Death deals doubtfully
Death deals doubtfully

Summary/Abstract: Aortic root aneurysm and aortic dissection are the most common cardiovascular manifestations of the Marfan syndrome. Among patients with aortic root replacement, the surgical reintervention rate at 10 years is about 40% and it increases in Marfan syndrome’s patients. These patients also present multiple complications, for example this case of a 45 year old woman with Marfan syndrome and aortic root and valve replacement 12 years ago for type 1 aortic dissection, complaining of dispnoea and frontal headache appeared 3 weeks ago. Mention must be made that concurrently with aortic root replacement the coronary arteries and the neck vessels in the conduct were implanted. At admission she was hemodynamically stable, the blood pressure was 135/80 mmHg and the heart rate was 74/min. The chest radiography showed off a tumor in the upper mediastinum with an antero-posterior diameter of 5 centimeters and the echocardiography disclosed an aortic pseudoaneurysm at the junction of the ascending aortic conduct with the aortic spoon, with an internal thrombus. The computed tomography angiography confirmed the presence of pseudoaneurism with a compressive effect on trachea, and complete atelectasis of the left lower lobe. The aortography revealed the suture dehiscence with a pseudoaneurysm formation at the junction of the brachiocephalic trunk with the aortic spoon. During hospitalization the patient was endotracheally intubated and mechanically ventilated, and presented transient disturbances of consciousness because of a bilateral hemispheric subdural hematoma, appeared under anticoagulant therapy, which was evacuated by a team of cardiologists, anesthesiologists and neurosurgeons. In the next phase we will probably make a stent implantation for tracheal stenosis. Is it possible to repair the anastomotic leak from the aortic spoon after all this? Our case report is a complex case of aortic dissection in a patient with Marfan syndrome, complicated with an anastomotic leak and compressive aneurism on the trachea and the left main bronchus, and also with subdural hematoma, the treatment requiring multidisciplinary efforts.

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