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Ischaemic heart failure and not stenocardia the first and unfortunately late symptom of coronary heart disease in a patient after surgery of aortic ascending dissection

Due to the permanent development of medicine, cardiac surgery at the beginning of the 21st century is undergoing constant transformation, yet still the aorta, particularly its ascending part, is one of the main areas for surgical action. During the last few years the amount of surgery of aortic aneurysm in Poland, especially due to its acute dissection, has still been increasing. At the same time, mortality related to this particular field of cardiac surgery has been gradually decreasing. There is a significant improvement in prognosis and more and more patients recover completely. As a result a new group of patients is being formed, namely those whose past history is marked by surgery of the aorta. The article below presents a history of a patient treated in the Cardiac Surgery Department of the 4th Military Hospital in Wrocław because of an acute aortic ascending dissection, who less than two years later
underwent a CABG procedure. The history of the case described below leads to an analysis of a newly arisen issue – the course of ischaemic heart disease associated with past aortic surgery. During observation of the patient’s history the authors’ attention was focused on the painless, poorly symptomatic course of chronic heart ischaemia, which finally caused heart failure. The article below shows the connection between the undergone aortotomy and an irreparable break of the nerve pathway for stenocardia. The authors’ intention was, by presenting that particular case of the patient, to provoke a debate on a new concept of diagnosing, latent before aortic surgery or developing in the future, asymptomatic ischaemic heart disease.