Aortic dissection following coronary arterial bypass graft surgery

A 60-year-old man underwent coronary arterial bypass graft surgery for unstable angina. After surgery, he developed a widened mediastinum on the chest x-ray film and a murmur consistent with aortic regurgitation. He refused study until the return of his anginal symptoms five years after surgery. At that time the patient had unchanged chest x-ray film and physical findings. Aortograms revealed a large type-1 aortic dissection extending from the aortic root to the descending thoracic aorta. Long-term survival with an aortic dissection after coronary arterial bypass grafting is possible. The pathophysiologic and pathologic findings of a spontaneous type-1 aortic dissection may differ from that of the dissection described herein, and these differences may relate to survival.