PMID: 8969381Sep 1, 1996Paper

Diagnosis and management of cerebral malperfusion phenomena during aortic dissection repair by transesophageal Doppler echocardiographic monitoring

Journal of Cardiac Surgery
G ColettiO Alfieri

Abstract

Early diagnosis and surgical decision making are the key for survival in acute type A aortic dissection (AAD-A). As such, transesophageal echocardiography (TEE) is widely accepted tool in the diagnosis of AAD-A. We used TEE in 49 cases as the sole diagnostic examination of AAD-A since November 1989. It was particularly useful intraoperatively to detect cerebral malperfusion during AAD-A repair. We were able to accurately monitor the blood flow of the aortic arch by using TEE for all patients throughout the operation. Only two patients developed severe cerebral malperfusion after the distal anastomosis was finished under deep hypothermic circulatory arrest. TEE showed that the malperfusion after the bypass was re-established. In both cases the expanded false lumen blocked the true lumen. We immediately switched the perfusion cannula from the femoral artery to the ascending aortic graft to create antegrade flow. The subsequent TEE showed only the flow in the true lumen. One patient recovered without any complication while the other suffered mild, temporary neurological defects. Cerebral malperfusion is a potential catastrophic complication of AAD-A, which may exist before surgery or be caused by the operation itself. We recommend...Continue Reading

References

Jul 1, 1987·British Heart Journal·R ErbelJ Meyer

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Citations

Feb 5, 2000·The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi·Y SakakibaraT Mitsui
Feb 7, 2006·Journal of Cardiothoracic and Vascular Anesthesia·Kazumasa OrihashiKatsuhiko Imai
May 30, 2015·Interactive Cardiovascular and Thoracic Surgery·Roberto Gaeta
May 11, 2006·Journal of Cardiac Surgery·James KuoJonathan Unsworth-White
Jan 1, 2012·Annals of Vascular Diseases·Kazumasa Orihashi
May 18, 2000·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·D A ChungS A Nashef
Mar 25, 2004·AJR. American Journal of Roentgenology·Hélène VernhetPhilippe Douek
Oct 4, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Harish RamEugene A Hessel

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