Journal of Acute Care

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VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Transesophageal Echocardiography-guided Left Ventricular Transapical Cannulation of Aorta in Acute Stanford Type: An Aortic Dissection: A Case Report

Ritika Sharma, Pooja Natarajan, Rohan Makwana, Varun Shetty

Keywords : Case report, Stanford type A acute aortic dissection, Transapical aortic cannulation, Transesophageal echocardiography

Citation Information : Sharma R, Natarajan P, Makwana R, Shetty V. Transesophageal Echocardiography-guided Left Ventricular Transapical Cannulation of Aorta in Acute Stanford Type: An Aortic Dissection: A Case Report. 2024; 3 (1):32-34.

DOI: 10.5005/jp-journals-10089-0101

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


We present a safe technique of transapical left ventricular (LV) cannulation under the guidance of a transesophageal echocardiogram (TEE) in a case of acute aortic dissection. This technique ensures the perfusion of the true lumen avoiding malperfusion syndromes. Case description: A 44-year-old male presented to the hospital with a history of acute chest pain. This gentleman was a chronic smoker, alcoholic, and known to suffer from hypertension to diabetes mellitus. Transthoracic echocardiography and computerized tomography of the chest revealed acute Stanford type A aortic dissection. He underwent emergent hemiarch and ascending aorta replacement under cardiopulmonary bypass (CPB). TEE-guided LV transapical cannulation was done with a 24 Fr size straight arterial cannula, which was directed to the aorta through the aortic valve for arterial return from CPB. The patient was cooled to 26°C with a total CPB time being 285 minutes and a total aortic cross-clamp time of 156 minutes. With the aid of retrograde cerebral perfusion (RCP) through superior vena cava cannulation and later antegrade cerebral perfusion (ACP) through innominate and left common carotid artery, hemiarch of the aorta was replaced and circulation restarted. Following this, the ascending aorta replacement was completed. Surgery was successful and the patient was discharged home on the 10th postoperative day. Conclusion: Left ventricular (LV) transapical cannulation can be performed safely with TEE guidance to ensure a safe perfusion strategy. Acute aortic dissection is a serious life-threatening condition; therefore, a safe strategic plan is very crucial for a successful outcome of surgery. TEE helps to guide the accurate placement of the aortic cannula through the LV apex into the true lumen of the aorta and ensures adequate perfusion.

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