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CC BY 4.0 · Aorta (Stamford) 2020; 08(05): 155-158
DOI: 10.1055/s-0040-1715124
Images in Aortic Disease

Iatrogenic Acute Type A Aortic Dissection following Elective Cardiopulmonary Bypass

Pierre Huette 
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Christophe Beyls 
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Mathieu Guilbart
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Guillaume Haye 
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Jérémie Vial
3   Radiologic Department, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Gilles Touati
2   Cardiac surgery Department, Amiens University Medical center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Yazine Mahjoub
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
,
Osama Abou-Arab
1   Department of Anesthesia and Critical Care, Cardiac Thoracic Vascular and Respiratory Intensive Care Unit, Amiens University Medical Center, 1 rue du Professeur Christian Cabrol, Amiens, France
› Author Affiliations Funding None.
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Abstract

We report a 62-year-old woman who was scheduled for an elective Tirone David valve sparing aortic root replacement under cardiopulmonary bypass. Within the next few hours, the patient developed bilateral acute ischemia of both lower limbs. A thoracic and abdominopelvic computed tomography scan showed acute Type A aortic dissection with a perforation at the brachiocephalic arterial trunk and a complete malperfusion of the inferior mesenteric and iliac arteries.

Keywords

cardiopulmonary bypass - iatrogenic acute aortic dissection - lower limb ischemia

Editor's Comments

The authors did an excellent initial aortic root operation before this extensive arch, thoracic, and abdominal aortic dissection developed. Another treatment alternative would have been a fenestration, done retroperitoneally at an infra-renal level. Our extensive experience with fenestration has found that this procedure is extremely effective at restoring flow to all branch vessels, both above and below the level of the fenestration. Especially with the excellent self-retaining retractors available in this era, the retroperitoneal approach for fenestration is quick, easy, and well tolerated.[1] [2] [3]

References

1. Elefteriades JA, Hammond GL, Gusberg RJ, Kopf GS, Baldwin JC. Fenestration revisited. A safe and effective procedure for descending aortic dissection. Arch Surg. 1990;125(06):786–790.

2. Morales DL, Quin JA, Braxton JH, Hammond GL, Gusberg RJ, Elefteriades JA. Experimental confirmation of effectiveness of fenestration in acute aortic dissection. Ann Thorac Surg. 1998;66(05):1679–1683.

3. Elefteriades, JA and Ziganshin BA. Practical Tips in Aortic Surgery. Springer. 2020 [In press]




Publication History

Received: 20 June 2019

Accepted: 11 June 2020

Article published online:
23 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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