Early postoperative acute aortic dissection, the leading cause of sudden death after cardiac surgery? Critical role of the computed tomography scan.
Iatrogenic acute aortic dissection (AOD) is known to occur during cardiac surgery or cardiac catheterization, whereas delayed AOD usually happens up to several years after an uneventful operation. Both entities usually are easily recognized, and their management is well described in the literature. Conversely, early postoperative AOD has not been described with any frequency in the literature, leading one to believe that once surgery is terminated, AOD is unlikely to occur and account for any early postoperative mortality or morbidity. We present our recent experience with 4 patients who sustained early postoperative AOD and whose diagnoses were facilitated by computed tomography (CT) scanning of the chest. Early postoperative acute AOD may not be uncommon and may account for more disasters and deaths than are acknowledged in the literature. Diagnosis is made expeditiously if such AOD is suspected and a CT scan of the chest is done. Prevention may be based on avoiding the manipulation of the ascending aorta and a tighter control of hypertension in the immediate postoperative period. The treatment of this AOD entity is not very difficult and is within the reach of every trained cardiac surgeon.
Tabry
Imad
I
Department of Surgery, Holy Cross Hospital, Fort Lauderdale, Florida, USA. itabry@bellsouth.net
Costantini
Eugene
E
Reyes
Elmore
E
Tamim
Wael
W
Habal
Salem
S
Hughes
Linda
L
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging*; D001026:Coronary Artery Bypass / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects* / Q000379:methods; D008297:Male; D012086:Reoperation; D014057:Tomography, X-Ray Computed