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Address for Correspondence: Dr. Onur Argan, Clinic of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey e-mail: onur_argan@yahoo.com ORCID ID: orcid.org/0000-0001-7745-7736 Received: 29 March 2018 Accepted: 22 June 2018 • DOI: 10.4274/balkanmedj.2018.0567 Available at www.balkanmedicaljournal.org Cite this article as: Argan O, Ural D, Bozyel S. Rare Case of Both Left Atrial and Ventricular Compression by Dissecting Aortic Aneurysm. Balkan Med J 2018;35:406-7 ©Copyright 2018 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House. A 75-year-old patient with a history of arterial hypertension was admitted to the emergency service in cardiac arrest. His medical history revealed a thoracic endovascular aortic repair operation that was performed about 2 years ago. According to the information received from relatives, he developed sudden cardiac arrest following chest pain and shortness of breath. The patient’s blood pressure was 70/50 mmHg and the heart rate was 125 pulses/min. ST depression in the D1-AVL-V5-V6 and left ventricular hypertrophy were detected in the electrocardiogram. Parasternal long axis and four-chamber images in the echocardiography showed aortic dissection and compression of the left atrium and the left ventricle caused due to an aneurysm when the patient was evaluated for the first time (Figure 1a). When we repeated the echocardiography before the exitus, the compression of the heart chambers progressed (Figure 1b). Thoracic computed tomography images supported the findings of echocardiography. Compression of the left atrium and ventricle due to 10×11.5 cm descending aorta, including the graft material and the thrombosed pseudolumen, was observed in the computed tomography images (Figure 2a, 2b). The patient with the deep hypotension died shortly after the admission. Written informed consent was obtained from the patient's parents. Large dissecting aortic aneurysm compressing the heart chambers sufficient to cause hemodynamic deterioration is a rare condition. Studies have reported about the compression related to the right atrium (1), the left atrium (2), and the right ventricle (3) caused by the aortic aneurysm. To our knowledge, this is the first case of both left atrial and left ventricular compression caused due to the dissecting aortic aneurysm. In a patient with aortic dissection, ischemia, aortic valve insufficiency, and tamponade may cause hypotension. The echocardiographic findings of the present case revealed an additional mechanism that may lead to hemodynamic instability. The descending aorta is very near to the left atrium. Compression of the left atrium and ventricle due to the enlarged aorta results in decreased cardiac output and hypotension. The pleural effusion observed in this case suggests the presence of congestive 1Clinic of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey 2Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey 3Clinic of Cardiology, Kocaeli University of Health Sciences, Derince Training Research Hospital, Kocaeli, Turkey Onur Argan1, Dilek Ural2, Serdar Bozyel3 Rare Case of Both Left Atrial and Ventricular Compression by Dissecting Aortic Aneurysm Balkan Med J 2018;35:406-7