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[Acute aortic dissection after coronary revascularization--a case report]
T Sakurada1, Y Shibata, M Kamada
1Department of Cardiovascular Surgery, Hiraka General Hospital, Akita, Japan.
Insights
Acute aortic dissection is a rare complication following open heart surgery, particularly after aortic perfusion during cardiopulmonary bypass. This case highlights the potential for myonephropathic-metabolic syndrome after repairing acute aortic dissection with limb ischemia.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiopulmonary Bypass
Background:
- A 59-year-old male with coronary artery disease and peripheral artery disease underwent complex surgical procedures.
- The patient received bypass grafts for both coronary and lower extremity arteries.
Observation:
- Postoperatively, the patient developed acute kidney injury and subsequently Stanford type A acute aortic dissection.
- The dissection originated at the site of aortic perfusion during cardiopulmonary bypass.
Findings:
- Surgical repair of the ascending aorta was performed.
- Following reperfusion of the femoral artery, hyperkalemia led to cardiac arrest.
- Hemodialysis stabilized hemodynamics, but the patient succumbed to low cardiac output syndrome.
Implications:
- Acute aortic dissection is a critical, albeit rare, complication of cardiopulmonary bypass with aortic perfusion.
- The case underscores the risk of myonephropathic-metabolic syndrome in patients with acute aortic dissection and limb ischemia.
- This presentation emphasizes the need for vigilance regarding aortic complications after cardiac surgery.
Abstract:
A 59-year-old man with coronary artery disease and arteriosclerosis obliterans of left lower extremity underwent anastomosis of left internal thoracic artery to left anterior descending artery with cardiopulmonary bypass of aortic perfusion and left femoro-popliteal bypass with saphenous vein graft. On the first postoperative day, urinary output decreased and then stopped. The transesophageal echocardiography and angiography revealed the Stanford A type acute aortic dissection. Immediately the resection of the ascending aorta including the intimal tear, which was found on the site of the previous aortic perfusion, and the reconstruction of the ascending aorta with the prosthetic graft was performed. After the reperfusion of left femoral artery, which was used as the route of the arterial perfusion during cardiopulmonary bypass, serum potassium level increased gradually and at last the heart was arrested. Hemodialysis with draining from inferior vena cava produced the stability of hemodynamics, but on the next day he died of low cardiac output syndrome. We presented the case with the acute aortic dissection after open heart surgery, which was one of the rare complications in aortic perfusion of cardiopulmonary bypass and emphasized the possibility of occurrence of myonephropathic-metabolic syndrome after the repair of acute aortic dissection with limb ischemia.