Brain swelling in acute superior vena cava syndrome due to aortic dissection: unusual and lethal manifestation aggravated by induction of general anesthesia

Abstract

A 32-year-old woman with Marfan syndrome experienced acute superior vena cava syndrome due to aortic dissection. The patient had previously undergone a Bentall operation. The aneurysm from the ascending to the transverse aorta compressed the superior vena cava, the right pulmonary artery, and the trachea. The rare and life-threatening neurological complication in this patient may have been related to brain edema, which was revealed by preoperative computed tomography. The induction of general anesthesia aggravated the symptoms of the superior vena cava syndrome and led to a fatal condition. Additional cannulation in the right subclavian vein was mandatory to alleviate the symptoms because the venous drainage from the upper half of the body created only by the femorofemoral bypass was not adequate. Total arch replacement was performed. The postoperative course was uneventful.