Biliary cardiac tamponade as a result of iatrogenic biliary-pericardial fistula

摘要

The patient in the' present case was in stable cardiovascular condition after the dissection. No cardiac complications were present that would have indicated immediate intervention. As the patient had a patent right vertebral artery, no cerebrovascular ischemia had occurred. In a similar reported case, Tochii et al (3) performed subacute aortic arch replacement to avert potential risk of fatal complications. This is in line with common recommendations for surgical ascending aorta and arch graft replacement after retrograde iatrogenic type A aortic dissection (4). We decided to refrain from surgical repair and treated the patient conservatively. Our decision was based on the consideration that there was only retrograde poststenotic flow and no direct aortic blood pressure feeding the false lumen originating from the LSA. We therefore did not expect further expansion of the false lumen, nor development of cardiac complications. Follow-up CT angiograms confirmed our hypothesis, showing shrinkage and complete healing of the aortic dissection. As the present case shows, for evaluation of treatment after iatrogenic type A aortic dissection, precise analysis of the blood supply to the false lumen can help in making the proper therapeutic decision.