Early Postoperative Acute Aortic Dissection, the Leading Cause of Sudden Death after Cardiac Surgery? Critical Role of the Computed Tomography Scan
DOI:
https://doi.org/10.1532/hsf.641Abstract
Iatrogenic acute aortic dissection (AOD) is known to occur during cardiac surgery or cardiac catheterization, whereas delayed AOD usually happens up to several years after an uneventful operation. Both entities usually are easily recognized, and their management is well described in the literature. Conversely, early postoperative AOD has not been described with any frequency in the literature, leading one to believe that once surgery is terminated, AOD is unlikely to occur and account for any early postoperative mortality or morbidity. We present our recent experience with 4 patients who sustained early postoperative AOD and whose diagnoses were facilitated by computed tomography (CT) scanning of the chest. Early postoperative acute AOD may not be uncommon and may account for more disasters and deaths than are acknowledged in the literature. Diagnosis is made expeditiously if such AOD is suspected and a CT scan of the chest is done. Prevention may be based on avoiding the manipulation of the ascending aorta and a tighter control of hypertension in the immediate postoperative period. The treatment of this AOD entity is not very difficult and is within the reach of every trained cardiac surgeon.References
Archer AG, Choyke PL, Zemen RK, Green CE, Zuckerman M. 1986. Aortic dissection following coronary artery bypass surgery: diagnosis by CT. Cardiovasc Intervent Radiol 9:142-5.nBlakeman BM, Pifarre R, Sullivan HJ, et al. 1988. Perioperative dissection of the ascending aorta: types of repair. J Card Surg 3:9-14.nCarter AJ, Brinker JA. 1994. Dissection of the ascending aorta associated with coronary angiography. Am J Cardiol 73:922-3.nChavanon O, Carrier M, Cartier R, et al. 2001. Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery? Ann Thorac Surg 71:117-21.nDunning DW, Kahn JK, Hawkins ET, O'Neill WW. 2000. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv 51:387-93.nEndo M, Benhameid O, Morin JF, Shennib H. 2002. Avoiding aortic clamping during coronary artery bypass using an automated anastomotic device. Ann Thorac Surg 73:1000-1.nFrater, R. 2002. Response posted August 14, 2002, to August 4 query of Donald Ross in The Heart Surgery Forum discussion forum topic, Aortic Complications in OPCAB Surgery. Available at: http://www.hsfo-rum.com/forum. Accessed July 7, 2003.nGillinov AM, Lytle BW, Kaplon RJ, Casselman FP, Blackstone EH, Cosgrove DM. 1999. Dissection of the ascending aorta after previous cardiac surgery: differences in presentation and management. J Thorac Cardiovasc Surg 117:252-60.nKatz ES, Tunick PA, Colvin SB, Culliford AT, Kronzon I. 1993. Aortic dissection complicating cardiac surgery: diagnosis by intraoperative biplane transesophageal echocardiography. J Am Soc Echocardiogr 6:217-22.nLam R, Robinson MJ, Morales AR. 1977. Aortic dissection complicating aortocoronary saphenous vein bypass. Am J Clin Pathol 68:729-35.nStill RJ, Hilgenberg AD, Akins CW, Daggett WM, Buckley MJ. 1992. Intraoperative aortic dissection. Ann Thorac Surg 53:374-9.nStranger O, Oberwalder P, Dacar D, Knez I, Rigler B. 2002. Late dissection of the ascending aorta after previous cardiac surgery: risks, presentation and outcome. Eur J Cardiothorac Surg 21:453-8.nYip HK, Wu CJ, Yeh KH, et al. 2001. Unusual complication of retrograde dissection to the coronary sinus of Valsalva during percutaneous revascularization: a single center experience and literature review. Chest 119:493-501.n
