弓部置換術後に脳ヘルニアを発症したStanford A型急性大動脈解離の1例

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  • A Stanford Type A Acute Aortic Dissection with Cerebral Herniation after an Aortic Arch Replacement

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Stanford type A dissection has a poor prognosis. Moreover, when it is associated with branch ischemia, the reported short-term mortality rate is high: 30%–50%. We report a case of unsuccessful emergency treatment of a patient with type A aortic dissection with brachiocephalic artery ischemia in whom cerebral herniation developed after aortic arch replacement. Case: A 63-year-old woman was admitted to our hospital with a diagnosis of cerebral infarction. However, on hospital day 2, she lost consciousness and a left conjugate deviation developed. Aortic dissection was diagnosed on the basis of computed tomographic (CT) images, which revealed a depression of the brachiocephalic artery by a false lumen. Because the patient appeared to recover consciousness, emergency aortic arch replacement was performed. However, although the patient temporarily regained consciousness postoperatively, her consciousness steadily deteriorated again. CT revealed a massive cerebral edema and brain herniation, and the patient died on day 9 postoperatively. In patients with type A aortic dissection associated with widespread cerebral infarction, surgery should be performed if the cerebral edema improves, and if this is not possible, an attempt should be made to perform external decompression, or ligate the common carotid artery.

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