Brain swelling in acute superior vena cava syndrome due to aortic dissection: unusual and lethal manifestation aggravated by induction of general anesthesia.
A 32-year-old woman with Marfan syndrome experienced acute superior vena cava syndrome due to aortic dissection. The patient had previously undergone a Bentall operation. The aneurysm from the ascending to the transverse aorta compressed the superior vena cava, the right pulmonary artery, and the trachea. The rare and life-threatening neurological complication in this patient may have been related to brain edema, which was revealed by preoperative computed tomography. The induction of general anesthesia aggravated the symptoms of the superior vena cava syndrome and led to a fatal condition. Additional cannulation in the right subclavian vein was mandatory to alleviate the symptoms because the venous drainage from the upper half of the body created only by the femorofemoral bypass was not adequate. Total arch replacement was performed. The postoperative course was uneventful.
Division of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-cho, Utsunomiya, Tochigi, 321-0974, Japan. kiyoshi_koizumi@saimiya.com
Kiyoshi
K
Koizumi
Toshihiko
T
Ueda
Kenichi
K
Hashizume
Shinya
S
Inoue
Ryuichi
R
Takahashi
D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects*; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000209:etiology*; D005260:Female; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011859:Radiography; D013479:Superior Vena Cava Syndrome / Q000139:chemically induced / Q000150:complications*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging