Three-channeled aortic dissection in Marfan syndrome.

ABSTRACT

Among the various types of aortic dissection, three-channeled aortic dissection, in which two adjacent false lumens are present, is rarely observed. The authors surgically treated 20 Marfan syndrome patients with this type of dissection, who accounted for 29.4% of 68 patients with aortic dissection in Marfan syndrome and who were surgically treated in the authors' institution prior to July 1999. Patient age ranged from 24 to 51 years (mean of 40 years). The malefemale ratio was 137. Valved conduit procedure had been performed previously in 14 patients. Pain was observed at various times in 13 patients. Computed tomography scanning and magnetic resonance imaging were useful for preoperative diagnosis. The morphology of the first and second false lumens was Stanford type A + type B in 10 patients and type B + type B in 10 patients. Re-entry of the second false lumen was observed in five patients. The descending aorta was replaced in 13 patients, thoracoabdominal aortic replacement was performed in five, extra-anatomic bypass in one patient and iliac artery-superior mesenteric artery bypass in one. Four patients died in hospital. There were three late deaths during a follow-up of 1-208 months (mean of 51 months). When pain recurs in Marfan patients with aortic dissection, three-channeled dissection should be suspected and subsequent surgery is required. The incidence of this dissection is high in patients with Marfan syndrome.