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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Fatal, spontaneous, unknown aortal aneurysm dissection in a woman of 38 weeks’ gestation


We describe a case of spontaneous dissection of an unknown ascending thoracic aortic aneurysm in a 35year-old woman in her 38th week of pregnancy, resulting in an atypical clinical picture, emergency caesarean section, and lethal outcome in both the mother and child.

Key words: aortic dissection, pregnancy, caesarean section, perinatal death

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Emergency Open Cardiac Massage via Subxyphoid Approach in Ruptured Type A Aortic Dissection


Patient sustained cardiac tamponade caused by rupture of type A aortic dissection may result in sudden death. Pericardiocentesis is a lifesaving procedure; nevertheless, blood may occlude the catheter and fail to relieve the pressure. However, open-chest cardiac massage in resuscitation has been studied in animal models by some medical centers and laboratories with inspiring results. We report a 58-year-old woman who was transferred from a local hospital with the diagnosis of cardiac tamponade caused by ruptured type A aortic dissection. Pulseless electrical activity followed by cardiac arrest occurred thereafter. Successful resuscitation in the emergency department was achieved using open cardiac massage through the sub-xyphoid region by opening a pericardial window. Therefore, in unstable patients with cardiac tamponade due to aortic dissection, this resuscitative procedure is feasible, safe and efficient.

Keywords: direct cardiac compression, resuscitation, sub-xyphoid approach, cardiac tamponade, aortic dissection

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