr, KIME S. W., Jr Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958 Sep;37(3):217–279. doi: 10.1097/00005792-195809000-00003. [DOI] [PubMed] [Google Scholar]
  10. Roberts W. C. Aortic dissection: anatomy, consequences, and causes. Am Heart J. 1981 Feb;101(2):195–214. doi: 10.1016/0002-8703(81)90666-9. [DOI] [PubMed] [Google Scholar]
  11. WHEAT M. W., Jr, PALMER R. F., BARTLEY T. D., SEELMAN R. C. TREATMENT OF DISSECTING ANEURYSMS OF THE AORTA WITHOUT SURGERY. J Thorac Cardiovasc Surg. 1965 Sep;50:364–373. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES