Repair of acute dissection of the ascending aorta associated with aortic coarctation.

A 54-year-old man with coarctation of the thoracic aorta and acute dissection of the ascending aorta ruptured into the pericardium underwent emergency repair of the dissection by means of replacement of the ascending aorta and the aortic valve. Correction of the aortic coarctation was performed 4 months later. The authors examine the special problems encountered in the treatment of this infrequent clinical emergency, which include decisions on the optimal sequence and timing of repair, on the best surgical exposure, and on the technique and adequacy of circulatory support (especially the choice of the arterial cannulation site.