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Standing tall after DeBakey Type I aortic dissection extending to left iliac artery

Deepak Natarajan1, Nalin Natarajan1

  • 1Park Hospitals, Delhi NCR, India.

Indian Heart Journal
|December 26, 2015
PubMed

Insights

This case report details a DeBakey Type I aortic dissection missed initially in a hypertensive woman with prior heart surgery. Early suspicion and multi-detector computed tomography aortography are crucial for diagnosing aortic dissection.

Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Thoracic Surgery

Background:

  • Aortic dissection is a life-threatening condition often presenting with severe chest pain.
  • Previous cardiac surgery and hypertension are risk factors for aortic dissection.
  • Diagnostic delays can lead to significant morbidity and mortality.

Observation:

  • A middle-aged hypertensive female with a history of mitral valve replacement presented with abrupt tearing chest and back pain.
  • Initial presentation was misdiagnosed due to normal electrocardiogram (ECG) and cardiac biomarkers.
  • Delayed diagnosis occurred despite symptoms suggestive of aortic dissection.

Findings:

  • Multi-detector computed tomography aortography (MD CTA) confirmed extensive DeBakey Type I aortic dissection involving the ascending aorta, arch, and descending aorta.
  • Coronary angiography performed weeks later for unrelated symptoms showed normal coronary arteries.
  • The patient opted for medical management with beta-blockers and losartan, remaining stable for 18 weeks.

Implications:

  • Highlights the critical need for a high index of clinical suspicion for aortic dissection in patients with characteristic symptoms, even with negative initial workup.
  • Emphasizes the diagnostic utility of MD CTA in identifying aortic dissections, particularly in complex cases.
  • Suggests that medical management can be a viable option for selected patients with aortic dissection, with careful monitoring.

Keywords:
Aortic dissectionBeta-blockerDeBakey Type ILosartanMulti detector CT aortography

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