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A Case of Acute Type A Aortic Dissection with Double Aortic Arch
Katsuaki Tsukioka1, Tetsuya Kono2, Kohei Takahashi1
1Department of Cardiovascular Surgery, Iida Municipal Hospital, Iida, Nagano, Japan.
Annals of Vascular Diseases
|January 17, 2020
Summary
Double aortic arch (DAA) is a rare adult condition. This case highlights a DAA with aortic dissection and pericardial effusion, managed emergently with ascending aortic replacement.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Double aortic arch (DAA) is a rare congenital anomaly with limited adult presentations.
- Acute aortic dissection in adults with DAA is exceptionally uncommon.
- Pericardial effusion can complicate aortic pathologies, necessitating urgent intervention.
Purpose of the Study:
- To report a rare case of acute aortic dissection in an adult with a double aortic arch.
- To describe the emergency surgical management of this complex presentation.
- To discuss the challenges and outcomes associated with DAA and aortic dissection.
Main Methods:
- A 71-year-old female presented with syncope and was diagnosed with acute aortic dissection and DAA with massive pericardial effusion via non-enhanced CT.
- Emergency pericardiocentesis was performed due to hemodynamic instability.
- Ascending aortic replacement was conducted using aortic arch clamping without circulatory arrest.
Main Results:
- The patient survived the emergency surgery for ascending aortic replacement.
- Postoperative complications included tracheomalacia and residual dissection in the remaining DAA.
- Hemodynamic instability precluded detailed pre-operative enhanced CT imaging.
Conclusions:
- Management of acute aortic dissection in adults with DAA requires careful surgical planning.
- Emergent surgical intervention can be successful despite imaging limitations.
- Long-term outcomes may be affected by residual disease and iatrogenic complications such as tracheomalacia.
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