Matters of the Heart
Emergency surgery for Aortic Dissection
Dissection of aorta is a serious, life threatening condition. The
underlying cause is often an inherent weakness of the aortic wall,
increased stress on weakened wall due to hypertension or weakness in
a particular part due to an atherosclerotic ulcer.
A 46 year old male with a history of transient loss of consciousness
and complaints of severe chest and upper back pain accompanied by
pain in the right lower limb visited BLK Heart Centre. His detailed
examination revealed elevated blood pressure, absent pulses in the
right lower limb and a normal ECG. This led to a suspicion of acute
dissection. A CT Angio of the thoracic and abdominal aorta revealed
type A dissection extending from the aortic root to the bifurcation, with
the left renal artery arising from the false lumen and the dissection flap
extending into the right common iliac artery severely compromising
the flow. The patient underwent ECHO which revealed moderate AR.
The left femoral vessels were exposed and looped. A median Sternotomy
was done, and Cardiopulmonary Bypass was instituted through the left
femoral artery and right atrium. The aorta was entered after clamping.
The aortic valve was structurally normal and the regurgitation was
moderate. It was decided to repair the aortic valve by re-suspending its
commissures. The entry of dissection or the initial tear was restricted
to the ascending aorta. The ascending aorta from the root to the arch
was replaced with a prosthetic graft. On the post operative day one, the
kidney shut down and haemodyalysis had to be initiated to maintain
fluid and electrolyte balance.
Haemodynamics of the patient improved steadily and he was discharged
on post operative day nine. The patient recovered well after discharge
and the recovery was fairly uneventful. He is able to carry out his daily
routine properly without any problem.
Surgery for Aortic Dissection and its complications is challenging, yet
gratifying. If the procedure is performed with meticulous technique
and at the right time, it can yield satisfying results.