Intraoperative Diagnosis of Stanford Type A Dissection by Transesophageal Echocardiogram in a Patient Presenting for Renal Transplantation

Abstract EN

A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation.

On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border.

The patient had a history of pericardial effusions and reported “a feeling of chest fullness” when lying flat.

As such, a transesophageal echocardiogram (TEE) was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur.

The TEE revealed a Stanford Type A aortic dissection.

The renal transplant was cancelled (organ reassigned within region), and the patient underwent an urgent ascending and proximal hemiarch aortic replacement.

This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.