Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

Abstract

Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.

A rare case of Watson syndrome

“…[6] The accepted surgical strategy has included an aneurysmorrhaphy with resection of a strip of anterior wall of aneurysm or replacement of the main trunk with a prosthetic Dacron graft or homograft. [7] The aneurysm in our case involved not only the main pulmonary trunk but also both the right and left pulmonary arteries. This pathologic finding is easily amenable to repair by longitudinal aneurysmorrhaphy through a median sternotomy.…”