Suspected Iatrogenic Aortic Dissection During Cardiopulmonary Bypass and Veno-Arterial Extracorporeal Membrane Oxygenation: A Challenging Dilemma

Echocardiography. 2024 Dec;41(12):e70043. doi: 10.1111/echo.70043.

Abstract

Iatrogenic aortic dissection (IAD) is a life-threatening condition, primarily caused by arterial cannulation during cardiopulmonary bypass (CPB) in cardiac surgeries. Transesophageal echocardiography (TEE) is the first-line diagnostic tool in the acute setting, but the presence of several artifacts can easily lead to misinterpretation. A 55-year-old man underwent coronary artery bypass grafting and implantation of central veno-arterial extracorporeal membrane oxygenation (V-A ECMO). TEE revealed what appeared to be an intimal dissection flap in the aortic arch and descending thoracic aorta, raising concerns for an IAD, which was not confirmed by computed tomographic angiography. This case highlights the pitfalls and limitations of echocardiography in the diagnosis of IAD, especially in settings with complex flow patterns such as during CPB or V-A ECMO.

Keywords: artifacts; cardiopulmonary bypass; iatrogenic aortic dissection; intra‐operative transesophageal echocardiography; veno‐arterial extracorporeal membrane oxygenation.

Publication types

  • Case Reports

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery
  • Aortic Dissection* / etiology
  • Aortic Dissection* / surgery
  • Cardiopulmonary Bypass* / adverse effects
  • Diagnosis, Differential
  • Echocardiography, Transesophageal* / methods
  • Extracorporeal Membrane Oxygenation* / methods
  • Humans
  • Iatrogenic Disease*
  • Intraoperative Complications / diagnosis
  • Intraoperative Complications / diagnostic imaging
  • Intraoperative Complications / etiology
  • Male
  • Middle Aged