Navigating complexity: ruptured pulmonary artery dissection originating from type B aortic dissection via a persistent ductus arteriosus Botalli.

Pulmonary artery dissection (PAD) is a rare, life-threatening condition requiring prompt diagnosis and treatment. We present a case of ruptured left PAD originating from an acute type B aortic dissection (aTBAD) through a persistent ductus arteriosus Botalli (PDA) in an otherwise healthy 29-year-old man. The patient was successfully treated by means of thoracic endovascular aortic repair (TEVAR) alone. This case illustrates a rare and severe cardiovascular emergency, highlighting the critical importance of interdisciplinary collaboration. For the first time, we demonstrated that addressing the root of the problem - the primary aortic entry - leads to full symptom resolution and vascular remodeling.