Stanford Type A Acute Aortic Dissection with Intimal Intussusception

Abstract

In case of complete circumferential dissection of the ascending aorta, the dissected flap has the potential to fold backwards, causing several complications. We report two cases of Stanford type A acute aortic dissection (AAD) whose intimal flaps intussuscepted into the left ventricular outflow tract.Case 1: A 41-year-old man with AAD in whom transthoracic echocardiography (TTE) showed the dissected flap as folded back into the left ventricular outflow tract, causing severe aortic regurgitation (AR) with rapidly progressing acute pulmonary edema. Despite performing salvage surgery, the patient could not be rescued.Case 2: An 81-year-old man with annuloaortic ectasia developed Stanford type A AAD. TTE showed an extremely mobile intimal flap intussuscepting into the left ventricular outflow tract. However, AR was not severe as it was prevented by the flap itself. The patient was rescued by performance of the modified Bentall procedure.

A Case of Circumferential Type A Aortic Dissection with Intimo–Intimal Intussusception

“…The aortic root reconstruction or arch procedure may be required according to the existence of another tear, degree of the aortic valve dysfunction, and suffocation of the coronary ostium or arch vessels. 4 , 5 , 7 – 9 )…”

“…As classified by Sanders et al, 3) these flaps intussuscept antegrade to the aortic arch [1][2][3][4] or retrograde to the left ventricle. 3,[5][6][7][8][9] The antegrade intussusception may cause a malperfusion of the aortic arch vessels, and the retrograde intussusception causes an aortic valve insufficiency or coronary artery suffocation. Bidirectional intussusception case was also reported.…”

“…10) To diagnose in an acute setting, multiple modalities were used. 3,[5][6][7][8]10) Less invasive modalities, such as an echocardiography and a CT, are frequently used. [2][3][4][5][6][7][8][9][10] An angiogram was once adopted when an angiogram was a gold standard tool.…”

“…3,[5][6][7][8]10) Less invasive modalities, such as an echocardiography and a CT, are frequently used. [2][3][4][5][6][7][8][9][10] An angiogram was once adopted when an angiogram was a gold standard tool. 1,2) Even now, when the symptom is mimicking acute coronary syndrome in the retrograde intussusception, an angiogram is selected to evaluate the disease, but it may fail to reach a correct diagnosis.…”

Acute type A aortic dissection with complete intimal intussusception into the descending aorta

“…We typically utilize central cannulation via modified Seldinger's technique for TAAD but not in the setting of a complex arch tear because of the risk of tear propagation 1 . Aortic intussusception has been demonstrated before in a retrograde fashion following circumferential dissection of the ascending aorta, resulting in acute aortic regurgitation 2 . However, as demonstrated in this case, it is rare for the intimal flap to intussuscept antegrade and recognition of this may impact cannulation and arch reconstruction strategy.…”