Aortic Arch Pseudoaneurysm Causing Acute Coronary Artery Occlusion and Cardiogenic Shock in a Postoperative Patient Presenting to the Emergency Department

Abstract

Background: Pseudoaneurysm is one complication of type A aortic dissection (TAAD) arch repair. It occurs in 10-24% of patients after TAAD repair and typically warrants elective operative intervention in hemodynamically stable patients.

Case report: We present a rare case of a patient with a pseudoaneurysm compressing the left coronary artery after repaired TAAD who presented to the emergency department (ED) in cardiogenic shock. Given hemodynamic instability, resuscitation began in the ED and the patient was managed nonoperatively with salvage maneuver revascularization in the cardiac catheterization laboratory. Why Should an Emergency Physician Be Aware of This? For swift recognition and treatment, emergency physicians must be aware of the complications of aortic dissection repair and interventions available for this patient population.

Keywords: Aortic arch pseudoaneurysm; Aortic dissection; Cardiogenic shock; Percutaneous coronary intervention.