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Review
. 2021 Jul 28;16(1):201.
doi: 10.1186/s13019-021-01581-0.

Stanford type A acute aortic dissection with proximal intimo-intimal intussusception: a case report and literature review

Hao Pan  1 , Wei Sun  2
Affiliations
Review

Stanford type A acute aortic dissection with proximal intimo-intimal intussusception: a case report and literature review

Hao Pan et al. J Cardiothorac Surg. .

Abstract

Background: Acute aortic circumferential dissection with proximal intimo-intimal intussusception is a rare and potentially lethal occurrence. We here report a case and review previous works to better understand this particular condition and help surgeons to determine accurate diagnosis and optimal intervention strategies by intraoperative transesophageal echocardiography (TEE).

Case presentation: We report a case of a 46-year-old male who complained of sudden substernal chest pain. Stanford type A acute aortic dissection with proximal intimo-intimal intussusception was confirmed by contrast-enhanced computed tomography (CECT), transthoracic echocardiography (TTE), and TEE. We found the intimal flap prolapsed into the left ventricle outflow tract (LVOT), which caused severe aortic regurgitation (AR) and obstructed the ostia of the coronary arteries. Given the preexisting aneurysmal dilatation of aortic sinus and severity of aortic root and arch dissection, Bentall procedure and Sun's procedure were performed for our patient.

Conclusions: Intraoperative TEE used by anesthesiologists here played an increasingly valuable role in the determination of acute aortic dissection. Hence, it is necessary that TEE screening is routinely performed in patients with acute aortic dissection to provide valuable information for facilitating surgical strategies.

Keywords: Acute aortic dissection; Aortic regurgitation; Intimo-intimal intussusception.

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Conflict of interest statement

The authors declare no competing interests in this work.

Figures

Fig. 1
Fig. 1
An intimal flap prolapsed into the left ventricular outflow tract in coronal view (A), sagittal view (B) and axial view (C and D) by CECT. Red arrow: aortic valve leaflet. Blue arrow: right coronary artery ostia. Yellow arrowhead: intimal flap. AO: aorta; LA: left atrium; LV: left ventricle; CECT: contrast-enhanced computed tomography
Fig. 2
Fig. 2
Transesophageal echocardiography showed views of the intimal flap in long axis (A: diastole, B: systole, C: diastole with color Doppler) and short axis (D-F). Red arrow: aortic valve leaflet. Blue arrow: left coronary artery ostia. Yellow arrowhead: intimal flap. LA: left atrium; RA: right atrium
See this image and copyright information in PMC

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