Retrograde type A aortic dissection after thoracoabdominal aneurysm repair: early diagnosis with intraoperative transesophageal echocardiography.
Retrograde type A aortic dissection that arises immediately after open replacement of the thoracoabdominal aorta is a rare and potentially lethal complication that has only been reported twice previously. A 74-year-old man with a history of expanding Crawford type I thoracoabdominal aortic aneurysm presented for open surgical repair. The intraoperative course was unremarkable. However, intraoperative transesophageal echocardiography after the repair revealed type A aortic dissection extending up to the sinotubular junction. Subsequently, emergent aortic arch repair was performed under deep hypothermic circulatory arrest. Early diagnosis with transesophageal echocardiography and optimal cerebral protection were instrumental in the successful outcome of this repair.
From the *Department of Anesthesiology, Albany Medical Center, Albany, New York; and †Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Shobana
S
Rajan
Abraham
A
Sonny
Shiva
S
Sale
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000209:etiology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D042241:Early Diagnosis; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D016343:Monitoring, Intraoperative; D014656:Vascular Surgical Procedures / Q000009:adverse effects