Aortic dissection, the risk that you will not miss even after the Bentall intervention

Objective: We present a rare case of a 52 years old woman with hystorical of aortic prosthesis type Bentall and aortocoronary bypass with VSI on ADA which was presenting in emergency room after one transient episode of right hemiplegia and trauma by falling from the same level
Methods: Fisrt examination patient was stable hemodynamic, temporospace-oriented, motor-free, with no signs of systemic or pulmonary stasis. ECG RS with AV 80 bpm without change of repolarization phase.
Results: Transthoracic echocardiography highlights normofunctional aortic prosthesis without attach-ments attached to fixed or mobile prosthetic elements, dilatation of ascending aorta with double lumen, free pericardium. Emergency thoracic CT with intravenous contrast substance administrated is shown dilatation of aorta, continuity solution at the site of implantantion of left coronary artery with periprosthesis blood effrac-tion and compressible effect on the prosthtesis. Tran-sesophageal echocardiography showing 30 mm the diameter of the prosthesis with peripheral hematoma is performed, the diameter of the lumen of the aorta reaching 52 mm. At approximately 1 – 1.5 cm from the prosthesis ring, on the back wall, near the place of implantation of the trunk of the left coronary artery, the continuity solution is highlighted. It should be mentioned that the periprotetic is higher than the intraprotective pressure, the lumen of the prosthesis having the appearance of sinusoids. Emergency is required to consult the cardiac surgery that recommends emergency surgery, the intervention consisting in reimplation of the left coronary artery trunk and fistula of the peri-prosthetic lumen and the right atrium.
Conclusions: Unfortunately for personal reasons, the patient stops surgery for 4 days, on Monday, June 4, we will repeat angioCT and after the result we will go to surgery.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)