Recipient Aortic Dissection After Orthotopic Heart Transplant: A Case Report

Aortic dissection following orthotopic heart transplant is a rare but life-threatening event and typically occurs at the donor-recipient aortic anastomosis. In the case described here, a 40-year-old male patient, 10 years after he had received a heart transplant to treat dilated cardiomyopathy, presented with chest pain and dyspnea. Imaging revealed a chronic dissection that originated from the suture line between the donor and recipient aortas and extended to the iliac arteries. Notably, a mismatch was observed between the donor and recipient aortas during the initial transplant surgery. Although most cases reported in the literature involve dissections in the donor aorta, this dissection occurred in the recipient aorta. Surgical management included replacement of the ascending aorta with a Dacron graft and reinforcement of the anastomosis line. The postoperative course was uneventful, and follow-up imaging showed complete thrombosis of the false lumen. Aortic dissection after heart transplant, although rare, requires immediate surgical intervention due to its high mortality risk. Surgical precision during the initial transplant, especially with regard to the donor-recipient aortic mismatch, and vigilant long-term follow-up are crucial to prevent such complications and thereby facilitate improved patient outcomes.