Intraoperative Malperfusion after Central Repair for Acute Aortic Dissection

A 54-year-old man was hospitalized with sudden occurrence of chest and back pains. Computed tomography revealed a thrombus acute type A aortic dissection. Emergency prosthetic graft replacement of the ascending aorta was performed. After completion of the central repair, intraoperative transesophageal echocardiography showed significant narrowing of the true lumen due to the expansion of the false lumen at the level of the descending thoracic aorta. We successfully performed surgical aortic fenestration at the level of the descending thoracic aorta after the reestablishment of cardiopulmonary bypass. Key words: malperfusion; acute type A aortic dissection; surgical fenestration