New applications of the coronary flow meter. Acute dissection of the ascending aorta with involvement of the supra-aortic trunks: a case report

Isabel Franco-Fernández, Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, España
Alejandra Barreto-Guevara, Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, España
Miguel Rubio-Alonso, Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, España
Ali Ayaon-Albarrán, Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, España
Enrique Villagrán-Medinilla, Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, España

Coronary flow meter is commonly used in myocardial revascularization surgery since it allows an intraoperative assessment of blood flow through the different bypasses performed, ensuring an optimal result of the surgery. However, in cardiovascular surgery, the measurement of intraoperative arterial flows could be applied in other types of surgery other than coronary surgery. We present the case of a 68 years-old female patient diagnosed with Standford type A dissection who underwent urgent surgery, replacing the ascending aorta and aortic arch with an Evita Open Neo® prosthesis with direct reimplantation of the supra-aortic trunks using the Frozen Elephant Trunk technique. Once the prosthesis was implanted, hemostasis was achieved by reinforcing the end-to-end subclavian artery-prosthesis anastomosis with a circumferential pericardial patch, followed by a decrease in blood pressure observed in the monitorization of the radial artery of the left arm. In this situation, blood flow in the left subclavian artery was measured before and beyond the anastomosis, finding a significant decrease. Given the results of the measurement, the patch wad removed from the anastomosis and a second flow measurement was performed, verifying adequate flow distal from the anastomosis and recovery of blood pressure values in invasive monitoring.

Keywords: Aortic dissection. Coronary flow meter. Supra-aortic trunks.