Successful treatment of ruptured giant aneurysm of the aortic arch--usefulness, disadvantages and controversies of the thromboexclusion method with a permanent long aortic bypass
Maeta, H.; Murayama, F.; Fukuda, I.; Mitsui, T.; Hori, M.
Nihon Kyobu Geka Gakkai 32(10): 1872-1879
1984
ISSN/ISBN: 0369-4739 PMID: 6520456 Document Number: 241257
A 51-yr-old male with ruptured giant aneurysm of the aortic arch was successfully operated upon the ascendoabdominal aortic bypass grafting combined with exclusion of the aneurysm. It was useful for the treatment of ruptured one, because the operation could be carried out neither with direct maneuver to the aneurysm nor extracorporeal circulation. Postoperatively, however, a rapid progressive concentric hypertrophy of the left ventricle was observed. Post-operative catheterization revealed elevated systolic pressure and decreased diastolic pressure in the aortic root. Furthermore, at the closed blind end in the descending aorta, systolic pressure was elevated with a peaking and steepening phenomenon. Woven Dacron graft used for the long aortic bypass can not be extended to a radius axis in the cardiac ejection phase and, therefore, does not give the Windkessel effect. Loss of the Windkessel effect and abrupt interruption of the descending aorta increase systolic pressure in the aortic root and descending aorta, and decrease diastolic pressure in the aortic root. Although orifice of the graft (22 mm in diameter) is wide enough, it may result in increase in impedance to flow. Formation of a complicated secondary or turbulent flow due to the angular end-to-side anastomosis may increase energy loss of the cardiac ejection work. As the results, since all those factors increase the afterload of the left ventricle in systole and decrease the coronary flow in diastole, myocardial hypertrophy or ischemic damage may occur as an unfavorable reaction to the patient's overloaded heart. The pressure increase in the descending aorta may lead to rupture of the aneurysm on the use of Carpentier's method. Those observations have never been described before. This study will lead a benefit of a new artificial vascular graft compliant and extensible to the radius axis coincident with blood ejection, not so elongated longitudinally.