[Acute aortic dissection after coronary revascularization--a case report].

A 59-year-old man with coronary artery disease and arteriosclerosis obliterans of left lower extremity underwent anastomosis of left internal thoracic artery to left anterior descending artery with cardiopulmonary bypass of aortic perfusion and left femoro-popliteal bypass with saphenous vein graft. On the first postoperative day, urinary output decreased and then stopped. The transesophageal echocardiography and angiography revealed the Stanford A type acute aortic dissection. Immediately the resection of the ascending aorta including the intimal tear, which was found on the site of the previous aortic perfusion, and the reconstruction of the ascending aorta with the prosthetic graft was performed. After the reperfusion of left femoral artery, which was used as the route of the arterial perfusion during cardiopulmonary bypass, serum potassium level increased gradually and at last the heart was arrested. Hemodialysis with draining from inferior vena cava produced the stability of hemodynamics, but on the next day he died of low cardiac output syndrome. We presented the case with the acute aortic dissection after open heart surgery, which was one of the rare complications in aortic perfusion of cardiopulmonary bypass and emphasized the possibility of occurrence of myonephropathic-metabolic syndrome after the repair of acute aortic dissection with limb ischemia.