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J Thorac Cardiovasc Surg 2009;138:771-773
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Successful emergency surgery for coexistent acute aortic syndrome and acute carotid artery obstruction

Masahiko Ando, MD*, Kazuhito Imanaka, MD, Hideaki Yamabi, MD, Hiroshige Sato, MD

Department of Cardiovascular Surgery, Saitama Medical Center, Saitama, Japan

Received for publication May 11, 2008; revisions received May 11, 2008; accepted for publication May 26, 2008.

* Address for reprints: Masahiko Ando, MD, 1981 Tsujido-machi, Kamoda, Kawagoe-shi, Saitama 350-8550, Japan. (Email: masandoo@hotmail.com).

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


   Introduction
 
Few surgeons advocate surgical intervention for patients with acute aortic syndrome and coma, especially on an emergency basis, because of very poor outcome.1Go We herein describe an emergency operation for a comatose and hemiplegic octogenarian in a state of profound shock caused by rupture of a penetrating aortic ulcer (PAU) in the ascending aorta. Duplex scanning disclosed a slightly mobile thrombus nearly impacting into the right internal carotid artery. This patient successfully underwent replacement of the ascending aorta and right carotid endarterectomy concomitantly. Removal of this thrombus appeared to be highly beneficial. Preoperative evaluation of the carotid arteries has priority in patients with acute aortic syndrome and some neurologic deficits.


   Clinical Summary
 
An 82-year-old man with a history of hypertension suddenly fell unconscious and exhibited left hemiplegia. He was transferred to our emergency care unit in a state of profound shock. Echocardiographic analysis revealed cardiac tamponade, which necessitated immediate surgical drainage. Computed tomographic scanning of the chest demonstrated . . . [Full Text of this Article]






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