TYPE A DISSECTION HEADED IN THE RIGHT DIRECTION: A CATASTROPHIC DIAGNOSIS

Abstract

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aortic dissection is most commonly associated in those with history of hypertension, valvular abnormalities, and numerous connective tissue diseases. Aortic dissection is uncommon and occurs at an estimated rate of 3 per 100,000 people per year and more commonly seen in men. The average age of diagnosis is about 63 and roughly 10% of cases occur before the age of 40. Aortic dissection is categorized by type A and type B. We focus our attention on type A which is associated with a high morbidity and mortality. Due to the high mortality rate of about 50% at 48 hours without surgical intervention, type A dissection is a grim diagnosis. However, surgery is the best chance of survival. We present an extensive case of type A dissection following surgical intervention. CASE PRESENTATION: We describe a case of a 40 year old female with past medical history of hypertension who presented to the hospital with acute onset chest pain. She states a sharp pain developed suddenly in her throat and preceded to extend into her chest. The pain then radiated into her back and she became short of breath. Upon arrival, she was in acute distress and exam revealed diminished pulses in bilateral lower extremities with associated numbness and tingling. The patient was tachypneic, otherwise vitals were stable. She underwent CTA illustrating type A dissection extending from aortic root to distal left common iliac artery, intimal flap extending into the left subclavian and left renal arteries, and an aortic root aneurysm measuring 6.3cm. She was taken emergently to operating room for an aortic root replacement with 29 mm Magna Ease bioprosthetic valve and 34 mm Valsalva graft, ascending hemiarch replacement with 28 mm graft, frozen elephant trunk placement with 34 mm x 10 cm stent graft, and reconstruction of the left subclavian artery with 13 mm x 2.5 cm stent. Her hospital course was complicated by bilateral large pleural effusions requiring thoracentesis. She tolerated the procedure with no complications and was eventually stable for discharge. Work-up for connective tissue disorders or autoimmune causes was negative. DISCUSSION: The natural history of aortic dissection can have a diverse presentation but with prompt evaluation and diagnosis, it can expedite surgical intervention. Additionally, this diagnosis is associated with a high rate of perioperative and postoperative complications. CONCLUSIONS: This case was unusual since the patient had no genetic predisposition and well controlled blood pressure to have such an impressive dissection. Reference #1: White A, Broder J, Mando-vandrick J, Wendell J, Crowe J. Acute aortic emergencies--part 2: aortic dissections. Adv Emerg Nurs J. 2013;35(1):28-52. Reference #2: Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-11. Reference #3: Criado FJ. Aortic dissection: a 250-year perspective. Tex Heart Inst J. 2011;38(6):694-700. DISCLOSURES: No relevant relationships by Rahim Jiwani, source=Web Response No relevant relationships by Rita Rehana, source=Web Response