Hao Pan1, Wei Sun2. 1. Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu road, Jinan, 250021, Shandong, China. 2. Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu road, Jinan, 250021, Shandong, China. sunw1983@126.com.
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.
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.
Authors: E Neri; T Toscano; U Papalia; G Frati; M Massetti; G Capannini; E Tucci; D Buklas; L Muzzi; L Oricchio; C Sassi Journal: J Thorac Cardiovasc Surg Date: 2001-03 Impact factor: 5.209