Type A aortic dissection immediately after open replacement of the thoracoabdominal aorta is a rare and potentially lethal complication that has only been reported twice previously. Dr. Abraham Sonny, Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, and colleagues describe a 74-year-old man with a history of expanding Crawford Type I thoracoabdominal aortic aneurysm who presented for open surgical repair in their article published in the March 1 issue of A&A Case Reports titled “Retrograde Type A Aortic Dissection After Thoracoabdominal Aneurysm Repair: Early Diagnosis with Intraoperative Transesophageal Echocardiography.”
Routine intraoperative transesophageal echocardiography after the repair revealed a new type A aortic dissection extending up to the sinotubular junction. Subsequent emergent aortic arch repair was performed successfully under deep hypothermic circulatory arrest. Intraoperative type A aortic dissection is associated with a very high risk of early mortality and morbidity such as prolonged ventilation, renal failure, and cardiogenic shock. Routine postoperative transesophageal echocardiographic exam after aortic surgery facilitates early diagnosis and may identify associated complications such as pericardial effusion, aortic insufficiency, and coronary ischemia. Efficient surgical decision making and cerebral protection during the emergent repair are necessary for a successful outcome.