Relief of cardiac tamponade by a congenital partial left-sided pericardial defect in a patient with ruptured acute type A aortic dissection: a case report

• Published in: JA clinical reports 2019-01, Vol.5 (1), p.4-4, Article 4
• Main Authors: Nishimoto, Kota, Umegaki, Takeshi, Ohira, Sayaka, Nakajima, Yurina, Soeda, Takehiro, Kamibayashi, Takahiko
• Format: Article
• Language: English
• Subjects: Acute type A aortic dissection; Anesthesiology; Aortic dissection; Cardiac tamponade; Case Report; Case reports; Congenital pericardial defect; Critical Care Medicine; Defects; Emergency Medicine; Health risk assessment; Intensive; Medical prognosis; Medicine; Medicine & Public Health; Pain Medicine
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-019-0223-4

Background Acute type A aortic dissections have an extremely poor prognosis, and cardiac tamponade is a major cause of death in these patients. Here, we describe a case where congenital partial pericardial defect relieved cardiac tamponade caused by ruptured type A aortic dissection. Case presentation A 79-year-old woman was hospitalized after experiencing chest pains and respiratory distress. She developed out-of-hospital cardiopulmonary arrest and was resuscitated with no sequelae 5 days before admission. Computed tomography confirmed pericardial and left pleural effusions, and type A aortic dissection was diagnosed. We began emergency ascending aortic replacement surgery under general anesthesia with propofol and remifentanil and incidentally discovered a congenital partial left-sided pericardial defect that allowed drainage of the hemopericardium and relieved cardiac tamponade. The surgery was successfully performed, and the patient recovered without complications. Conclusions We experienced an extremely rare case where a congenital partial pericardial defect relieved cardiac tamponade associated with aortic dissection and contributed to the patient’s survival.