Successful Pericardial Fenestration Drainage and Emergency TEVAR for Retrograde Type A Aortic Dissection in a Patient with Cardiac Tamponade

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  • 心タンポナーデを伴う逆行性Stanford A型急性大動脈解離に対して，心膜開窓ドレナージと緊急胸部ステントグラフト内挿術を施行し救命し得た1例

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<p>A 78-year-old man with back pain went into cardiopulmonary arrest while being transferred by ambulance to our hospital. After performing cardiopulmonary resuscitation, his heartbeat restarted. Enhanced CT scans demonstrated non communicating aortic dissection from the ascending to the descending thoracic aorta and a slight contrast enhancement in the distal aortic arch. Following the CT screening, he again had a cardiac arrest due to the cardiac tamponade. His heartbeat subsequently restarted after performing subxiphoid pericardial fenestration drainage. However, massive bleeding from the pericardium continued. We immediately performed an endovascular procedure in Zone 2 to close the entry site on the distal aortic arch. This successfully controlled the bleeding. The postoperative course was uneventful and a CT scan performed after three months showed no endoleak. However, after four months, he again had a back pain, and a CT revealed retrograde type A aortic dissection (RTAD). He subsequently underwent emergent total arch replacement. Thus, although the endovascular procedure was effective and life-saving for a Stanford type A aortic dissection, the possibility that RTAD could occur should be considered.</p>

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