Extremely Localized Aortic Dissection and Intussusception of the Intimal Flap into the Left Ventricle

• Published in: Annals of Thoracic and Cardiovascular Surgery Vol. 17; no. 4; pp. 431 - 433
• Main Authors: Yamabi, Hideaki, Imanaka, Kazuhito, Sato, Hiroshige, Matsuoka, Takahiro
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 2011
• Subjects: Aneurysm, Dissecting - complications; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - physiopathology; Aneurysm, Dissecting - surgery; Aortic Aneurysm - complications; Aortic Aneurysm - diagnosis; Aortic Aneurysm - physiopathology; Aortic Aneurysm - surgery; aortic regurgitation; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Blood Vessel Prosthesis Implantation; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Female; Hemodynamics; Humans; intussusception of the intimal flap; localized acute aortic dissection; Middle Aged; Severity of Illness Index; Shock, Cardiogenic - etiology; Tomography, X-Ray Computed; Treatment Outcome
• DOI: 10.5761/atcs.cr.10.01594
• ISSN: 1341-1098

Stanford type A aortic dissection frequently deforms the aortic root and causes aortic regurgitation (AR). On the rare occasion, massive AR can occur due to circumferential intimal disruption and prolapse of the cylinder-shaped intimal flap into the left ventricle. Because of the critical, general, and hemodynamic state of such patients, surgery for this condition carries a high risk. A 62-year-old woman suffered acute chest pain and fell into cardiogenic shock. Computed tomography and transthoracic echocardiography failed to identify the etiology of this rapid hemodynamic collapse. Transesophageal echocardiography (TEE) demonstrated circumferential intimal disruption, 3 centimeters above the aortic valve annulus; a very localized aortic dissection in the proximal ascending aorta; and a to-and-fro motion of cylinder-shaped intima causing severe AR. The dissection did not affect the aorta beyond the intimal tear, and TEE was the only useful modality for the diagnosis. Emergency replacement of the ascending aorta and resuspension of the aortic valve was successfully performed. Residual AR was absent, and the postoperative course was uneventful.