Iatrogenic Type A Aortic Dissection Repair In A Surgical Atrial Septal Defect Closure Patient
PRAVEEN R. TAMBRALLIMATH, MBBS , MS ,M CH (CTVS )1, Abhishek Prabhu, MBBS , MS , MCH1, Abhijeet Shitole, MBBS , MD1, Richard Jonas, M.D.2.
1KLE DR PRABHAKAR KORE HOSPITAL, BELAGAVI, India, 2Childrens National Medical Centre, Washington DC, WA, USA.
Objective(s):This video aims to outline the surgical management of iatrogenic acute type-A aortic dissection, a dreaded complication of open heart surgery, if not addressed timely.
Methods: A 19 year old girl was taken up for elective atrial septal defect (ASD) repair. On cardiopulmonary bypass aortic line pressures were normal. However after coming off bypass femoral pressures were 70/50 against a direct aortic pressure of 120/86. Also the patient was anuric during and after bypass. This led to the suspicion of aortic dissection and was confirmed on transesophageal echo. CPB was resumed and the patient was cooled to 20 degree centigrade. Hypothermic circulatory arrest was initiated and transverse aortotomy performed just below the aortic cannulation site . A 2 cm transverse primary intimal tear was identified on the posterior wall of aorta which had occurred at the time of aortic cannulation. Dissection was extending into the arch and descending thoracic aorta but carotid arteries were spared. Origin of the dissection was closed with circular bovine pericardial patch with interrupted 5-0 polypropylene sutures. Aortotomy closed and circulation re-established.
Results: We were able to successfully re-establish circulation in to the true lumen after closing the iatrogenic primary intimal tear. Patient was extubated and discharged from hospital on day one and seven respectively without any neurological deficit.
Conclusions: Timely detection and prompt surgical correction can prevent negative outcome in a case of iatrogenic type A aortic dissection, however this complication is best treated by its prevention.