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Thorac Cardiovasc Surg 2012; 60(08): 552-554
DOI: 10.1055/s-0032-1322615
Case Report
Georg Thieme Verlag KG Stuttgart · New York

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

Konstantin von Aspern
1   Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Saxony, Germany
,
Christian D. Etz
1   Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Saxony, Germany
2   Department of Cardiac Surgery, Mount Sinai School of Medicine, New York, United States
,
Lukas Lehmkuhl
3   Department of Diagnostic and Interventional Radiology, Heart Centre Leipzig, Leipzig, Saxony, Germany
,
Friedrich W. Mohr
1   Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Saxony, Germany
,
Pascal M. Dohmen
1   Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Saxony, Germany
› Author Affiliations
Further Information

Publication History

27 February 2012

20 March 2012

Publication Date:
09 November 2012 (online)

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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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Hufnagel CA, Conrad PW. Intimo-intimal intussusception in dissecting aneurysms. Am J Surg 1962; 103: 727-731
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Yacoub MH, Fagan A, Staassano P, Radley-Smith R. Results of valve conserving operations for aortic regurgitation. Circulation 1983; 68: 311-312
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar