40 years old male came with c/o pain in chest since 3months.Echocardiogram and CT aortogram showed severe Aortic Stenosis, bicuspid aortic valve, dilated aortic root ascending aortic and arch aneurysm.CT angiogram showed normal coronaries.He underwent Modified Bentall’s operation + ascending aortic replacement and arch replacement under deep hypothermic circulatory arrest with antegrade cerebral perfusion.AORTIC ARCH REPLACEMENT

An aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery.

First, the heart and aorta are accessed by dividing the sternum (breast bone). Then the patient is put on the heart-lung machine and the heart is stopped beating. The circulation through the aortic arch must then be stopped so that the diseased segment can be removed, and a synthetic replacement graft inserted.

Since the circulation is stopped during the repair a number of precautions are taken to prevent brain injury. The patient is cooled to between 18-28 °C, which reduces the activity of cells in the brain and body to a level low enough that prevents injury from occurring for a short time. A separate heart-lung machine circuit is setup, which allows blood to flow to the brain whilst the circulation in the rest of the body is stopped (referred to as “selective antegrade cerebral perfusion”).AORTIC ARCH REPLACEMENT +AORTIC ROOT +ASCENDING AORTA REPLACEMENT


Contributed by: DR. K PRAMOD REDDY