Document Type : Case Report
Authors
- Ahmad Amouzeshi 1
- Mahmoud Ganjifard 2
- Azam Rezaei 3
- Mohammad Bakhtiari 4
- Maryam Ghadimi 5
- Yasamin Chaibakhsh 5
- Maryam Bahramian 6
- Mozhgan Bahramian 6
- Seyyed Ebrahim Hosseini Zargaz 7
1 Department of Cardiology, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
2 Department of Anesthesiology and Critical Care, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
3 Department of Internal Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
4 School of Medical Sciences, Sirjan School of Medical Sciences, Kerman, Iran
5 Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran
6 Department of Social Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
7 Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
Abstract
Background: Aortic dissection is a rare emergency type A aortic dissection associated with Marfan syndrome is a rare emergency condition that typically occurs in young individuals. Mortality and morbidity rates in these patients are higher compared to those of other open-heart surgeries.
Case Report: We report a 31-year-old man with Marfan syndrome who presented to our center with chest pain. A CT angiography confirmed a diagnosis of type A aortic dissection. The patient underwent open-heart surgery, during which a moderate hypothermia technique, along with systemic arrest, was utilized during cardiopulmonary bypass. Following the operation, he was transferred to the intensive care unit and was ultimately discharged after seven days.
Conclusion: Although aortic dissection is a rare emergency condition, a series of protective measures during cardiopulmonary bypass (CPB), such as systemic arrest and other considerations, can prevent complications arising from prolonged bypass time and hypothermia. Furthermore, surgical techniques and cardiopulmonary bypass management both play significant roles in surgical outcomes.
Keywords
Main Subjects
- Madadi F, Aval ZA, Bagheri A, Fani K, Ghanbarpour MH, Murodov M, Dabbagh A. The role of connective tissue genomics in ascending aortic dissection: A case of Marfan syndrome. Journal of Cellular & Molecular Anesthesia. 2019 Jan 1;4(3). https://doi.org/10.22037/jcma.v4i3.28189
- Harky A, Shaw M, Bashir M. Thoracic aortic aneurysm surgery in Marfan patients: a perspective from the UK. Brazilian journal of cardiovascular surgery. 2020 Mar 23;35:58-64. https://doi.org/10.21470/1678-9741-2019-0214
- Leacche M, Byrne JG. Type A aortic dissection in Marfan syndrome: a case for more aggressive and extensive surgery at the time of the initial surgical operation. Circulation. 2014 Apr 1;129(13):1373-4. https://doi.org/10.1161/CIRCULATIONAHA.114.008745
- Dewi DA, Ayusta MD. Acute thoracic aortic dissection: a case report. Intisari Sains Medis. 2020 Aug 1;11(2):769-72. DOI:10.15562/ism.v11i2.715
- Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart. 2007 Feb 1;93(2):266-70. https://doi.org/10.1136/hrt.2005.078550
- Januzzi JL, Marayati F, Mehta RH, Cooper JV, T O'Gara P, Sechtem U, Bossone E, Evangelista A, Oh JK, Nienaber CA, Eagle KA. Comparison of aortic dissection in patients with and without Marfan's syndrome (results from the International Registry of Aortic Dissection). The American journal of cardiology. 2004 Aug 1;94(3):400-2. https://doi.org/10.1016/j.amjcard.2004.04.049
- Rashidinejad H, Nasri H, Salehi M, Moazenzadeh M. Quality of life after Coronary Artery Bypass Grafting (CABG) in older adults. Journal of Kerman University of Medical Sciences. 2019 Sep 1;26(5):384-9.
- Hashemi J, Ghaffari Nejad M, Baharestani B, . Esfandiari R, Panahipoor A (2011) Evaluation and comparison of use of low-dose aprotinin and tranexamic acid in CABG: a double–blind, prospective, randomized study of 150 patients. Iranian Heart Journal. 12(1):40-4.
- Abbaszadeh S, Eslami M, Nikparvar M. Aortic Dissection in an 11-Year-Old Boy: Case Report. Iranian Heart Journal. 2019 Jul 1;20(3):95-100.
- Cabanelas N, Nobre Â, Guerra N, Gallego J, Ferreira R, Carvalheiro C, Roque J, Peres M, Siopa L, Martins VP, Silva G. Images in Cardiology after clinical observation—Aortic dissection in Marfan syndrome. Revista Portuguesa de Cardiologia (English Edition). 2011 Sep 1;30(9):735-41. https://doi.org/10.1016/S2174-2049(11)70018-6
- Abbas-Hashemi SA, Hosseininasab D, Rastgoo S, Shiraseb F, Asbaghi O. The effects of caffeine supplementation on blood pressure in adults: A systematic review and dose-response meta-analysis. Clinical nutrition ESPEN. 2023 Dec 1;58:165-77. https://doi.org/10.1016/j.clnesp.2023.09.923
- Heydarian A, Tahvilian N, Shahinfar H, Abbas‐Hashemi SA, Daryabeygi‐Khotbehsara R, Aryaeian N. Effect of cardamom consumption on inflammation and blood pressure in adults: A systematic review and meta‐analysis of randomized clinical trials. Food science & nutrition. 2024 Jan;12(1):3-12 https://doi.org/10.1002/fsn3.3738
- Guan Y, Yang J, Wan C, He M, Dong P. Cardiopulmonary bypass for thoracic aortic aneurysm: A report on 488 cases. The Journal of ExtraCorporeal Technology. 2004 Mar 1;36(1):22-7. https://doi.org/10.1051/ject/200436122
- Kandil OA, Motawea KR, Darling E, Riley JB, Shah J, Elashhat MA, Searles B, Aiash H. Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis. Clinical Cardiology. 2021 Dec;44(12):1700-8. https://doi.org/10.1002/clc.23750
- Lee JH. Prevention and management of difficult hemostasis in acute type A aortic dissection repair. Asian Cardiovascular and Thoracic Annals. 2023 Jan;31(1):15-9. https://doi.org/10.1177/02184923221074409
- Gao B, Liu Y, Yao YT, Evidence in Cardiovascular Anesthesia (EICA) Group. Efficacy and safety of tranexamic acid in patients undergoing thoracic surgery: a systematic review and PRISMA-compliant meta-analysis. Journal of Cardiothoracic Surgery. 2024 Apr 9;19(1):195. https://doi.org/10.1186/s13019-024-02716-9
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