Eur J Cardiothorac Surg 1999;15:108-109
© 1999 Elsevier Science NL
Images in cardio-thoracic surgery |
Aortic dissection limited to the ascending aorta mimicking intramural hematoma
P.A. Berdat,
T. Carrel
Clinic for Thoracic and Cardiovascular Surgery, University Hospital, CH-3010 Berne, Switzerland
Received 6 October 1998;
received in revised form 12 October 1998;
accepted 12 October 1998.
Corresponding author. Tel.: +41-31-632-2376; fax: +41-31-382-0279; e-mail: thierry.carrel@insel.ch
Intramural hematoma of the thoracic aorta has emerged as a
diagnosis of exclusion in recent years. Significant overlap with acute
aortic dissection exists despite the increased sensitivity of
preoperative CT-scan, transesophageal echocardiography (TEE) or
magnetic resonance imaging. Surgical treatment has been recommended
when the ascending aorta is involved. This 74-year-old patient was
admitted with acute chest pain and chest X-ray showed an enlarged
mediastinum. CT scan and TEE demonstrated a large intramural hematoma
of the ascending aorta but did not show any intimal flap (Fig. 1). However, an acute dissection limited to the ascending aorta was found
intraoperatively with the intimal tear located above the left coronary
ostium (Figs. 2 and
3).
Supracoronary graft
replacement of the ascending aorta was performed immediately, using
deep hypothermic cardiopulmonary bypass and a brief period of
circulatory arrest for the confection of the distal anastomosis. The
patient recovered well and was discharged 2 weeks following surgery.
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Fig. 3. Intimal tear located above the left coronary ostium (arrowhead) and typical finding of a thrombosed false channel (small arrow: intima-media layers, large arrow: aortic adventitia).
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Fig. 3
