Right Heart Failure as an Atypical Presentation of Chronic Type A Aortic Dissection - Multimodality Imaging for Accurate Diagnosis and Treatment. A case report and mini-review of literature
Article Category: Research Article
Data publikacji: 12 sie 2022
Zakres stron: 204 - 213
Otrzymano: 09 kwi 2022
Przyjęty: 12 cze 2022
DOI: https://doi.org/10.2478/jccm-2022-0016
Słowa kluczowe
© 2022 Ioan Tilea, Robert Adrian Dumbrava, Alexandra Mihaela Ratiu, Marius Mihai Harpa, Cosmin Marian Banceu, Dorina Nastasia Petra, Horatiu Suciu, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Background
An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment.
Case presentation
A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were successfully performed. The patient was discharged in good condition with appropriate pharmacological treatment, guideline-directed; no imagistic signs of acute post-surgery complications were ascertained.
Conclusion
This paper highlights the importance of recognizing and providing a timely clinical and imagistic diagnosis of this very rare, potentially avoidable cause of right heart failure in patients with previous cardiac surgery.