Pulmonary artery dissection caused by extension of a chronic type a aortic dissection through a patent ductus arteriosus.

Abstract

A 41-year-old woman presented to our hospital with chest discomfort, cough, and worsening shortness of breath for 2 months. She had no history of connective tissue disease or family history of aortic catastrophes. Five years before this presentation, she had undergone physical examination in a hospital, and transthoracic echocardiography showed type A aortic dissection. The patient, despite the advice of several cardiologists and cardiac surgeons, had always refused surgical correction. Routine contrast-enhanced computed tomography and transthoracic echocardiography were performed. Imaging revealed a chronic type A aortic dissection originating from the aortic annulus and extending to the aortic arch that was associated with moderate aortic regurgitation. The aortic dissection infiltrated the pulmonary trunk through the patent ductus arteriosus (PDA; Figure 1). The concomitant anomaly was moderate mitral valve insufficiency diagnosed on the basis of transthoracic echocardiography. The patient underwent elective surgery. After induction of general anesthesia, the procedure was performed through a full median sternotomy under cardiopulmonary bypass with moderate hypothermic circulatory arrest at 25°C, right axillary artery cannulation for cardiopulmonary bypass, and selective antegrade cerebral perfusion. Figure 1. Routine contrast-enhanced computed tomography ( A ) showing aortic dissection infiltrating the pulmonary trunk through the patent ductus arteriosus (arrow). Transthoracic echocardiography ( B ) showing that the dissection flap is visible in the ascending aortic artery (AAO) and pulmonary artery (PA; arrow). Computed tomography angiographic images …