Subtotal thoracic aortic replacement as reoperation for ruptured aortic dissection: report of a case.

We report successful repair of a ruptured chronic aortic dissection in a 63-year-old female who had undergone end-to-end anastomosis for acute type A dissection 8 years before. The patient had hypotension with back pain and cough. A computed tomogram revealed a large chronic aortic dissection (Stanford type A) and complete atelectasis of the left lung due to hemothorax. The brachiocephalic artery was also dissected and aneurysmal. Emergency surgery was performed. Subtotal thoracic aortic replacement with reconstruction of 4 cervical vessels was carried out using hypothermic circulatory arrest with selective cerebral perfusion via a redo-sternotomy and a left anterolateral thoracotomy. The patient was discharged from the hospital without any sequelae.