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[A clinical experience of signs of compression in the neighboring organs after operation with Carpentier's method in dissecting aneurysm of the aorta].

A patient with a DeBakey IIIb type dissecting aneurysm of the aorta was treated with Carpentier's method. But after surgery the thromboexclusion procedure at the pseudo-lumen was insufficient. Fourteen months after surgery the left lung area suddenly became opaque, suggesting the possibility of impending rupture of the aneurysm. Therefore the patient underwent emergency surgery in which another permanent clamp was attached to the peripheral end of the aneurysm. After this operation, the aneurysm became reduced in size and the left lung inflated again, but an aorto-pulmonary fistula was formed 24 days later. After 6 months after second surgery, the patient began to experience dysphagia and dyspnea on exertion. Detailed examinations showed that these symptoms were caused by compression of the esophagus, bronchus and pulmonary artery by the permanent clamp. That is, this clamp, which possibly moved during organic change and size reduction of the aneurysm, seems to have compressed the adjoining organs enough to cause dysfunction. Such a compression of the neighboring organs can be regarded as one of problems originating from Carpentier's method, and shows that the procedure is not problem free yet.