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Aortic dissection following coronary artery bypass surgery: diagnosis by CT
Insights
An aortic dissection after coronary artery bypass graft surgery caused spinal cord infarction. Computed tomography (CT) accurately diagnosed the rare complication and its extent.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Radiology
Background:
- Aortic dissection is a rare but serious complication following cardiac bypass surgery.
- Intimal tears can result from aortic cross-clamping, cannulation, or suturing during graft procedures.
- Underlying aortic diseases like atherosclerosis increase risk.
Observation:
- A case of aortic dissection originating from an intimal tear at a coronary artery bypass graft suture line is presented.
- The dissection extended to the aortoiliac bifurcation and innominate artery.
- Rupture into the left pleural cavity was identified.
Findings:
- Computed tomography (CT) effectively diagnosed the aortic dissection.
- CT imaging demonstrated the full extent of the dissection, including its extension and rupture.
- The dissection was linked to spinal cord infarction.
Implications:
- CT is a valuable tool for diagnosing aortic dissections post-cardiac surgery.
- Early detection and assessment of dissection extent are crucial for patient management.
- This case highlights an unusual cause of spinal cord infarction following bypass surgery.
Abstract:
We describe an unusual case of aortic dissection causing spinal cord infarction. The dissection arose from an intimal tear at the suture line of a coronary artery bypass graft. CT was used to diagnose the dissection and to demonstrate its extension to the aortoiliac bifurcation and innominate artery and its rupture into the left pleural cavity. The most common causes of intimal tears following cardiac bypass surgery are aortic cross-clamping, aortic cannulation, and injury during suturing of the graft to the aorta. An underlying disease of the aorta such as atherosclerosis, cystic medial necrosis, or aortitis is commonly present. CT is an accurate and safe means of detecting aortic dissections following cardiac surgery, and is also useful in assessing the extent of the dissection and identifying its rupture into the pleural or pericardial cavity.