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Case Reports
. 2020 Feb 20;26(1):51-54.
doi: 10.5761/atcs.cr.18-00015. Epub 2018 Mar 17.

Stanford Type A Acute Aortic Dissection with Intimal Intussusception

Yohsuke Yanase  1 , Akihito Ohkawa  1 , Satomi Inoue  1 , Yukihiro Niida  2
Affiliations
Case Reports

Stanford Type A Acute Aortic Dissection with Intimal Intussusception

Yohsuke Yanase et al. Ann Thorac Cardiovasc Surg. .

Abstract

In case of complete circumferential dissection of the ascending aorta, the dissected flap has the potential to fold backwards, causing several complications. We report two cases of Stanford type A acute aortic dissection (AAD) whose intimal flaps intussuscepted into the left ventricular outflow tract.Case 1: A 41-year-old man with AAD in whom transthoracic echocardiography (TTE) showed the dissected flap as folded back into the left ventricular outflow tract, causing severe aortic regurgitation (AR) with rapidly progressing acute pulmonary edema. Despite performing salvage surgery, the patient could not be rescued.Case 2: An 81-year-old man with annuloaortic ectasia developed Stanford type A AAD. TTE showed an extremely mobile intimal flap intussuscepting into the left ventricular outflow tract. However, AR was not severe as it was prevented by the flap itself. The patient was rescued by performance of the modified Bentall procedure.

Keywords: aortic dissection; aortic regurgitation; thoracic aorta.

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Figures

Fig. 1
Fig. 1. Imaging evaluation in case 1. (a) and (b) show eCT images, which seemed to indicate the absence of dissection in the ascending aorta (a). However, the dissected intimal flap was visible at the aortic root (b), the so-called “missing flap.” (c) and (d) show TEE images. The dissected intimal flap was intussuscepted into the left ventricular outflow tract (c). Since the intimal flap prevented closure of the aortic valve in diastole, it resulted in severe AR (d). eCT: enhanced computed tomography; AR: aortic regurgitation; TEE: transesophageal echocardiography
Fig. 2
Fig. 2. Imaging evaluation in case 2. (a) and (b) show eCT images. Dissection was not seen in the ascending aorta (a) (“missing flap”) although an intimal flap was apparent in the aortic root (b). The aortic root was dilated. (c) and (d) show transesophageal echocardiography images. The dissected intimal flap exhibited dynamic mobility. It was intussuscepted into the left ventricular outflow tract during diastole (c) and returned to the ascending aorta during systole (d). eCT: enhanced computed tomography
See this image and copyright information in PMC

References

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