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Published on: July 18, 2014
Type A aortic dissection following heart transplantation: A case report
Zhu Zeng1, Lin-Jie Yang2, Chao Zhang1
1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
Insights
A rare case of type A aortic dissection in a heart transplant recipient with an aberrant right subclavian artery required complex hybrid repair. This highlights the challenges in managing aortic complications post-cardiac transplantation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Transplantation Surgery
Background:
- Cardiac transplantation is the standard for end-stage heart failure, with ~100 procedures annually at the authors' center.
- Common complications include rejection, infection, and dysfunction; aortic dissection is a rare but serious event.
- Management of aortic dissection post-cardiac transplant often necessitates complex hybrid procedures.
Observation:
- A 58-year-old female, post-heart transplant, presented with type A aortic dissection and an aberrant right subclavian artery.
- Initial management included blood pressure control with urapidil.
- The patient underwent a hybrid procedure involving ascending aorta and aortic arch replacement, subclavian artery reconstruction, and endovascular aneurysm repair.
Findings:
- Cardiopulmonary bypass was established via femoral vessels due to the inability to use the right axillary artery.
- The aberrant right subclavian artery presented a unique challenge for standard surgical approaches.
- Bilateral cerebral perfusion was achieved by cannulating the common carotid arteries.
Implications:
- This case underscores the importance of detailed pre-operative imaging in heart transplant recipients with suspected aortic pathology.
- Aberrant vasculature, like the right subclavian artery, requires tailored surgical strategies for cardiopulmonary bypass and aortic repair.
- Successful hybrid repair demonstrates the feasibility of managing complex aortic dissections in the context of prior cardiac transplantation.
Background:
Cardiac transplantation is considered the standard treatment for refractory end-stage heart failure. Worldwide, 5074 heart transplantations were performed in 2015. About 100 heart transplants are performed at the authors' center each year. The usual complications of heart transplantation include graft rejection, infection, and graft dysfunction. Aortic dissection after heart transplantation is very rare and is a serious complication that requires a hybrid procedure.
Case Summary:
A 58-year-old female patient was admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in July 2020 because of unprovoked low back pain without precipitating causes. Magnetic resonance imaging and computed tomography angiography showed type A aortic dissection with an aberrant right subclavian artery. After admission, urapidil was used to control blood pressure. Ten days later, the patient underwent ascending aortic and aortic arch replacement, subclavian artery reconstruction, and endovascular repair of abdominal and thoracic aortic aneurysms. A cardiopulmonary bypass was established through the right femoral artery and femoral vein. The aberrant right subclavian artery, innominate artery, left common carotid artery, and left subclavian artery were blocked, and the left and right common carotid arteries were cannulated for bilateral cerebral perfusion.
Conclusion:
The right axillary artery could not be selected for cardiopulmonary bypass intubation because of aberrant right subclavian artery.
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