Dynamic aortic obstruction in a patient with acute type B dissection.
There are at least 7000 aortic dissections diagnosed in the United States each year. Type B dissections accounted for 38% of cases enrolled in the prospective International Registry of Aortic Dissection. We report a case of a 48-year-old hypertensive woman with an acute type B aortic dissection causing significant dynamic obstruction of the aorta. Intravascular ultrasound of her aorta revealed a mobile intimal flap nearly obliterating the true lumen with each systolic contraction. Simultaneous pressure tracings obtained from her ascending aorta and femoral artery demonstrated a systolic pressure gradient in excess of 100 mm Hg. The patient developed progressive renal failure and ultimately underwent successful operative replacement of the proximal descending thoracic aorta with a Dacron graft. In this case presentation, we highlight the unusual physiology exemplified by this case and explore contemporary management strategies for complicated type B aortic dissection, including surgery and catheter-based techniques.
Mega
Jessica L
JL
Brigham and Women's Hospital, Boston, Massachusetts, USA. jmega@partners.org
Opotowsky
Alexander R
AR
Curillova
Zelmira
Z
O'Gara
Patrick T
PT
D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011859:Radiography; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography