Asian Cardiovasc Thorac Ann 2007;15:80-81
© 2007 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Treatment of Type A Dissection with Stent-graft
Shang Dong Xu, MD,
Fang Jiong Huang, MD,
Jin Fei Yang, MD,
Jia Hui Du, MD1,
Xue Yong Wang, MD2,
Zhao Guang Zhang, MD
Cardiac Surgery Division
1 Radiology Division
2 Anesthesiology Division, Beijing Institute of Heart, Pulmonary & Vascular Diseases, Capital University of Medical Science affiliated Beijing Anzhen Hospital, Beijing, China
For reprint information contact: Shang Dong Xu, MD Tel: 86 10 6445 6776 Fax: 86 10 6445 6216 Email: xushangdong{at}vip.sina.com, Cardiac Surgery Division, Beijing Institute of Heart, Pulmonary & Vascular Diseases, Capital University of Medical Science affi liated Beijing Anzhen Hospital, Beijing 100029, China.
A 61-year old man was admitted to our hospital because of sudden severe back pain. Computed tomographic angiography (CTA) showed intramural hematoma of the descending aorta (Figure 1
). The patient was treated medically and discharged. He felt good at home. One month later, magnetic resonance angiography (MRA) showed retrograde type A dissection. The intima rupture was 1 cm distal to the opening of the left subclavian artery (LSCA). Thrombus formed in the false lumen of the ascending aorta (Figure 1). Stent-graft implantation was conducted in the catheterization lab under epidural anesthesia. Two stent-grafts were deployed (Microport, Shanghai, China, 32mm x 120mm, 34mm x 60mm) consecutively from distal to proximal with overlapping. The intima rupture was totally sealed. The opening of the LSCA was also occluded (Figure 2). The patient recovered smoothly. Computed tomographic angiography showed totally thrombosed false lumen (Figure 2). The case told us that aortic intramural hematoma could develop into dissection without any symptom. Stent-graft was effective in the treatment of some retrograde type A dissection.
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Figure 1. Top: CTA of the patient when first admitted to the hospital; intramural hematoma could be seen in the descending aorta. Lower: MRA of the patient one month later. Retrograde type A dissection could be seen. The false lumen in the ascending aorta was totally thrombosed. CTA=Computed tomographic angiography; MRA=Magnetic resonance angiography.
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Figure 2. Top: Angiography during the procedure. Top left: Aortography before stent-graft deployment. The rupture was distal to the LSCA. False lumen could be seen involving the aortic arch and descending aorta. Top right: Aortography after stent-graft deployment. No false lumen could be seen. The opening of the LSCA was occluded. Lower: CTA of the patient one week after stent-graft implantation. The false lumen was totally thrombosed. Lower left: Cross section of the thoracic aorta. Lower right: Three dimension reconstruction of the thoracic aorta. LSCA=Left subclavian artery; CTA=Computed tomographic angiography
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