Author + information
- Received October 6, 2015
- Accepted October 22, 2015
- Published online February 22, 2016.
- Yinsu Zhu, MD,
- Lijun Tang, MD, PhD and
- Haibin Shi, MD, PhD∗ ()
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- ↵∗Reprint requests and correspondence:
Dr. Haibin Shi, Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
A 26-year-old female patient was admitted to our center with chest pain and dyspnea. She had a 2-year history of hypertension (highest systolic pressure was 180 mm Hg) and retrosternal chest pain for more than 1 year without any previous interventional procedure. Thoracic computed tomography angiography (CTA) revealed a Stanford type B aortic dissection and main pulmonary artery dissection accompanied with patent ductus arteriosus (PDA) (Figure 1). The aortic angiogram confirmed the diagnosis (Figure 2A). Consequently, endovascular aortic stent-graft implantation was performed successfully (Figure 2B). The patient’s post-operative course was uneventful without any noteworthy symptoms. A follow-up CTA scan at 16 months showed no migration of the covered stent with partial false lumen thrombosis, closure of PDA, and still the existence of pulmonary artery dissection (Figure 2C).
Aortic dissection with concomitant pulmonary artery dissection is a rare entity associated with high mortality. It is a lethal complication of PDA, and the dissection usually occurs as a result of chronic pulmonary hypertension or Eisenmenger’s syndrome (1). We speculated that the infiltration could have dissected the layers of the pulmonary artery and aortic wall through the PDA.
The optimal management of this disease has not been defined because of limited cases in the published data. On the basis of anecdotal reports, surgical repair and heart-lung transplantation have been performed in occasional patients (2,3); otherwise, the outcome is fatal. In our patient, the fully closed PDA was revealed by follow-up CTA after the aortic stent-graft implantation. To our knowledge, this is the first case of a patient with pulmonary artery and aortic dissection using an endovascular procedure and remaining well during follow-up. Therefore, in comparison with surgery, endovascular treatment could be an attractive option for pulmonary artery and aortic dissection associated with PDA.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Zhu and Tang contributed equally to this work.
- Received October 6, 2015.
- Accepted October 22, 2015.
- American College of Cardiology Foundation