A54 year old gentleman was referred to me with progressive dyspnea and chest pain for one month. His echocardiography was suggestive of aortic dissection with aortic regurgitation. We diid a CECT of the chest which showed a chronic dissecting aneurysm of aorta measuring 8.5 cm. His echo also revealed a severe aortic regurgitation with dilated LV but normal EF.
A chronic aortic aneurysm may occur in patients who survive acute aortic dissection. In acute aortic dissection the layers of aorta split creating true and false lumens. In patients who survive or are not operated the weak aortic wall dilates with time and leads to aneurysm formation. The loss of support to aortic leaflets leads to development of aortic regurgitation. The tretment of this condition is surgery as rupture of aneurysm can cause sudden death.
The surgical procedure entails excising all diseased tissue i.e. aneurysmal aorta, aortic valve and replacing it with a prosthetic conduit and valve. The coronarie have to be reimplanted on to this conduit. This is the Bentalls operation. In this case however due to the large diameter of aneurysm and dense adhesions between aorta and pulmonary artery, coroary button fashionon for Bentall seemed impossible. I therfore chose to perform a Cabrols procedure. In this operation the aortic valved and aorta are replaced with a conduit the coronaries however are not implanted as buttons. They are connected with another graft which is then connected to aortic graft.
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| Cabrols Procedure |
The procedure went well and the patient discharged in a weeks time.
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| Post op CT showing replace aorta and coronary graft |
