We report herein successful treatment of a case of acute type A aortic
dissection complicated by cardiac tamponade and mesenteric malperfusion.
The patient was a 60-year-old man, with back and abdominal pain and in
shock, who was transported to our hospital 2 hours after symptom onset.
Computed tomography revealed DeBakey type I dissection with massive
hemopericardium and obstruction of both the celiac artery and superior
mesenteric artery. After emergency pericardiotomy and removal of the
hematoma, superior mesenteric artery-external iliac artery bypass was
constructed with a vein graft, and this restored mesenteric perfusion.
Open distal hemiarch replacement was then performed. The postoperative
course was uneventful. Superior mesenteric artery revascularization
achieved immediately after release of the cardiac tamponade prevented
further mesenteric ischemia and paved the way for the aortic repair.