RESUMEN
The optimal management of Stanford type A accute aortic dissection (TAAAD) with mesenteric malperfusion (TAAADwM) is controversial. Our strategy of TAAADwM is open superior mesenteric artery (SMA) bypass prior to aortic repair, if we suspect TAAADwM on computed tomography (CT) scan, whatever other findings might be or not. The need of treatment of mesenteric malperfusion prior to aortic repair is not always linked with digestive symptom, lactate, intraoperative finding. The mortality of 14 patients with TAAADwM was 21.4%, which was an allowable result. Our strategy might be proper at instances of, allowable time for management of open SMA bypass, unnecessarily of endovascular treatment, confirming an enteric property and ability to respond to a rapid hemodynamic change.
Asunto(s)
Disección Aórtica , Procedimientos de Cirugía Plástica , Humanos , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Ácido Láctico , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The patient was a 76-year-old man with myasthenia gravis (MG). He suffered from a sudden back pain, and was diagnosed with Stanford type A acute aortic dissection. We performed emergency graft replacement of the ascending aorta under cardiopulmonary bypass with hypothermic circulatory arrest. A neuromuscular blocking agent was administered only once at tracheal intubation. The operation was completed without incident. A neuromuscular antagonist was administered once just after the operation. Fifteen hours after the operation, the tracheal tube was extubated. His postoperative course was uneventful and he has been well for three years since the operation. This is a very rare surgical case report of acute aortic dissection with MG.