Incidental retroaortic innominate vein in a patient with acute aortic dissection
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(2020) 15:272
CASE REPORT
Open Access
Incidental retroaortic innominate vein in a patient with acute aortic dissection Hideki Sasaki1* , Takashi Harada1, Hiroshi Ishitoya1 and Osamu Sasaki2
Abstract Background: Retroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare. Case presentation: A 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement. Conclusions: Attention must be paid to the cannulation site for venous uptake and the method of myocardial protection. Keywords: Retroaortic innominate vein, Acute aortic dissection
Background Retroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, an isolated retroaortic innominate vein is quite rare. We present a patient with a diagnosis of Stanford type A acute aortic dissection in whom a retroaortic innominate vein was incidentally found on computed tomography. Case presentation A 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection (AAAD). Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava (SVC) on contrast-enhanced computed tomography (CT) (Fig. 1). We decided to perform emergent surgery. Median sternotomy approach was used. After the pericardium was opened, we confirmed that the left innominate vein coursed beneath the aortic arch. We established cardiopulmonary bypass * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, Ehime Prefectural Central Hospital, 83 Kasuga-cho, Matsuyama, Ehime 790-0024, Japan Full list of author information is available at the end of the article
(CPB) using right subclavian and left femoral artery inflow with right atrial (RA) drainage. Both antegrade cardioplegia and retrograde cardioplegia were used for myocardial protection. A retrograde cardioplegic cannula was inserted into the coronary sinus under transesophageal echo (TEE) guidance. Hemiarch replacement was performed with hypothermic circulatory arrest (bladder temperature 25 °C). An intimal tear was found in the small curvature of the proximal aortic arch, which was excluded. Antegrade selective cerebral perfusion was commenced for brain protection. Circulatory arrest time was 51 min. Aortic cross clamp time was 117 min, with CPB time of 211 min. The subsequent postoperative course was uneventful. The patient was discharged from our institution on the 18th postoperative day. We have followed him in the outpatient clinic.
Discussion The left innominate vein is usually located anterosuperior to the aortic arch, and connect
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