Eastern Cardiothoracic Surgical Society

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Ruptured Chronic Type A Dissection With Aorta to Right Atrial Fistula After Prior Dissection Repair
Jonathan M. Hemli, Antonio J. Guirola, Paley G. Arnone, Jui-Chuan Tseng, Kush R. Dholakia, S Jacob Scheinerman, Derek R. Brinster.
Lenox Hill Hospital / Northwell Health, New York, NY, USA.

OBJECTIVE: Patients who undergo repair of an acute type A dissection are still at risk for significant morbidity. Not only do patients sometimes require intervention on the downstream dissected aorta, they may also accrue complications related to the proximal repair itself. We present an unusual complication of chronic type A dissection in a patient who had already undergone prior repair. METHODS: Our technique for addressing a chronic type A dissection is demonstrated in a 73 year-old female who presents with a 9cm dissected ascending aortic aneurysm with contained rupture, severe aortic insufficiency, and an aorta to right atrial communication, 12 years after prior repair of an acute dissection. RESULTS: As illustrated in the video presentation, a small patch of prosthetic material was utilized to repair the patient's original acute aortic dissection. The aneurysm was opened, the true lumen was identified, and a new graft was sewn to the proximal arch. A fistula to the right atrium was repaired primarily. A new aortic root was constructed using a bioprosthetic valve-conduit composite graft. Vein grafts were used to perfuse each of the two main coronary arteries, rather than risk undue tension on friable tissue that may result from utilizing a typical button technique. CONCLUSIONS: Chronic type A dissection can be challenging enough to repair in and of itself, let alone in a patient with prior focal patch repair of a dissected aorta. An aorta to right atrial fistula is merely another unusual complication of chronic type A dissection.


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