A 52-year-old woman, who had been treated medically for 31 days with the diagnosis of type A aortic dissection, suddenly fell in shock because of acute cardiac tamponade. Emergent operation was performed two hours after the onset of shock. Entry and perforation were located in the ascending aorta. Ascending aorta was opened without cross-clamping under profound hypothermic low flow perfusion through femoral artery, and intraluminal grafting with a double ringed graft was completed. Combined technique of open distal anastomosis and ringed graft is useful in such an emergent case as cardiac tamponade of aortic dissection.