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Eur J Cardiothorac Surg 2007;32:935. doi:10.1016/j.ejcts.2007.09.006
Copyright © 2007, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Images in cardio-thoracic surgery

Visualization of entry and re-entry tears in a complex type A aortic dissection by 64-slice dual-source computer tomography

Tobias Heyea,*, Matthias Karckb, Götz Richtera, Waldemar Hoscha

a Department of Diagnostic Radiology, University Hospital, Heidelberg, Germany
b Department of Thoracic and Cardiovascular Surgery, University Hospital, Heidelberg, Germany

Received 17 July 2007; accepted 5 September 2007.

* Corresponding author. Address: Department of Diagnostic Radiology, University Hospital, INF 110, 69120 Heidelberg, Germany. Tel.: +49 6221 5639391; fax: +49 6221 565730. (Email: tobias.heye{at}med.uni-heidelberg.de).

Key Words: Computer tomography (CT) • Aortic dissection • Entry • Re-entry

ECG-gated, contrast-enhanced, 64-slice dual-source CT angiography of the chest demonstrates an acute type A aortic dissection by delivering submillimeter spatial with high temporal resolution to adequately identify the underlying wall pathology of the thoracic aorta. This modality is able to visualize entry and re-entry tears of the dissection membrane (Figs. 1 and 2 , Videos 1 and 2).


Figure 1
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  		Fig. 1. (A, C) Color-coded 3D reconstruction of the dual-source CT data with endovascular view of the thoracic aorta (A) and the left ventricle, ascending aorta and aortic arch (C); (B) curved multiplanar reconstruction (cMPR) of the course of the thoracic aorta. Two dissection membranes (black and white arrowheads) are beginning in the ascending aorta (A–C) with one membrane (black arrowhead) running along the whole thoracic aorta (B). The complex configuration of entry tears of the dissection is visible as multiple openings in the dissection membrane (white and gray asterisks in inset A, A–C). The re-entry tears are visible as multiple small openings (white arrows) in the dissection membrane located in the descending aorta. Note artificial aortic valve replacement (black asterisk). Abbreviations: LV, left ventricle; RV, right ventricle; LA, left atrium.

 

Figure 2
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  		Fig. 2. 3D reconstruction of the dual-source CT data with left anterior oblique (LAO) and left lateral heart view showing the course of the dissection membrane (black arrowheads) running from the ascending aorta through the whole thoracic aorta to continue in the abdominal aorta. A second dissection membrane with a patch-like appearance is shown at the ascending aorta (white arrowheads). Abbreviations: AO, ascending aorta; PA, pulmonary artery; RCA, right coronary artery; LAD, left anterior descending; CX, circumflex artery.

 
Appendix A

Supplementary data

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2007.09.006.




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