[Acute type A dissection of the ascending aorta after aortocoronary bypass operation].

A 63-year-old man with a history of hypertension and coronary artery bypass grafting (1 year ago) was admitted with acute onset severe chest pain suggesting bypass dysfunction. Biplane cineangiography revealed acute aortic dissection Stanford Type A without involvement of the aortic valve, the coronary arteries or the proximal anastomoses of the two venous bypass grafts, one of which was occluded. Urgent repair of the aorta by a prosthesis and reinsertion of the patent venous graft in the innominate artery by interposition of saphenous vein was performed without complications. Sixteen months later on routine follow-up a pseudoaneurysm of the ascending aorta surrounding the aortic prosthesis was discovered by transesophageal echocardiographic examination. Reoperation was performed with prosthetic replacement of the ascending aorta. The operative course and further follow-up of now 1.5 years were uneventful.