Ruptured aortic dissection into the pulmonary artery: A case study

A 39-year-old male patient was admitted to our emergency department with a complaint of severe chest pain lasting for the past 30 minutes and a short-term loss of consciousness. Shortly after his admission, he succumbed to cardiac arrest caused by pulseless ventricular tachycardia. Accordingly, direct defibrillation was performed using 200 Joules and cardiopulmonary resuscitation (CPR) was initiated along with the intravenous administration of 300-mg amiodarone. Furthermore, repeated biphasic electrical defibrillation therapies were implemented as required, all of which failed at conversion into any palpable rhythm. An emergency bedside echocardiographic evaluation performed via hand-held ultrasound device revealed a visual estimation of left ventricular ejection fraction to be 20% with no specific wall motion abnormality, pericardial effusion, or dilation in the right cardiac chambers. The ascending aorta and the pulmonary trunk could not be clearly assessed because of poor visualization. While transferring the patient to the catheter laboratory for an emergency coronary angiography, the rhythm degenerated into asystole. The findings of the first cineangiography demonstrated Stanford A, DeBakey type 2 aortic dissection ruptured into the pulmonary trunk in immediate vicinity of the aortic root with contrast passage further into the right pulmonary arterial tree (Fig. 1, Video 1). The tip of the diagnostic catheter was observed to lodge in the left main coronary artery with no passage of contrast agent into the left coronary arterial tree, possibly because of the propagation of the dissection flap further into the left coronary system. Despite CPR, the patient died soon