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[A successful emergency operation of acute aortic dissection (DeBakey I) with aortic root rupture and right coronary
Insights
This case report details a successful emergency surgery for acute aortic dissection (DeBakey I) complicated by cardiogenic shock. The patient recovered fully after complex aortic repair and coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Acute aortic dissection is a life-threatening condition requiring prompt surgical intervention.
- Cardiogenic shock in aortic dissection indicates a poor prognosis and necessitates immediate management.
- DeBakey type I aortic dissection involves the ascending aorta and aortic arch, often requiring complex surgical repair.
Observation:
- A 73-year-old male presented with severe chest pain, diagnosed with DeBakey I aortic dissection, aortic valve regurgitation, and massive pericardial effusion.
- The patient exhibited signs of cardiogenic shock, indicating hemodynamic instability.
- Emergency aortography and echocardiography confirmed the extent of the dissection and associated complications.
Findings:
- Emergency surgical repair was performed within 2 hours of symptom onset.
- Ascending aorta and aortic valve reconstruction utilized a composite graft due to aortic root rupture and right coronary avulsion.
- The procedure included saphenous vein graft for right coronary artery bypass and reimplantation of the left coronary artery.
Implications:
- This case highlights the feasibility and success of emergency surgical intervention in acute aortic dissection with cardiogenic shock.
- Complex aortic root reconstruction and coronary revascularization can be safely performed in critically ill patients.
- Successful management of such complex cases improves patient outcomes and survival rates in aortic emergencies.
Abstract:
We report a successful emergency operation for a patient of acute aortic dissection with cardiogenic shock. A 73-year-old man was admitted to our hospital with a complaint of severe chest pain. The emergency aortography and echocardiography demonstrated aortic dissection (DeBakey I) with aortic valve regurgitation and massive pericardial effusion. The emergency operation started 2 hours after the onset. We performed reconstruction of ascending aorta and aortic valve using composite graft, since the patient had aortic root rupture and right coronary avulsion. Subsequently, the right coronary bypass grafting of saphenous vein was performed in addition to the reimplantation of left coronary artery by carrel patch method. The postoperative course was uneventful and the patient remains asymptomatic.