Intraoperative iatrogenic type B aortic dissection. Temporary perfusion pause, immediate restoration and final...

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Aortic Diseases

Background:

• Ascending aortic aneurysms often require surgical intervention.
• Type B aortic dissections can present acutely or incidentally.
• Management strategies for aortic dissection vary based on presentation and complications.

Purpose of the Study:

• To report a unique case of incidental type B aortic dissection discovered during ascending aorta replacement.
• To discuss the management challenges and outcomes in a patient with combined aortic pathologies.
• To highlight the role of endovascular repair in managing malperfusion secondary to aortic dissection.

Main Methods:

• A 74-year-old female with a 50 mm ascending aortic aneurysm underwent ascending aorta replacement.
• Intraoperative discovery of type B aortic dissection with false lumen flow.
• Initial conservative management with blood pressure control.
• Subsequent endovascular repair for recurrent malperfusion syndrome.

Main Results:

• The patient initially recovered well but developed malperfusion syndrome.
• Temporary improvement was noted after initial interventions.
• Successful endovascular repair led to complete thrombosis of the false lumen.
• Resolution of malperfusion symptoms post-endovascular repair.

Conclusions:

• Incidental discovery of type B aortic dissection during other cardiac surgeries is possible.
• Malperfusion syndrome is a critical complication requiring timely intervention.
• Endovascular repair can be a successful treatment for malperfusion in complex aortic dissection cases.
• A multimodal approach combining surgical and endovascular techniques may be necessary for complex aortic pathologies.