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Acute aortic dissection in a patient with idiopathic dilated cardiomyopathy
Hiroyuki Tsukui1, Shigeyuki Aomi, Masahiro Endo
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Insights
Surgical repair of acute aortic dissection in patients with idiopathic dilated cardiomyopathy is rare but feasible. This case highlights successful emergency surgery for type A aortic dissection in a patient with poor left ventricular function.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Case Reports
Background:
- Idiopathic dilated cardiomyopathy (IDCM) presents challenges for managing concurrent aortic pathologies.
- Type A acute aortic dissection (TAAD) is a life-threatening condition requiring prompt intervention.
Observation:
- A 57-year-old male with diagnosed IDCM (reduced ejection fraction, enlarged left ventricle) developed TAAD.
- The patient underwent emergency surgical repair of the ascending aorta and hemiarch due to redissection and dilation.
Findings:
- The patient experienced an uneventful postoperative recovery with meticulous hemodynamic management.
- Successful surgical outcome was achieved despite pre-existing left ventricular dysfunction.
Implications:
- This case suggests that surgical intervention for TAAD can be safe and effective in select IDCM patients.
- Further research is needed to establish standardized criteria for surgical management of aortic dissection in patients with compromised left ventricular function.
Abstract:
Surgical treatment of acute aortic dissection in a patient with idiopathic dilated cardiomyopathy is rare. A 57-year-old man diagnosed with idiopathic dilated cardiomyopathy with left ventricular dimension of 59 mm in diastole, left ventricular dimension of 47 mm in systole, and fractional shortening of 0.19 on echocardiography developed type A acute aortic dissection. Emergency surgery was conducted for ascending aorta and hemiarch repair for ascending aorta redissection and dilation. The postoperative course was uneventful under appropriate hemodynamic control. Standardized criteria for aortic dissection in a patient with poor left ventricular contraction have not established, but surgery should be considered for all patients in good preoperative condition when it is the only effective life-saving alternative.