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Diagnostic challenges with transesophageal echocardiography for intraoperative iatrogenic aortic dissection: Role of epiaortic ultrasound


Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Correspondence Address:
Sudhakar Subramani
Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_4_19

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Year : 2021  |  Volume : 24  |  Issue : 1  |  Page : 83-86

 

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Iatrogenic aortic dissection is a rare and serious complication of cardiac surgery with an incidence between 0.12' and 0.16'. Dissections involving an intimal flap can be detected using trans-esophageal echocardiography (TEE) with a sensitivity of 94'–100' and specificity of 77'–100'. Rarely, dissections can occur that are not detectable by TEE. There have been reports of iatrogenic dissection in the ascending aortic cannulation site; however, a dissection at the antegrade cardioplegia cannulation site is very rare. It also presents challenges associated with early diagnosis and appropriate intervention. We are describing a rare case of aortic dissection at the antegrade cardioplegia cannulation site in the proximal ascending aorta. The dissection was unable to be visualized with TEE initially, and required epi-aortic ultrasound to diagnose dissection in timely manner.






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Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Correspondence Address:
Sudhakar Subramani
Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_4_19

Rights and Permissions

Iatrogenic aortic dissection is a rare and serious complication of cardiac surgery with an incidence between 0.12' and 0.16'. Dissections involving an intimal flap can be detected using trans-esophageal echocardiography (TEE) with a sensitivity of 94'–100' and specificity of 77'–100'. Rarely, dissections can occur that are not detectable by TEE. There have been reports of iatrogenic dissection in the ascending aortic cannulation site; however, a dissection at the antegrade cardioplegia cannulation site is very rare. It also presents challenges associated with early diagnosis and appropriate intervention. We are describing a rare case of aortic dissection at the antegrade cardioplegia cannulation site in the proximal ascending aorta. The dissection was unable to be visualized with TEE initially, and required epi-aortic ultrasound to diagnose dissection in timely manner.






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