Aortic Dissections Following Heart Transplantations

Abstract

Appropriate surgical repair performed in a timely fashion leads to excellent results improving the prognosis of these patients.

Fatal and Non-fatal Spontaneous and Iatrogenic Acute Aortic Dissection type A: Report of two cases

“…Aetiology and aetiopathogenesis: (spontaneous, acquired iatrogenic and acquired accidental) Degeneration of the aortic wall, in particular myxoid and mucoid degradation and deterioration of the aortic media layer, has been recognized as an etiologic factor of AD increasing its susceptibility to rupture [16] . AD occurs usually spontaneous [17] but acquired caused by iatrogenic trauma during invasive cardiovascular diagnostic procedure [18] , after coronary surgical intervention [19] and delayed dissection of the donor aorta 22 years following orthotropic heart transplantation [20] have been reported and accounts for 5% of cases [21]. In one of our patients (patient 5), acquired iatrogenic acute AD, without chest or back pain, occurred during diagnostic coronary artery catheterization.…”

Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation

“…Post-HTx dissection is rare and requires urgent surgical intervention with high mortality (1). Ruptures that occur in the acute period are dramatic and are due to tension in the suture line or aortic mismatch (3).…”

“…The cause of dissection is not clear (3). However, cross clamping trauma, de-airing needle location, connective tissue diseases such as Marfan syndrome (2), donor and recipient aortic mismatch, candida infection, secondary hypertension due to postoperative immunosuppressive therapy (1,2,4), technical reasons, mediastinal heart trauma, past percutaneous coronary intervention, or invasive interventions (4,6) can be the cause. Frequent antibiotic use, central catheter insertion, total parenteral nutrition are the most common causes of candida infections (3,4,5).…”

“…Donor and/or recipient aortic dissection following heart transplantation (HTx) was published in very small numbers of articles (1)(2)(3)(4)(5)(6)(7). As a result of the preparation of recipients, donor care, anesthesia and surgical techniques, improvements in immunosuppressive therapy, the survival of HTx patients are increasing day by day, thus increasing the incidence of late complications (1). Incompatibility between donor and the recipient aorta may cause infection, technical errors, impaired hemodynamic flow dynamics or hypertension.…”