IMAGES IN CARDIAC SURGERY
Aortic retrograde type A aortic dissection following repair of
a thoraco-abdominal aortic aneurysm
Jae Hyun Kim MD, PhD
Woo Sung Jang MD, PhD
Jae-Bum Kim MD
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea
Jae Hyun Kim MD, PhD, Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of
Medicine, Dalseung-ro 56, Jung-gu, Daegu 41931, South Korea.
Retrograde type A aortic dissection (RAAD) may occur early or late
following thoracic endovascular aortic/aneurysm repair procedures.
We present images of a RAAD following an open repair of a thoraco-
abdominal aortic aneurysm (TAAA).
A 59-year-old male underwent a repair of a 6-cm extent II TAAA
which had progressively increased over 1 year following an acute type
B aortic dissection (Figure 1).
At the time of surgery, a left thoraco-abdominal incision was
performed and the chest entered through the 6th interspace. Partial
cardiopulmonary bypass (CPB) was instituted with left femoral artery
and venous cannulation. The aorta was clamped between the left
carotid and subclavian arteries, and a #26-mm Gelweave thoraco-
abdominal graft (Vascutek Ltd, Inchinnan, Scotland) was placed distal
to the left subclavian artery extending to the infra-renal abdominal
aorta. T9 and 10 segmental intercostal arteries as well as the visceral
and renal arteries were re-attached to the graft. The patient tolerated
the procedure well; however, on the evening of surgery, he developed
cardiac tamponade, which required emergent pericardial drainage at
the bedside. A computed tomography (CT) angiogram examination
revealed a RAAD from the distal arch to the ascending aorta (Figure 2)
and an echocardiogram demonstrated severe aortic insufficiency. The
patient was taken to the operating room; a median sternotomy was
FIGURE 1 Preoperative computed tomography scan (3-dimensional
reconstruction) shows the extent II thoraco-abdominal aortic aneurysm
with chronic type B aortic dissection flap (yellow arrow)
FIGURE 2 Computed tomography scan (3-dimensional
reconstruction) shows the replaced extent II thoraco-abdominal
aortic aneurysm (white arrow) and retrograde type A aortic
dissection (yellow arrow)
© 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocs J Card Surg. 2018;33:116–117.