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Ann Thorac Surg 2002;73:953-955
© 2002 The Society of Thoracic Surgeons

Case report

Successful repair of intraoperative aortic dissection detected by transesophageal echocardiography

David Varghese, MB, ChB*a, Bernhard J.C.J. Riedel, FCAa, S. Nicholas Fletcher, FRCAa, Mohammed I. Al-Momatten, FRCSa, Asghar Khaghani, FRCSa

a Department of Cardiothoracic Surgery and Anesthetics, Harefield Hospital, Middlesex, United Kingdom

Accepted for publication April 21, 2001.

* Address reprint requests to Dr Varghese, 20 Lytham Close, Thamesmead, London, England SE 28 8QH, UK
e-mail: david{at}varghese.freeserve.co.uk

Aortic dissection is a rare but devastating complication of cardiac surgery. Early intraoperative diagnosis and management are essential for a favorable outcome. We describe the case of a 69-year-old man with worsening dyspnea who was admitted for mitral valve replacement having previously had a mitral valve repair. Pre-cardiopulmonary bypass transesophageal echocardiography confirmed mitral regurgitation and showed mild atherosclerotic changes in the descending aorta. Following successful replacement of the mitral valve, an attempt to wean from cardiopulmonary bypass failed. This was characterized by acute onset hypovolemia. The transesophageal echocardiography showed the presence of features of acute aortic dissection involving only the descending aorta without identifying the entry point. The tear was successfully repaired by direct suture within the lumen.




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