A Rare Pattern of Acute Type A Aortic Dissection: Circumferential Intimal Invagination

Abstract

A 59-year-old patient with chest pain was transferred to our emergency unit. Computed tomography depicted a dissection membrane limited to the aortic root and a seemingly normal ascending aorta. Further downstream stenosis of the descending aorta appeared. Intraoperatively, complete intimal absence in the ascending aorta with intussusception into the descending aorta was evident. Ascending aortic and hemiarch replacement was performed. This rare case should raise the surgeons' awareness that preoperative imaging can differ considerably from intraoperative findings.

Keywords

acute aortic dissection - complete circumferential intimal intussusception - NIRS - aortic intimal invagination

• References

• 1 Hagl C, Khaladj N, Peterss S , et al. Treatment of acute aortic dissection type A (AADA): technical considerations. Vasa 2010; 39 (3) 212-218
• 2 Niino T, Hata M, Sezai A , et al. Efficacy of neutrophil elastase inhibitor on type A acute aortic dissection. Thorac Cardiovasc Surg 2010; 58 (3) 164-168
• 3 Hufnagel CA, Conrad PW. Intimo-intimal intussusception in dissecting aneurysms. Am J Surg 1962; 103: 727-731
• 4 Nathan DP, Xu C, Gorman III JH , et al. Pathogenesis of acute aortic dissection: a finite element stress analysis. Ann Thorac Surg 2011; 91 (2) 458-463
• 5 Nakamura Y, Tagusari O, Ichikawa Y, Morita A. Impact of immediate aortic repair on early and midterm neurologic status in patients with acute type A aortic dissection complicated by cerebral malperfusion. Ann Thorac Surg 2011; 92 (1) 336-338
• 6 Logemann F, Gras C, Mehler D, Zuk J, Piepenbrock S. [Bilateral monitoring of cerebral oxygen saturation in aortic arch surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2001; 36 (6) 388-392
• 7 Etz CD, Bischoff MS, Bodian C , et al. The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl) S64-S70 , discussion S86–S91
• 8 David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992; 103: 617-621
• 9 Yacoub MH, Fagan A, Staassano P, Radley-Smith R. Results of valve conserving operations for aortic regurgitation. Circulation 1983; 68: 311-312
• 10 Etz CD, Zoli S, Brenner R , et al. When to operate on the bicuspid valve patient with a modestly dilated ascending aorta. Ann Thorac Surg 2010; 90 (6) 1884-1890 , discussion 1891–1892