Navigating Complex Cardiovascular Pathologies: A Case Report on Aortic Arch Replacement in a Middle-Aged Male with Stanford A DeBakey I Aortic Dissection

Saskia Dyah Handari, Muhammad Firdaus, Yan Efrata Sembiring


Background: Aorta dissection is characterized by the presence of an intimal tear, which permits the passage of blood through the tear and into the aorta media. This process leads to the separation of the intimal and the formation of a dissection flap, representing the true lumen and a newly formed false lumens. The incidence of aortic dissection varies between 0.2% and 0.8%. Management of acute aortic standford A aortic dissection primarily involves invasive surgical procedures.

Case presentation: A middle-aged male patient, aged 40, who possesses risk factors including uncontrolled hypertension and obesity, arrived to the emergency room with symptoms of chest pain. He described the pain as tearing in nature and said that it radiated towards the abdominal. The examination findings included a blood pressure reading of 255/143, a widened mediastinum and cardiomegaly observed on the chest X-ray, a slight elevation in Hs-Troponin levels, and the presence of sinus rhythm with left ventricular hypertrophy. He underwent CT scan, which demonstrated the presence of an aortic dissection extending from the ascending to descending aorta, with no associated damage to the aortic valve from echocardiography. He was diagnosed with Standford A DeBakey I Aortic dissection and underwent preference replacement of the aortic arch and elephant trunk implantation instead of Bentall procedure.

Conclusion: The surgical and perioperative methods employed may differ based on the specific clinical presentation and the nature of the aortic disease. Because there was no involvement of the aortic valve, we performed total aortic arch replacement and elephant trunk procedure over the Bentall procedure.


Aortic dissection, Total aortic arch replacement, dissection flap

Full Text:




Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection–a review. Scandinavian Cardiovascular Journal. 2020;54(1):1–13.

Sayed A, Munir M, Bahbah EI. Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances. Curr Cardiol Rev 2020;17(4).

Isselbacher EM, Preventza O, Black JH, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):E334–482.

Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35(41):2873–926.

Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846–60.

Dinato FJ, Ribeiro Dias R, Abrahão Hajjar L. DISSECÇÃO DA AORTA: MANEJO CLÍNICO E CIRÚRGICO. Revista da Sociedade de Cardiologia do Estado de São Paulo 2018;28(3):260–6.

Juraszek A, Czerny M, Rylski B. Update in aortic dissection. Trends Cardiovasc Med. 2022;32(7):456–61.

Liu Y, Li L, Xiao Z, et al. Early endovascular intervention for unfavorable remodeling of the thoracic aorta after open surgery for acute DeBakey type I aortic dissection: study protocol for a multicenter, randomized, controlled trial. Trials 2023;24(1).



  • There are currently no refbacks.

Copyright (c) 2024 Saskia Dyah Handari, Muhammad Firdaus

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.