Simultaneous pulmonary artery and Stanford type B aortic dissections via the ductus arteriosus

Abstract

Pulmonary artery dissection is an exceedingly rare and highly lethal diagnosis that can result in arterial rupture; hence, it is most often identified postmortem. Moreover, pulmonary artery complications resulting from aortic dissection are uncommon occurrences that have seemingly only been reported in cases of Stanford type A aortic dissections. Due to the rarity of pulmonary artery dissections, there is no current established algorithm for treatment of these patients, unlike aortic dissections. We herein present a case of a 40-year-old male with history of uncontrolled hypertension who developed acute back and leg pain that was subsequently diagnosed with a Stanford type B aortic dissection that extended into the main pulmonary artery by way of the ductus arteriosus. Although the patient received appropriate care for his aortic dissection and hypertensive emergency, he eventually died due to development of extensive additional vascular insults: cerebrovascular accidents, compartment syndrome, and myocardial infarction. To our knowledge, this is the first case of combined pulmonary artery dissection and Stanford type B dissection in the literature, which unfortunately adds to the understanding that cases of pulmonary artery dissection tend to have a grim prognosis.

Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis

“…Despite possible overestimation of survival rates due to publication bias, we suggest that the prognosis of PAD significantly differs by the aetiology ( Table 1 ). Patients with PAD due to CHD or non-CHD associated with PH had relatively poorer survival than those with miscellaneous causes or those with aortic dissection-related [ 8 , 67 , 68 , 70 , 72 , [87] , [88] , [90] , [91] , [92] ]. This discrepancy in PAD prognosis is attributed to the patient's comorbidities (such as pulmonary hypertension), underlying complications, and the possibility of reconstruction surgery ( Table 2 ).…”

Two- and Three-Dimensional Transesophageal Echocardiographic Detection of Aortic Dissection Rupture With Extension of Dissection Into the Pulmonary Artery

“…Six of these cases showed the dissection directly propagating from the AO into the PA through a patent ductus arteriosus (PDA) by CTA. 1 , 2 , 3 , 4 , 5 , 6 In these cases, the presence of a PDA appears to act as a conduit that facilitates extension of the dissection into the PA. In another patient, 7 the PDA was an associated finding, but no mention was made regarding extension of the dissection through its lumen.…”

“…Combined aortic (AO) and main pulmonary artery (MPA) dissection is a very rare and highly lethal entity, with only 16 cases reported in the literature. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 We report an elderly patient in whom two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) performed intraoperatively showed rupture of the AO dissection false lumen into the pulmonary artery (PA) with the dissection flaps in the PA clearly noted to be continuous with and extending from the AO false lumen. Thus, we were able to make a definitive diagnosis of PA dissection resulting from AO dissection rupture by TEE in this patient.…”