Acute dissection of the descending thoracic aorta: repair in an unusual case

Acute tamponade, although a rare manifestation of a descending thoracic aneurysm, was the dominant clinical feature of a classic type III dissecting aneurysm (arising distal to the left subclavian artery) in a 52-year-old man. High-quality aortography confirmed the diagnosis, ruling out any anomaly of the ascending aorta and the aortic arch. Surgical treatment was carried out 24 hours after the initial episode without cardiopulmonary bypass. Through a left thoracotomy, a Gott shunt was inserted proximally at the apex of the left ventricle and distally in the left femoral artery. Aortic repair with the interposition of a 30-mm woven Dacron prosthesis was successful. Postoperative aortography showed complete restoration of aortic integrity.