Question 1

When treatment deliberately causes a thrombus to form in the false lumen to relieve organ ischaemia, could that thrombus break loose and travel to the lungs as a pulmonary embolism that kills the patient?

Dr. Dinesh Kumar Mittal · Accepted Answer

The thrombus we are talking about sits in the false lumen of the aorta, and for the aortic surgeon it is a boon. When we operate, for example a Bentall operation, we replace the ascending aorta and hope that the rest of the false lumen thromboses, because a thrombosed false lumen stops the disease from progressing. Second, this thrombus is on the left side of the circulation. A thrombus can reach the pulmonary circulation only if it lies on the right side of the heart or in the venous system, so there is no way a false-lumen thrombus can cause a pulmonary embolism.

Question 2

In children with coarctation of the aorta, which symptoms should raise the index of suspicion?

Dr. Dinesh Kumar Mittal · Accepted Answer

First, coarctation of the aorta is a different condition from aortic dissection. Children with coarctation present at different ages. Many present as newborns, in congestive heart failure. Those who present later often come with hypertension, because blood flow to the lower body, including the kidneys, is reduced.

Question 3

How do you protect perfusion of the brain and of other organs such as the liver and kidneys while performing this surgery?

Dr. Dinesh Kumar Mittal · Accepted Answer

For the brain, we use antegrade cerebral perfusion. If the innominate artery is healthy, I place the arterial cannula in the innominate artery; if it is not, I place it in the axillary artery. I first use this cannula to go on cardiopulmonary bypass. When I have to stop the bypass and the whole circulation, I start antegrade cerebral perfusion through the same cannula, and during that time we use near-infrared spectroscopy and neuromonitoring. Second, if I expect to need more than one hour of circulatory arrest, I also place a cannula in the femoral artery to supply the lower body, including the renal and splanchnic vessels.

Live Discussion with Dr. Dinesh Kumar Mittal

When treatment deliberately causes a thrombus to form in the false lumen to relieve organ ischaemia, could that thrombus break loose and travel to the lungs as a pulmonary embolism that kills the patient?

In children with coarctation of the aorta, which symptoms should raise the index of suspicion?

How do you protect perfusion of the brain and of other organs such as the liver and kidneys while performing this surgery?

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In This Series: Aortic Dissection: Presentation, Treatment and Complications