Surgery for Three-Channeled Aortic Dissection.

Abstract

Among aortic dissections, three-channeled aortic dissection, in which two parallel false lumens are present, is relatively rare. We surgically treated 26 patients with this type of dissection, they accounted for 7.4% of all 349 patients with aortic dissection surgically treated between 1978 and May 1997. Their ages ranged from 24 to 77 years (mean 45 years). The male/female ratio was 1:1. Marfan's syndrome was present in 15 patients and Bentall's-type operation had been performed in 12 patients. Pain at different times was observed in 19 patients. For preoperative diagnosis, computed tomography (CT) and magnetic resonance imaging (MRI) were useful. The morphology of the 1st and 2nd false lumens was Stanford type A + type B in 11 patients, type B + type B in 12, type A + type A in 2, and localized abdominal dissection in 1. Reentry of the second false lumen was observed in only 3 patients. Descending aortic replacement was performed in 13 patients, thoracoabdominal aortic replacement in 6, ascending aortic replacement in 3, and others in 4. Seven patients died in the hospital. There were 4 late deaths during follow-up for 10-158 months (mean, 58 months). When pain recurred in patients with aortic dissection, three-channeled dissection should be suspected. The incidence of this dissection is high in patients with Marfan's syndrome.