Acute Type B dissection and Aortic Coarctation, Now What?

Abstract

Introduction: Acute type B dissection is a rare complication in patients with aortic coarctation. Medical therapy is the standard therapy for an uncomplicated acute type B dissection. Nowadays aortic coarctation should be treated by endovascular means. We describe a case of a patient with an acute type B dissection and a silent coarctation. Methods: We describe a case of a patient with an acute type B dissection and an underlying coarctation treated with a thoracic endograft. Results: A 58-year old man was admitted to another hospital with acute interscapular thoracic pain radiating to the left shoulder. CT-scan revealed a Stanford type B dissection with secondary dilatation up to 6 cm and a hematoma in the adjacent fatty tissue suspect for impending rupture. Patient was referred to our centre for treatment. A new CT-scan did not show any evolution, there was no malperfusion and the pain was under control. He was admitted to the intensive care unit for observation and antihypertensive therapy. Further investigations with transthoracic echocardiography showed a bicuspid aortic valve, a dilated arch and descending aorta, and a suspicion of aortic coarctation. Because of the impending rupture, the dilated descending aorta and the persisting limited thoracic pain we decided to treat the dissection after 14 days. A thoracic endografting was successfully performed, covering the entry point of the dissection, the coarctation and the dilated part of the descending aorta. Conclusion: In this case we describe a rare case of a patient with an acute type B dissection and an underlying coarctation, treated with a thoracic endograft. We discuss the preoperative work-up and surgical decision making, the technical aspects of thoracic endografting and the results of the procedure.