CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
e3
After sufficient haemostasis was achieved, the chest was closed.
The hemispheric antegrade cerebral perfusion time was 35
minutes during the open aortic technique. The average aortic
cross-clamp time was 63 minutes. The right radial artery
pressure was maintained at 35 to 60 mmHg during the operation.
On the first postoperative day, the patient regained
consciousness, and the endotracheal tube was extubated on the
second postoperative day. A postoperative enhanced CT showed
no abnormal findings at the anastomotic site of the prosthesis,
and no residual aortic dissection. The pathological diagnosis was
aortic dissection without cystic medial necrosis. The patient was
discharged on postoperative day 10 without any problems.
Discussion
Diseases of the aorta are important contributory factors for
morbidity and mortality, and are related to cardiovascular
disease. One of these diseases is aortic dissection (AD), with
a prevalence of five to 30 cases per million people per year. It
is an exceptionally lethal condition. Almost three quarters of
AD cases affect the ascending aorta and this, in the acute phase
of the disease, carries a high risk of serious complications.
Patients with aortic dissection may also present with acute aortic
regurgitation, cardiac dysfunction, congestive heart failure,
ischaemia to various organs, and neurological deficits.
The few patients who survive the initial phase of an untreated
type II aortic dissection have an extremely high long-term risk of
mortality and often have clinical findings different from those of
acute dissections. Many patients with aortic dissection die before
hospital admission. Mortality has been estimated at 1–2% per
hour during the first two days.
Early clinical recognition is crucial for emergency (usually
surgical) management of these cases. However, in up to 38% of
patients, the diagnosis is missed on initial clinical evaluation. In
more than 20% of patients, the diagnosis is made only at autopsy,
and few have been reported as chronic dissections. Meticulous
diagnostic imaging and urgent surgical treatment are essential to
improve survival.
1,2
Aneurysms of the ascending aorta are generally caused by
Marfan’s syndrome, post-stenotic dilatation in aortic valve
disease, aortic arteriosclerosis, or chronic aortic dissection.
The relationship between aortic aneurysm and chronic aortic
dissection of the ascending aorta is one of a high rate of
in-hospital mortality and poor long-term survival. Aneurysms
caused by chronic aortic dissection are quite rare. The incidence
of chronic ascending aortic dissection ranges from 21–31% in
clinical and pathological series, and these include patients with
previous cardiac surgery.
Fig. 3.
Intra-operative photo after the aortotomy illustrates the
dissection with extensive involvement of the ascend-
ing aorta.
Fig. 4.
Postoperative view following ascending tubular graft
replacement.
