CTICasesIatrogenic Type A Aortic Dissection from the Cannulation Site
Imaging findings
A patient who underwent tricuspid and mitral valve repair coded five days post-operatively. CTA of the chest, abdomen, and pelvis shows a massive type A aortic dissection with a small blush adjacent to the aortotomy/cannulation site (marked by a felt pledget), the dissection involving the left main coronary artery and extending through the thoracic and abdominal aorta. Delayed imaging shows one of the most extensive myocardial infarcts, with a dilated left ventricle, and side-branch filling in the descending aorta.
Key takeaways
Aortic cannulation for cardiac surgery can be the origin of an iatrogenic type A dissection, recognizable by a dissection and contrast blush arising at the cannulation/aortotomy site. Extension into the left main coronary can cause a catastrophic myocardial infarct, strikingly demonstrated on the delayed phase of a multiphase CTA, and this is a devastating complication of otherwise routine valve surgery.
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