Late Post-Dissection Dynamic Intermittent Malperfusion of the Aortic Arch in Association with a Rare Heterogenous LOX Gene Variation

TL;DR

A rare late complication of aortic dissection surgery is linked to a unique gene variation and intermittent blood flow issues in the aortic arch.

Contribution

This case report highlights a rare LOX gene variation associated with late post-dissection complications and intermittent aortic arch malperfusion.

Findings

A 41-year-old patient experienced late complications six years after Bentall surgery for aortic dissection.

Intermittent dynamic occlusion of the aortic arch and a rare LOX gene variation were identified as contributing factors.

Surgical replacement of the aorta and arch resolved the patient's symptoms.

Abstract

Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve.

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