Case of sudden death from retrograde type A dissection two days after surgery for a type B dissecting aneurysm

A 64-year-old man underwent a descending aortic replacement for a chronic type B dissecting aneurysm with left thoracotomy. The patient was weaned from the mechanical ventilator immediately after surgery without any neurological complications. However, on the second post-operative day, he suddenly suffered from cardiopulmonary arrest when talking with his family. Despite 6 hours of cardiopulmonary resuscitation, the patient died. The postmortem examination revealed a 1000 mL blood volume and huge hematoma in the pericardium owing to a retrograde type A dissection, which descended from an intimal laceration between the common carotid and left subclavian arteries that corresponded with aortic cross clamping. We here report a rare case of iatrogenic retrograde type A dissection caused by surgical clamping on the aortic arch 2 days post-surgery.