Iatrogenic Supravalvular Aortic Stenosis

Abstract

We describe a case of hemolytic anemia and proximal anastomotic site stenosis following emergency repair of a Type A aortic dissection. This rare complication led to a reoperation to correct the iatrogenic aortic stenosis and cure the consequent hemolysis. A "sandwich" technique (with two Teflon strips on the outside and inside of the aortic wall) was used in the initial repair to reinforce the suture line and prevent bleeding from the aortic anastomoses. At the time of reoperation, the inner Teflon strip at the proximal aortic anastomosis was found to have inverted into the aortic lumen, as suggested by the preoperative magnetic resonance imaging. Surgical treatment consisted of resecting the portion of inner Teflon that had turned in and tacking the remaining part back onto the aortic wall. The observed hemolysis was likely due to the turbulent flow associated with the supra-aortic stenosis and the collision of red cells with the internal Teflon strip. The patient made an uncomplicated recovery with no further hemolysis and was discharged on postoperative day 8.

Keywords: Aortic dissection; Hemolysis; Sandwich technique; Teflon strip.

Figure 1.

Lateral view of the magnetic resonance imaging scans showing turbulent flow across the stenotic proximal anastomosis and true and false lumen in the arch and descending aorta.

Figure 2.

Frontal view showing the same pathologic feature of turbulent flow.

Figure 3.

Graft opened, before refashioning.

Figure 4.

After refashioning, the aortic lumen is clearly patent with a visibly larger diameter.