title: Successful repair of intraoperative aortic dissection detected by transesophageal echocardiography.
abstract: Aortic dissection is a rare but devastating complication of cardiac surgery. Early intraoperative diagnosis and management are essential for a favorable outcome. We describe the case of a 69-year-old man with worsening dyspnea who was admitted for mitral valve replacement having previously had a mitral valve repair. Precardiopulmonary bypass transesophageal echocardiography confirmed mitral regurgitation and showed mild atherosclerotic changes in the descending aorta. Following successful replacement of the mitral valve, an attempt to wean from cardiopulmonary bypass failed. This was characterized by acute onset hypovolemia. The transesophageal echocardiography showed the presence of features of acute aortic dissection involving only the descending aorta without identifying the entry point. The tear was successfully repaired by direct suture within the lumen.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthetics, Harefield Hospital, Middlesex, United Kingdom. david@varghese.freeserve.co.uk
authors.forename: David
authors.initials: D
authors.lastname: Varghese
authors.forename: Bernhard J C J
authors.initials: BJ
authors.lastname: Riedel
authors.forename: S Nicholas
authors.initials: SN
authors.lastname: Fletcher
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Al-Momatten
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012421:Rupture; D014057:Tomography, X-Ray Computed