Case description
A 57-year-old male with a history of Bentall, Sun's procedure and left atrial appendage clip occlusion performed 3 months prior was admitted for haemolytic anaemia. Aortic computed tomography angiography (CTA) and transthoracic echocardiography (TTE) revealed coronary anastomotic leaks via the aortic wrap to the right atrium: one left-sided (3.3 mm) and two right-sided (2.9 and 1.2 mm) (Panels A and B).
Digital subtraction angiography (DSA)-guided leak occlusion was performed. A 5-mm ventricular septal defect occlude (Lifetech Scientific, Inc. Shenzhen, China) successfully sealed the primary left leak (Panels C and D); however, intra-operative DSA fluoroscopy demonstrated a retrograde placed stent silhouette at the distal aortic arch, which swung continuously in the distal aortic arch throughout the cardiac cycle (Panel E), causing mechanical destruction of blood, suggesting a causal relationship with haemolytic anaemia. Further history review revealed that the initial frozen elephant trunk (FET) procedure was performed using a 30-30-080 covered stent (Weiqiang Medical Tech, Co., Ltd, Hangzhou, China). However, it was retrograde placed with its morphological distal end anchored within a 28-mm Four-Branched artificial vascular graft at the distal aortic arch. One month later, thoracic endovascular aortic repair (TEVAR) was performed to deploy a covered stent (Medtroni, 30-30-150) to secure the swinging stent to prevent any further movement (Panel F). A compliant balloon was then advanced to the malpositioned stent segment and inflated to remodel the stent-graft. At 1-month follow-up, haemoglobin levels trended from 56 g/L (second admission) to 50 g/L (third admission), rising to 102 g/L recently.
Haemolytic anaemia is a catastrophic complication following acute type A aortic dissection repair. Severe anaemia may necessitate transfusion, and its management remains clinically challenging.
Contributor Information
Shanliang Chen, Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No. 16766, Jingshi Road, Jinan 250014, China.
Xiaozhou Zheng, Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No. 16766, Jingshi Road, Jinan 250014, China.
Huimin Cui, Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No. 16766, Jingshi Road, Jinan 250014, China.
Author contributions
Shanliang Chen [Writing—original draft (supporting)], Xiaozhou Zheng [Writing—original draft (supporting)], and Huimin Cui [Writing—original draft (supporting)]
Consent: The patient had previously given us permission to access his medical record for research purpose. We declare that the figure used in this manuscript has no association with the third party.
Funding
None declared.
Data availability
The data underlying this article will be shared upon reasonable request to the corresponding author.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data underlying this article will be shared upon reasonable request to the corresponding author.