Discussion
Although extremely rare, FET malposition into the FL is reported to be a
fatal complication. Most cases of FET malposition into the FL were
diagnosed using postoperative CT.2-4 Tamai et al.
reported a case of FET malposition diagnosed by TEE during circulatory
arrest that was successfully treated by additional FET deployment into
the TL.5 In our case, FET malposition was suspected
after weaning from CPB by TEE and pulseless SMA. Although FET removal
and re-deployment or additional FET deployment into the TL could be
alternative options, we performed endovascular rescue because additional
cardiac and circulatory arrest could cause excessive invasion.
Fenestration of the dissecting flap using a radio frequency system and
subsequent endograft deployment has been reported as an effective
technique in cases of chronic dissection.4 However,
percutaneous endovascular fenestration and endografting for FET
malposition in cases of acute dissection have never been reported.
Because the dissecting flap architecture is much thinner in acute
dissection than in chronic dissection,6 the dissecting
flap can be easily perforated only by a tapered tip microguidewire
through an angled catheter under IVUS and fluoroscopic guidance.
In conclusion, percutaneous endovascular fenestration of the dissecting
flap and subsequent endograft deployment from the FET to the TL of the
descending aorta under the guidance of IVUS are effective and
less-invasive surgical treatments after FET malposition into the FL for
TAAD.