A 75 year old man with a history of hypertension and coronary artery disease presented with syncope following a cardiac arrest at home. He was sent to our hospital from another centre with a diagnosis of aortic dissection.
The patient was unconscious, intubated, and his overall condition was poor. He was sent to the operating room immediately where he suffered a severe hypotensive episode.
Transoesophageal echocardiogram (TOE) revealed a linear structure going up and down from the aorta to the left ventricle. In the two chamber view at 90° this structure appeared like a tube extending into the left ventricle (below left). In the left ventricular outflow track view at 120° the complete dissection of the aorta from the aortic arch to the sinotubular junction was observed (below right).
The dissection produced a severe aortic regurgitation with dilatation of the left ventricle. We performed a complete repair of the aortic arch with a supracoronary tube. The subsequent echocardiogram revealed only mild aortic regurgitation. However, the patient died five days later because of brain damage caused by the cardiac arrest.
A complete dissection of the aorta is not very common. In this case, the dissection was spectacular due to the complete separation of the intima, which produced these images on TOE.
CITA DEL ARTÍCULO Heart. 2005 Jan;91(1):101.