title: Intraoperative diagnosis of stanford type a dissection by transesophageal echocardiogram in a patient presenting for renal transplantation.
abstract: A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported "a feeling of chest fullness" when lying flat. As such, a transesophageal echocardiogram (TEE) was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur. The TEE revealed a Stanford Type A aortic dissection. The renal transplant was cancelled (organ reassigned within region), and the patient underwent an urgent ascending and proximal hemiarch aortic replacement. This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Hand
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bratton
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Burch
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy