Chronic Stanford Type A Aortic Dissection Complicated by Secondary Tracheomalacia

BACKGROUND: Tracheomalacia is an uncommon airway disorder, and vascular compression is a rare underlying cause. Reports of tracheomalacia associated with chronic aortic dissection are exceedingly limited. CASE SUMMARY: A 46-year-old woman with hypertension, stroke with residual left-sided weakness, HIV, and chronic kidney disease presented with chronic aortic dissection of an 8.8-cm ascending aortic aneurysm. She underwent elective ascending aortic hemiarch replacement. Her postoperative course was complicated by delayed extubation and recurrent hypoxic respiratory failure. Bronchoscopy revealed previously undiagnosed severe tracheomalacia, necessitating tracheostomy and prolonged ventilatory support. She gradually improved and was discharged to rehabilitation. DISCUSSION: This case highlights that the early recognition of airway collapse in patients with large thoracic aneurysms is crucial to prevent extubation failure and optimize postoperative care. TAKE-HOME MESSAGE: Early postoperative extubation failure in patients with large thoracic aneurysms should prompt evaluation for airway collapse. Prompt bronchoscopic assessment is important for planning management.