ACUTE AORTIC DISSECTION TYPE-A AFTER CORO NARY-ARTERY BYPASS-GRAFTING

A 63-year-old man with a history of hypertension and coronary artery b ypass grafting (1 year ago) was admitted with acute onset severe chest pain suggesting bypass dysfunction. Biplane cineangiography revealed acute aortic dissection Stanford Type A without involvement of the aor tic valve, the coronary arteries or the proximal anastomoses of the tw o venous bypass grafts, one of which was occluded. Urgent repair of th e aorta by a prosthesis and reinsertion of the patent venous graft in the innominate artery by interposition of saphenous vein was performed without complications. Sixteen months later on routine follow-up a ps eudoaneurysm of the ascending aorta surrounding the aortic prosthesis was discovered by transesophageal echocardiographic examination. Reope ration was performed with prosthetic replacement of the ascending aort a. The operative course and further follow-up of now 1.5 years were un eventful.