Surgical Correction of Dissecting Aneurysm of Ascending Aorta... (Baylor College of Medicine, 1963)

This program presents a case of a thirty year old man with Marfan's syndrome to illustrate the surgical procedure for correcting a dissecting aneurysm of the ascending aorta with aortic valvular insufficiency. The patient's preoperative physical findings and aortograms which indicate the need for this surgery are presented. In this instance the entire ascending portion of the aorta is involved. The transverse and descending aorta are not considered unusual. General endotracheal anesthesia and cardiopulmonary bypass are used and the chest is entered through a median sternotomy incision. The pericardium is incised longitudinally. A woven, crimped dacron graft is placed with over-and-over sutures in the place in the ascending aorta from which the aneurysm has been excised. In this case the cusps of the aortic valve had prolapsed. As a result, the graft was sutured in such a way to both the inner and outer walls of the aorta as to pull the prolapsed cusps back from within the ventricle. The distal anastomosis is done before the proximal. Drawings are also used to aid in the visualization of the pathological features of the aneurysm and the surgical procedure. The patient's uneventful postoperative course is briefly described. Retrograde radiographs done reveal satisfactory function of the graft without aortic valvular insufficiency.

1963)