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Images in cardiovascular medicine. Acute type I aortic dissection with concomitant pulmonary artery dissection
KHATCHATOURIAN, Gregory, VALA, Dominique Lucie Mylene
KHATCHATOURIAN, Gregory, VALA, Dominique Lucie Mylene. Images in cardiovascular medicine. Acute type I aortic dissection with concomitant pulmonary artery dissection.
Circulation , 2005, vol. 112, no. 19, p. e313-4
DOI : 10.1161/CIRCULATIONAHA.104.524538 PMID : 16275874
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G. Khatchatourian and D. Vala
Acute Type I Aortic Dissection With Concomitant Pulmonary Artery Dissection
Print ISSN: 0009-7322. Online ISSN: 1524-4539
Copyright © 2005 American Heart Association, Inc. All rights reserved.
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doi: 10.1161/CIRCULATIONAHA.104.524538 2005;112:e313-e314
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Acute Type I Aortic Dissection With Concomitant Pulmonary Artery Dissection
G. Khatchatourian, MD; D. Vala, MD
A
55-year-old white male with hypertension and acute type I aortic dissection diagnosed on the basis of transthoracic echocardiography underwent emergency sur- gery. A large hematoma was found on the left lateral aspect of the ascending aorta, infiltrating the pulmonary trunk. A“hemi-arch” repair was performed with an open distal anas- tomosis technique using a standard tubular graft.
Postoperative course was uneventful without any notewor- thy symptoms. Routine postoperative computed tomography (CT) scan was performed. Imaging revealed residual arch and descending aortic dissection (Figure 1, dotted arrow) and, surprisingly, pulmonary artery dissection (Figure 1, arrow) originating at the distal trunk (Figure 2, arrow), with involve- ment of the left pulmonary artery (Figure 3, arrow). Repeat
CT scan at 3 months was identical and the patient was asymptomatic.
Dissection of the pulmonary artery has been previously described in cases of pulmonary artery aneurysms associated with either severe pulmonary hypertension or congenital heart malformations, and in cases of connective tissue disor- ders. In acute type I aortic dissection, aorto-pulmonary fistulization or thrombosis of the pulmonary artery has been reported. To our knowledge, pulmonary artery dissection has never been described in association with aortic dissection. We speculate that the infiltrating hematoma could dissect the layers of the pulmonary artery wall. Another explanation might be that perioperative manipulation of fragile tissues could create iatrogenic dissection.
From the Clinic for Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland.
Correspondence to Dr G. Khatchatourian, MD, Clinic for Cardiovascular Surgery, University Hospital of Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail g.khatchatourov@bluewin.ch
(Circulation.2005;112:e313-e314.)
© 2005 American Heart Association, Inc.
Circulationis available at http://www.circulationaha.org DOI: 10.1161/CIRCULATIONAHA.104.524538 Figure 1.Postoperative CT scan showing residual descending
aortic dissection (dotted arrow) and pulmonary artery dissec- tion (arrow).
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Images in Cardiovascular Medicine
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Figure 2.Three-dimensional reconstruction of postoperative CT scan showing pulmonary artery dissection originating at the pul- monary trunk (arrow).
Figure 3.Three-dimensional reconstruction of postoperative CT-scan showing pulmonary artery dissection with involvement of the left pulmonary artery.
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