Acute Cardiac Dysfunction and Rapid Descending Aortic Expansion Following Surgery for Acute Stanford Type A Aortic Dissection: a case report

Abstract Background Severe true lumen stenosis of the aorta can increase left ventricular afterload and impair cardiac function. We report a rare case of significant true lumen stenosis and cardiac dysfunction after undergoing total arch replacement for acute type A aortic dissection. Case Summary A 39-year-old man with acute Stanford type A aortic dissection and intimal tear in the ascending aorta underwent the Bentall procedure and total arch replacement with a frozen elephant trunk. He was readmitted one month after discharge with progressive cardiac dysfunction. Myocardial scintigraphy excluded ischemia, and computed tomography revealed severe true lumen stenosis at the distal frozen elephant trunk, resulting in an elevated left ventricular afterload. Thoracic endovascular aortic repair to expand the true lumen resulted in gradual improvement in cardiac function. However, there was progressive dilation of the descending and thoracoabdominal aorta: 26 mm at onset, and 32 mm and 46 mm at two and six months postoperatively, respectively. To close distal re-entries, endovascular aortic repair was performed after two months. His brain natriuretic peptide level decreased from 2901 pg/mL to 142 pg/mL over eight months; open abdominal aortic replacement was performed nine months after the onset, after sufficient cardiac function recovery (ejection fraction = 40%). Discussion True lumen stenosis is a substantial reversible cause of cardiac dysfunction after type A dissection surgery. Thoracic endovascular aortic repair effectively reduces the afterload and restores cardiac function; long-term imaging and staged intervention are essential to address distal aortic remodeling.