Acute aortic dissection following cannulation of the iliac artery.

The aorta of a patient with aortic valve stenosis may be unduly thin, fragile, and liable to dissect irrespective of the presence or absence of atheroma. Indeed, Coleman (1955) stated that aortic dissection in young people was most commonly associated with coarctation or with bicuspid aortic valve. Petch (1952) reported fatal haemopericardium from ruptured dissecting aneurysm in a man of 35 years with calcific aortic stenosis; a similar example in a man of 65 years was described by Heath, Edwards, and Smith (1958). Hudson (1965) also refers to the association between aortic valve stenosis and aortic dissection, sometimes with Marfan's disease also. In the following fatal case this complication followed unsuccessful cannulation of the left external iliac preliminary to establishing cardiopulmonary bypass for surgical replacement of the diseased aortic valve.