Emergency management of acute panaortic dissection complicated by stroke-a happy end story

Introduction: Acute aortic dissection is a life-threatening clinical emergency, with a high mortality risk, at which major challenges include accurate diagnosis, appropriate treatment given the variability in clinical presentations and the need for timely treatment.
Case presentation: We submit the case of a 66-year-old male obese, hypertensive patient who was reffered for chest pain relief by nitroglycerin. At presentation, a stable haemodynamic patient (BP 130/80 mmHg, HR 75 beats/ min, OS 99%), no systolic blood pressure differences, no sign of asymmetric pulses, no cardiac murmurs, ECG show-sinus rhythm 76 beats, RBBB, echocardiography – ascending aortic aneurysm, minor aortic insuffciency, left ventricular hypertrophy, EF 60%, without other pathological changes. During monitoring, the patient develops severe chest pain, with back radiation, associated with elevated blood pressure. Computed tomography angiography (CTA) in emergency revealed an acute panaortic dissection. A cardiac surgery has been made, where upward re-section of the aorta is practiced, the stitch of the en-trance to the crown aortic and suture of a Dacron pros-thesis with favorable postoperative initially evolution. 7 days after intervention, the patient develops stroke with right part motor deficiency, being transffered to the Neurological Department for neurological recovery. Revaluation at 3 months is favorable, with improved motor deficit and bilateral suport and well-controlled blood pressure. Patient with acute aortic dissection, with initial atypical symptom for dissection at which prompt diagnosis, effective surgery, careful monitoring and collaboration in team (cardiologist, cardiovascular surgeon, anesthesiologist, neurologist) determined the therapeutic success and favorable patient progression.
Conclusions: Aortic dissection is a relatively rare condition (3: 100,000), the proper diagnosis is difficult to identify, the interdisciplinary team playing a crucial role for patient survival, the mortality rate being extremely high.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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