Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 5077-5081
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5077
Type A aortic dissection following heart transplantation: A case report
Zhu Zeng, Lin-Jie Yang, Chao Zhang, Fen Xu
Zhu Zeng, Lin-Jie Yang, Chao Zhang, Fen Xu, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Zeng Z performed the conceptualization, data curation, project administration, resources, supervision, and visualization, and wrote the original draft; Yang LJ performed the data curation, formal analysis, software, validation, and visualization, and wrote and edited the manuscript; Xu F obtained the funding; Zhang C performed the investigation and methodology.
Supported by Natural Science Foundation of Hubei Province in 2016, No. 2016CFB644.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin-Jie Yang, BSc, Nurse, Chief Nurse, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. 358520754@qq.com
Received: December 10, 2021
Peer-review started: December 10, 2021
First decision: January 26, 2022
Revised: January 30, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 26, 2022
Processing time: 165 Days and 6.3 Hours
Abstract
BACKGROUND

Cardiac transplantation is considered the standard treatment for refractory end-stage heart failure. Worldwide, 5074 heart transplantations were performed in 2015. About 100 heart transplants are performed at the authors’ center each year. The usual complications of heart transplantation include graft rejection, infection, and graft dysfunction. Aortic dissection after heart transplantation is very rare and is a serious complication that requires a hybrid procedure.

CASE SUMMARY

A 58-year-old female patient was admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in July 2020 because of unprovoked low back pain without precipitating causes. Magnetic resonance imaging and computed tomography angiography showed type A aortic dissection with an aberrant right subclavian artery. After admission, urapidil was used to control blood pressure. Ten days later, the patient underwent ascending aortic and aortic arch replacement, subclavian artery reconstruction, and endovascular repair of abdominal and thoracic aortic aneurysms. A cardiopulmonary bypass was established through the right femoral artery and femoral vein. The aberrant right subclavian artery, innominate artery, left common carotid artery, and left subclavian artery were blocked, and the left and right common carotid arteries were cannulated for bilateral cerebral perfusion.

CONCLUSION

The right axillary artery could not be selected for cardiopulmonary bypass intubation because of aberrant right subclavian artery.

Keywords: Type A aortic dissection; Heart transplantation; Aberrant right subclavian artery; Cardiopulmonary bypass; Case report

Core Tip: There is a risk of hypertension after heart transplantation. Hypertension is a risk factor for aortic dissection that needs surgery. Hybrid procedure shortened the operation time and reduced complications. In this case, the patient had an aberrant right subclavian artery, and unilateral antegrade cerebral perfusion through the right axillary artery cannot be performed.