ArticleEuropean heart journal. Case reports2024
4D computed tomography assessment of ruptured triple-lumen type B aortic dissection: a case report.
Article in European heart journal. Case reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Few studies have investigated the effect of the intimal morphology of type B aortic dissection (TBAD) on the blood flow after rupture. We report a case of a 30-year-old male with complicated TBAD, who underwent assessment with 4D computed tomography (4D-CT). Case summary: Patient presented with chest tightness for 14 days, a heart rate of 67 b.p.m., regular rhythm, and 2 years of hypertension. Precisely 14 days prior, he had been diagnosed with aortic dissection by ultrasound at another hospital. 4D-CT showed thoracoabdominal aortic dissection (Stanford type B), left haemothorax, multiple dissection tears, an initial tear located at the large curvature side of the aortic arch, a proximal tear entrance >15 mm, and a descending aorta exit >5 mm. 4D-CT analysis and visualization of the intimal flap showed a parallel three-lumen spatial morphology of true-false-true, and the lumen showed partial thrombosis in the false lumen. Further quantitative analysis of the area of the initial and re-entry tear during the cardiac cycle revealed that the ratio of the initial tear to re-entry tear was consistent with the expansion ratio of the false lumen to the true lumen of the re-entry tear. The patient improved and was discharged 1 week after undergoing thoracic endovascular aortic repair (TEVAR) for descending aortic dissection. Discussion: The complex triple-lumen TBAD, characterized by multiple tears and blood flow channels, poses challenges for TEVAR. 4D-CT facilitates the visualization of intimal flap spatial distribution and enables a thorough assessment of interlayer dilation risk within a realistic and complex haemodynamic context, thereby refining the risk stratification for the progression of complicated aortic dissection and its associated complex complications.
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