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A Simple and Safe Operation Method for Brachiocephalic Artery Aneurysms
Author(s) -
Yoda Masataka,
Kojima Wakako,
Hata Mitsumasa,
Sezai Akira,
Furukawa Nobuyuki,
Minami Kazutomo
Publication year - 2008
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2007.00548.x
Subject(s) - medicine , brachiocephalic artery , ascending aorta , median sternotomy , right common carotid artery , thrombus , aneurysm , cardiopulmonary bypass , anastomosis , common carotid artery , subclavian artery , surgery , aortic arch , cerebral perfusion pressure , cardiology , aorta , perfusion , carotid arteries
A 64‐year‐old man was referred to our hospital due to dyspnea and fever. The chest computed tomogram revealed a 60‐mm aneurysm of the brachiocephalic artery with mural thrombus. The aneurysm of the brachiocephalic artery and the right subclavian artery were exposed through only median sternotomy. Cardiopulmonary bypass with synchronized pulsatile perfusion was established with the ascending aorta and bi‐caval cannulation. A mean arterial pressure was kept at between 60 and 70 mmHg with the unloaded beating heart. Mild hypothermia was induced (blood temperature 27 °C, nasopharyngeal temperature 32 °C). The brachiocephalic artery, right carotid artery, and right subclavian artery were clamped when nasopharyngeal temperature was 32 °C after decreasing blood temperature to 27 °C. After opening the aneurysm, the mural thrombus and calcified aneurysmal wall were removed. First, an ascending aorta to the right common carotid artery bypass was performed using a 16‐8 mm Y‐ prosthetic graft with side‐clamp forceps. After the anastomosis, the right side cerebral perfusion was restarted and the patient was rewarmed. Then the right subclavian artery was anastomosed in an end‐to‐end fashion. The duration of the right side cerebral circulatory arrest was 30 minutes. The patient left hospital seven days after the operation.