CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
e10
AFRICA
Case Report
Acute aortic dissection with a dangerous duo in an
adolescent boy
TAHIR BEZGIN, CEM DOĞAN, ALI ELVERAN, ALI KARAGÖZ, CAN YÜCEL KARABAY, ALI METIN ESEN
Abstract
Acute type II aortic dissection and aortic coarctation are rare
combined disorders. This report is of a patient with coarc-
tation, a bicuspid aortic valve and type II dissection, who
underwent emergency repair for the dissection, with aortic
valve preservation. Repair of the coarctation was planned for
a future occasion. The optimal sequence and timing of the
repair, the best surgical technique, adequacy of blood perfu-
sion, and the most appropriate arterial cannulation site are
important issues in the repair of aortic dissection secondary
to aortic coarctation.
Keywords:
aortic dissection, coarctation, bicuspid aortic valve
Submitted 4/3/13, accepted 4/9/13
Cardiovasc J Afr
2013;
24
: e10–e12
DOI: 10.5830/CVJA-2013-064
A combination of acute aortic dissection (AAD) associated with
significant coarctation (CoA) of the aorta and other cardiac
abnormalities is rarely seen. In a review of the literature, it was
found that these combined disorders have been treated with
multi- or single-stage surgery.
1-4
In both conditions, there is a
problem with sufficient blood flow to the upper and lower torso.
We present a case of AAD associated with CoA and a
bicuspid aortic valve, which we were able to treat successfully
with a two-stage approach, first performing repair of the AAD,
with correction of the CoA done in another session.
Case report
A 16-year-old male was admitted to emergency because of
transient loss of consciousness. On clinical examination, a 2/6
diastolic murmur was noted in the precordium, with muffled
heart sounds. The blood pressure was 140/100 mmHg in his right
arm, 110/70 mmHg in his left arm and 90/40 mmHg in his legs.
The femoral pulses were weakly palpated. The body stature of
the patient was not Marfanoid.
Bedside transthoracic echocardiography revealed an
aneurysmal dilatation with an intimal flap in the ascending
aorta, a bicuspid aortic valve, minimal pericardial effusion, and
a mild degree of aortic regurgitation (Fig. 1). The diameter of the
ascending aorta was 7.5 cm. Left ventricular function was within
normal limits. Computed tomography with three-dimensional
reconstruction demonstrated CoA and a dissection plane starting
from the level of the aortic valve to the arcus aorta (Figs 2, 3).
The patient was immediately taken to the operating
room. Cardiopulmonary bypass was established with arterial
Cardiology Clinic, Kartal Koşuyolu Heart and Research
Hospital, Istanbul, Turkey
TAHIR BEZGIN, MD,
CEM DOĞAN, MD
ALI ELVERAN, MD
ALI KARAGÖZ, MD
CAN YÜCEL KARABAY, MD
ALI METIN ESEN, MD
A
B
Fig. 1. Transthoracic echocardiography with parasternal
long- and short-axis images shows the dissection flap,
aneurysm of the ascending aorta, pericardial effusion
and bicuspid aortic valve (arrow).
