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Case Reports
. 2021 Jun;30(2):160-164.
doi: 10.1055/s-0040-1718546. Epub 2021 Mar 11.

Aortic Delamination-A Possible Precursor of Impending Catastrophe

Ayman Saeyeldin  1   2 , Mohammad A Zafar  1 , Lauren A Baldassarre  3   4 , Hamid Mojibian  4 , Bulat A Ziganshin  1   5 , Sandip K Mukherjee  1   3 , John A Elefteriades  1
Affiliations
Case Reports

Aortic Delamination-A Possible Precursor of Impending Catastrophe

Ayman Saeyeldin et al. Int J Angiol. 2021 Jun.

Abstract

Aortic diameter is a powerful predictor of adverse aortic events, such as aortic rupture or dissection, forming the basis of prophylactic surgical repair criteria. Limited evidence is available regarding the association of aortic wall thickness (AWT) with these adverse aortic events. We present the case and surgical video of a 73-year-old man with chest pain and an increased AWT, who underwent ascending aortic repair and deep hemiarch placement under deep hypothermic circulatory arrest. Surgical pathology demonstrated evidence of aortic delamination and medial separation, indicative of an impending dissection. The patient recovered uneventfully, and his chest pain ultimately resolved after open repair. In this patient, increased AWT was felt to be the precursor to a potential aortic catastrophe.

Keywords: aortic wall thickness; ascending aorta; delamination; dissection; rupture.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Low-resolution computed tomography scan performed for attenuation correction shows circumferential hypodense area in the aortic wall with minimal medial displacement of intimal calcification (arrowheads).
Fig. 2
Fig. 2
Computed tomography angiogram of the chest: ( A ) coronal cut showing the thickened ascending aortic wall (arrows), ( B ) sagittal cut showing the thickened arch and proximal descending aorta, ( C ) axial cut showing the mildly enlarged aorta (3.8 cm) and markedly thickened aortic wall.
Fig. 3
Fig. 3
Magnetic resonance imaging of the chest, showing circumferential thickening of the ascending and descending aortic walls (arrows).
Fig. 4
Fig. 4
Thick ascending aortic wall at surgery.
Fig. 5
Fig. 5
Pathological specimen of the aortic wall: ( A ) intima, ( B ) media, ( C ) adventitia, ( D ) breaks in the medial wall (arrow), ( E ) fibrous cap, ( F ) atheromatous changes.
See this image and copyright information in PMC

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