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Eur J Cardiothorac Surg 2003;23:851
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Yavuz et al.

Gilles Touatia*, Doron Carmia, Faouzi Trojettea, Geneviève Jarryb

a Department of Cardiovascular Surgery, Centre Hospitalier Universitaire, CHU d'Amiens Hôpital Sud Amiens, 80054 Amiens Cedex 01, France
b Service de Cardiologie A CHU d'Amiens Hôpital Sud Amiens, Amiens Cedex, France

Received 21 January 2003; accepted 22 January 2003.

* Corresponding author. Tel.: +33-0322-455925; fax: +33-22-45-5331
e-mail: gtouati.hms{at}invivo.edu

Key Words: Intimo-intimal intussusception • Aortic dissection • Aortic regurgitation • Left ventricle

We appreciated the report by Dr Yavuz et al. and their comments on our case report [1].

These authors also describe a superb case in which the intussuscepted cylinder is not the distal cylinder, which was not detached, but the proximal cylinder which became obstructed in the aortic ring in diastole. This is an exceptional case and confirms that, although visualization of a flap on echocardiography confirms the diagnosis, the absence of this sign cannot formally exclude the diagnosis, especially in the presence of a suggestive clinical history and clinical examination.

The difficulty of the diagnosis is increased by the problem of the ‘blind zone’ on transoesophageal echocardiography in the case of isolated dissection of the descending aorta. We, therefore, systematically complete our assessment by thoracic CT or MRI, combined with Doppler ultrasound of the supra-aortic vessels.

An approach comprising cannulation of the right axillary artery is an original technique [2] and is much more logical than femoral arterial cannulation. It has now been adopted by a number of teams [3–5].

References

  1. Touati G., Carmi D., Trojette F., Jarry G. Intimo-intimal intussusception : a rare clinical form of aortic dissection. Eur J Cardiothorac Surg 2003;23:119-121.[Abstract/Free Full Text]
  2. Yavuz S., Goncu M.T., Turk T. Axillary artery canulation for arterial inflow in patients with acute dissection of the ascending aorta. Eur J Cardiothorac Surg 2002;22:313-315.[Abstract/Free Full Text]
  3. Neri E., Massetti M., Capannini G., Carone E., Tucci E., Diciolla F., Prifti E., Sassi C. Axillary artery cannulation in type a aortic dissection operations. J Thorac Cardiovasc Surg 1999;118(2):324-329.[Abstract/Free Full Text]
  4. Gillinov A.M., Sabik J.F., Lytle B.W., Cosgrove D.M. Axillary artery cannulation. J Thorac Cardiovasc Surg 1999;118(6):1153.[Free Full Text]
  5. Baribeau Y.R., Westbrook B.M., Charlesworth D.C. Axillary cannulation: first choice for extra-aortic cannulation and brain protection. J Thorac Cardiovasc Surg 1999;118(6):1153-1154.



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[Abstract] [Full Text] [PDF]

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