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J Thorac Cardiovasc Surg 2004;127:1530-1531
© 2004 The American Association for Thoracic Surgery

Brief communication

Direct cerebral perfusion and myocardial protection with moderate systemic hypothermic arrest for high descending aortic aneurysm

^a Department of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy,
^b Department of Cardiac Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy

Received for publication September 20, 2003; revisions received November 12, 2003; accepted for publication November 19, 2003.

^* Address for reprints: Germano Melissano, MD, IRCCS H. San Raffaele, Department of Vascular Surgery, Via Olgettina, 60, Postal Code 20132, Milan, Italy
g.melissano@hsr.it

The first 20% of the full text of this article appears below.

Hypothermic circulatory arrest (CA) allows treatment of aneurysms of the descending thoracic aorta (DTA) that involve the distal aortic without a neck that may be clamped.^1,2 Deep hypothermia has several drawbacks, however, particularly coagulopathy. Selective cannulation and blood perfusion of supra-aortic vessels (SAVs) provides excellent cerebral protection at temperatures as high as 26°C.³ At this temperature, however, myocardial protection is advisable. We describe a simple technique to replace the distal aortic arch and proximal DTA through a left thoracotomy with CA at 26°C, while the brain is perfused and the heart is protected with cardioplegia without isolation of the ascending aorta.

Clinical summary

A 35-year-old white man had a history of hypertension. A chest radiograph suggested aortic enlargement, and computed tomographic scan showed a 7.3-cm calcified aneurysm of the DTA without intraluminal thrombus involving the distal aortic arch and ectasia of the proximal left subclavian artery (2.3 cm) and of the ascending aorta (5.2 cm). Magnetic resonance angiography provided better understanding of the anatomy (Figure 1, A). The ejection fraction was (40%), with normal coronary arteries and mild aortic and . . . [Full Text of this Article]

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				I. Dorotta, P. Kimball-Jones, and R. Applegate II Deep hypothermia and circulatory arrest in adults. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 66 - 76. [Abstract] [PDF]