Dr. Sushant Srivastava
Director & Sr. Consultant
Cardiothoracic & Vascular
Surgery
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

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.

THE CASE

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 PROCEDURE

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.

THE RESULT

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.

DISCUSSION

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.