Intraoperative Descending Aorta Dissection During Cardiac Surgery - Abstract
Intraoperative acute descending aortic dissection is a rare and potentially fatal complication of open cardiac surgery. We report the case of a 62-year-old female who developed this condition during surgery includingmitral valvuloplasty, tricuspid valvuloplasty and the MAZE procedure. After induction of general anesthesia, baseline Transesophageal Echocardiography (TEE) examination revealed a normal ascending and descending aorta. At the time of weaning off cardiopulmonary bypass, we decided to use intra-aortic balloon pumping (IABP) because of insufficient left ventricular output. TEE examination of the descending aorta at this time revealed descending aortic dissection, which extended from just beyond the left subclavian artery to
above the celiac artery (DeBakey IIIb type). We decided to adopt a conservative approach because the dissection did not compromise circulation in the branch arteries; we also avoided using IABP.TEE is commonly used intraoperatively and is considered the modality of choice to diagnose this complication and direct the surgeon to the extent of the dissection.TEE is also useful for determining the therapeutic strategy for
acute descending aortic dissection.This case highlights the importance of maintaining a high level of suspicion of intraoperative descending aortic dissection and its prompt diagnosis using TEE.