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IMAGES IN CLINICAL PRACTICE
Year : 2016  |  Volume : 2  |  Issue : 3  |  Page : 158-159

Concomitant bentall-de bono procedure plus total arch replacement and coronary artery bypass grafting in acute aortic dissection


1 Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
2 Department of Anesthesiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Dr. Nayem Raja
Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-7438.191689

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  Abstract 

We report the images of a case of a 31-year-old male presented with acute Type A aortic dissection with severe aortic regurgitation involving the arch vessels. He was taken up for surgery on cardiopulmonary bypass (femoro-axillary-bicaval). Bentall-De Bono procedure with mechanical aortic valved conduit and total arch replacement with woven polyester branched graft under hypothermic circulatory arrest plus selective antegrade cerebral perfusion was performed. Reversed saphenous venous graft to proximal right coronary artery grafting was also performed.

Keywords: Bentall, selective antegrade cerebral perfusion, total arch replacement


How to cite this article:
Raja N, Agarwal A, Satyarthy S, Padhy AK, Datt V. Concomitant bentall-de bono procedure plus total arch replacement and coronary artery bypass grafting in acute aortic dissection. MAMC J Med Sci 2016;2:158-9

How to cite this URL:
Raja N, Agarwal A, Satyarthy S, Padhy AK, Datt V. Concomitant bentall-de bono procedure plus total arch replacement and coronary artery bypass grafting in acute aortic dissection. MAMC J Med Sci [serial online] 2016 [cited 2019 Sep 22];2:158-9. Available from: http://www.mamcjms.in/text.asp?2016/2/3/158/191689


  Case Summary Top


A 31-year-old male presented with acute Type A aortic dissection with severe aortic regurgitation involving the arch vessels as confirmed by clinical examination, transthoracic echocardiography, and computerized tomography (CT) angiography [Figure 1]a. The patient was taken up for surgery on cardiopulmonary bypass (CPB) (femoro-axillary-bicaval). Intraoperatively, the intimal dehiscence was seen just above the right coronary cusp of the aortic valve with the dissection flap extending up to just distal to the origin of the left subclavian artery, and also the dissection was extending to the right coronary artery (RCA) [Figure 2]a. Under cold cardioplegic arrest, Bentall procedure was performed with mechanical aortic valve conduit and under hypothermic circulatory arrest plus selective antegrade cerebral perfusion (SACP) [Figure 3], total arch replacement with #24 gelatin-impregnated woven polyester branched graft [[Figure 2]b:Inset] was performed. Reversed saphenous venous graft to proximal RCA was performed [Figure 2]b. Total CPB time was 333 min with aortic cross-clamp time of 257 min. SACP time was 25 min. Postoperatively, the patient was extubated in <24 h with an uneventful recovery. Postoperative CT angiography revealed normal reconstruction of the ascending aorta, arch, and the arch vessels [Figure 1]b.
Figure 1: Images of multiplanar computerized tomography angiography of the heart and great vessels: (a) Preoperative coronal section multiplanar image of the Type A aortic dissection involving the arch vessels extending from the aortic root up to just distal to the origin of the left subclavian artery with an aneurysmal ascending aorta. (b) Postoperative three-dimensional reconstructed computerized tomography angiography image showing the reconstructed ascending aorta, aortic arch, and arch vessels, with the reversed saphenous venous graft to proximal right coronary artery

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Figure 2: Intraoperative images showing the Type A aortic dissection with aneurysmal ascending aorta (a) and the image after concomitant Bentall procedure with total arch replacement with coronary artery bypass grafting (b). Inset: gelatin-impregnated 24 Fr branched polyester graft

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Figure 3: The schematic representation of the perfusion strategy adopted during the surgery

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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