Suspected Iatrogenic Aortic Dissection During Cardiopulmonary Bypass and Veno-Arterial Extracorporeal Membrane Oxygenation: A Challenging Dilemma.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8511187 Publication Model: Print Cited Medium: Internet ISSN: 1540-8175 (Electronic) Linking ISSN: 07422822 NLM ISO Abbreviation: Echocardiography Subsets: MEDLINE
    • Publication Information:
      Publication: Hoboken, NJ : Wiley-Blackwell
      Original Publication: Mount Kisco, N.Y. : Futura Pub. Co., [c1984-
    • Subject Terms:
      Extracorporeal Membrane Oxygenation*/methods ; Aortic Dissection*/surgery ; Aortic Dissection*/etiology ; Iatrogenic Disease* ; Echocardiography, Transesophageal*/methods ; Cardiopulmonary Bypass*/adverse effects; Humans ; Male ; Middle Aged ; Aorta, Thoracic/surgery ; Aorta, Thoracic/diagnostic imaging ; Diagnosis, Differential ; Aortic Aneurysm, Thoracic/surgery ; Aortic Aneurysm, Thoracic/diagnosis ; Intraoperative Complications/etiology ; Intraoperative Complications/diagnostic imaging ; Intraoperative Complications/diagnosis
    • Abstract:
      Iatrogenic aortic dissection (IAD) is a life-threatening condition, primarily caused by arterial cannulation during cardiopulmonary bypass (CPB) in cardiac surgeries. Transesophageal echocardiography (TEE) is the first-line diagnostic tool in the acute setting, but the presence of several artifacts can easily lead to misinterpretation. A 55-year-old man underwent coronary artery bypass grafting and implantation of central veno-arterial extracorporeal membrane oxygenation (V-A ECMO). TEE revealed what appeared to be an intimal dissection flap in the aortic arch and descending thoracic aorta, raising concerns for an IAD, which was not confirmed by computed tomographic angiography. This case highlights the pitfalls and limitations of echocardiography in the diagnosis of IAD, especially in settings with complex flow patterns such as during CPB or V-A ECMO.
      (© 2024 Wiley Periodicals LLC.)
    • References:
      J. C. Foster, M. Kilcoyne, L. Witer, and G. Whitener, “Multidirectional Blood Flow During Cardiopulmonary Bypass Mimicking an Iatrogenic Aortic Dissection During Transesophageal Echocardiographic Examination,” CASE 8, no. 9 (2024): 436–439. ISSN 2468–6441.
      P. Vignon, K. T. Spencer, G. Rambaud, et al., “Differential Transesophageal Echocardiographic Diagnosis Between Linear Artifacts and Intraluminal Flap of Aortic Dissection or Disruption,” Chest 119, no. 6 (2001): 1778–1790.
    • Contributed Indexing:
      Keywords: artifacts; cardiopulmonary bypass; iatrogenic aortic dissection; intra‐operative transesophageal echocardiography; veno‐arterial extracorporeal membrane oxygenation
    • Publication Date:
      Date Created: 20241203 Date Completed: 20241203 Latest Revision: 20241203
    • Publication Date:
      20241204
    • Accession Number:
      10.1111/echo.70043
    • Accession Number:
      39624930