Eur J Cardiothorac Surg 2009;36:189-190. doi:10.1016/j.ejcts.2009.03.015
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Aortic regurgitation and coronary malperfusion secondary to intimo-intimal intussusception into the left ventricle in acute aortic dissection
Naoto Morimoto*,
Kenji Okada,
Yutaka Okita
Division of Cardiovascular Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuuo-ku, Kobe, Hyogo, 650-0017, Japan
Received 8 January 2009;
received in revised form 4 March 2009;
accepted 10 March 2009.
* Corresponding author. Tel.: +80 783825942; fax: +80 783825959. (Email: naotofrcs{at}gmail.com).
Key Words: Coronary malperfusion • Aortic regurgitation • Intimo-intimal intussusception • Acute aortic dissection
A 49-year-old Marfan male presented with acute aortic dissection complicated by aortic regurgitation and myocardial ischemia. The intimal flap of ascending aorta prolapsed through the aortic valve into the left ventricle (Figs. 1 and 2
), resulting in aortic regurgitation and also obstructing the coronary orifice. He underwent valve-sparing aortic root replacement.
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Fig. 1. Contrast-enhanced CT showing Stanford type A aortic dissection. No intimal flap was present in the aortic root (a). The intimal flap was invaginating into the left ventricle (b). On intraopertive transesophageal echocardiography, the inverted intimal flap fell into the left ventricle through aortic valve during the diastolic phase (c) and the intimal flap was ejected back to the ascending aorta during the systolic phase (d).
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Fig. 2. Intraoperative appearance. The circumferential intimal tear was noticed at the sinotubular junction. Proximally the dissection included the aortic annulus with detachment of commissural posts between right- and non-coronary sinus and left- and non-coronary sinus. The proximal part of intimal flap (asterisk) was inverted into the left ventricular outflow tract.
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