[A case report of closing aortic dissection with cardiac tamponade]

Area of Science:

• Cardiology
• Vascular Surgery
• Hematology

Background:

• Acute type A aortic dissection is a life-threatening condition often requiring surgical intervention.
• Cardiac tamponade presents a critical complication, necessitating immediate management.
• The role of medical therapy in specific aortic dissection presentations warrants further investigation.

Observation:

• A 64-year-old male presented with severe chest and back pain, diagnosed with acute type A aortic dissection and cardiac tamponade.
• Initial management included emergency pericardial drainage, followed by medical treatment.
• Enhanced CT and DSA revealed a thrombosed false lumen without an intimal tear.

Findings:

• Laboratory results showed significant activation of both coagulation and fibrinolysis within the false lumen, evidenced by elevated fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha(2) plasmin inhibitor complex (PIC), fibrin degradation products (FDP), and D-Dimer.
• These thrombotic and fibrinolytic markers normalized within six weeks of admission.
• The patient was discharged in good health seven weeks after admission, indicating successful conservative management.

Implications:

• This case suggests that medical management can be effective for select patients with acute type A aortic dissection, particularly those with thrombosed false lumens and without intimal tears.
• The normalization of coagulation and fibrinolysis markers supports the potential for spontaneous resolution or stabilization in such cases.
• Further research is needed to define the criteria and long-term outcomes for non-surgical treatment of acute type A aortic dissection.