[Acute aortic dissection (Stanford A) with pericardial tamponade--extension of the dissection after emergency pericardial puncture].

The hemodynamic deterioration associated with acute aortic dissection (Stanford A) is caused by an acute loss of volume, acute aortic valve insufficiency, or possibly by hemopericardium with tamponade. In the latter case, a pericardiocentesis may restore hemodynamic stability. However, it is only indicated in the case of reduced perfusion of vital organs. The relief of the pericardial effusion can produce a pressure gradient between dissection and pericardial space, which again might cause hemodynamic deterioration by the blood flow into the pericardial space as well as extension of the aortic dissection. Following pericardiocentesis immediate surgery is indicated. In the present case, after a primarily effect hemodynamic stabilization by pericardiocentesis, this mechanism has very probably led to a repeated tamponade and extension of aortic dissection, which was successfully repaired by the implantation of a vascular prosthesis immediately following invasive diagnosis.