[Emergency surgical salvage for a closing aortic dissection: 2 case reports]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Diagnostic Imaging

Background:

• Acute aortic dissection (Stanford A type) is a life-threatening condition requiring prompt diagnosis and management.
• Closing aortic dissection, a newly identified subtype, presents diagnostic challenges due to a thrombosed pseudolumen.
• Cardiac tamponade is a severe complication associated with acute aortic dissection.

Observation:

• Two female patients (52 and 72 years old) presented with severe back pain and loss of consciousness, respectively.
• Diagnostic imaging including chest CT, aortography, and cardiac ultrasonography confirmed Stanford A type acute aortic dissection with cardiac tamponade.
• Enhanced chest CT revealed a thrombosed pseudolumen, indicative of a closing aortic dissection.

Findings:

• Emergency surgical salvage involving ascending aorta replacement and entry port resection was performed in both patients.
• Postoperative recovery was generally uneventful, with one patient requiring temporary hemodialysis.
• The successful surgical outcomes highlight the effectiveness of aggressive treatment for closing aortic dissection.

Implications:

• Closing aortic dissection represents a distinct entity within acute aortic dissections, necessitating specific diagnostic considerations.
• Early and aggressive surgical management is crucial for improving prognosis and preventing catastrophic outcomes in closing aortic dissection.
• Further research into the optimal diagnostic and therapeutic strategies for this rare aortic dissection subtype is warranted.