Pulmonary Artery Dissection and Rupture Associated With Aortopulmonary Window

Surgical repair of huge ascending aortic and arch aneurysms with aortic dissection combined with pulmonary artery dissection and aortopulmonary artery fistula

An aortopulmonary artery fistula combined with aortic and pulmonary artery dissection is extremely rare, and very few cases have been reported to date. Herein, we present a 38-year-old man with huge ascending aortic, arch and thoraco-abdominal aneurysms with chronic aortic dissection, pulmonary artery dissection and aortopulmonary fistula. Surgery was performed to replace the ascending aorta and the entire arch combined with a conventional elephant trunk implantation to correct the pulmonary artery dissection and repair the aortopulmonary fistula under selective cerebral perfusion with deep hypothermic circulatory arrest. The patient recovered uneventfully. A second-stage operation will be needed to replace the thoraco-abdominal aorta.

Pulmonary artery dissection in eight dogs with patent ductus arteriosus

OBJECTIVES

To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA).

ANIMALS

Eight dogs.

METHODS

Retrospective case series.

RESULTS

Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5-4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure.

CONCLUSIONS

Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome.

Transpulmonary correction of an isolated aortopulmonary window in an adult

We describe the operative management of a 65-year-old patient with a congenital type I aortopulmonary window. At surgery, heavy calcifications on the aortic side of the defect, and close proximity with the left coronary ostium, prevented patch repair from the transaortic access. Patch closure through a combined transpulmonary approach was therefore required. This case illustrates unique features of a late-presenting aortopulmonary window.

The dilated aorta in patients with congenital cardiac defects

Many patients with congenital cardiac disease are at risk for progressive aortic dilation. The mechanisms underlying aortic dilation in this patient cohort are described, and the similarities to the pathophysiologic alterations seen in Marfan syndrome are highlighted. Indications for treatment are discussed.

Acute Stanford type B dissection and cardiac tamponade: rupture from around ductus arteriosus

Pericardial tamponade is rarely associated with acute Stanford type B aortic dissection. We encountered this unusual combination in a 59-year-old patient. He underwent an emergency drainage procedure through a midline sternotomy. Operative findings strongly suggested that the dissected aorta ruptured into the pericardial cavity from around the ductus arteriosus. Clinicians should be aware that Stanford type B aortic dissection can cause pericardial tamponade.

Acute concomitant pulmonary artery and aortic dissection with rupture

Pulmonary artery (PA) dissection is uncommon and may lead to rupture and sudden death if encountered. A 63-year-old man presented to our emergency room with episodic left chest pain radiating to the back followed by shortness of breath. A 64-row multidetector computed tomography (MDCT) revealed ruptured dissection of the PA and the aorta with hemopericardium, hemomediastinum, and prominent extravasated blood along the central bronchovascular bundles of both lungs. The patient experienced cardiogenic shock immediately following CT study and died after resuscitation. Concomitant PA and aortic dissection with rupture is extremely rare with the pathogenesis remaining investigated. MDCT proves to be a powerful tool in its diagnosis for a timely surgical repair if the patient could survive to have the operation.