Aortic regurgitation causd by the proximal dissecting flap invagintion to the left ventricle
- 25 Downloads
Abstract
A 68-year-old male with sudden back pain and cardiogenic shock status transferred to our ward. Transthoracic echocardiography revealed that the abnormal rond shape string was in the left ventricular outflow tract. The continuity from the string to the aortic valve was unclear. Intimal flap could not be detected at the level of the ascending aorta. Color Doppler flow imaging showed that the severe AR jet extended into the round string. TEE showed that the intimal tear and flap was seen just above the left subclavian artery. Preoperative diagnosis was acute Stanford type A dissection and acute severe AR due to the inversion of the proximal intimal flap to the left ventricular outflow tract through the aortic valve. At operation, the proximal intimal flap was dissected circumferentially and was cut all the way around 8 cm above the aortic valve ring and was inverted to the left ventricular outflow tract. The aortic valve was preserved because of its normal character after exclusion of the proximal intimal flap. Ascending and arch replacement was carried out. Postoperative TEE and TTE showed no findings of AR. The patient’s postoperative course was uneventful. To our knowledge, this is the first reported case that severe AR caused by the proximal intimal invagination to the left ventricle.
Keywords
Left Ventricle Aortic Valve Aortic Dissection Aortic Regurgitation Left Ventricular Outflow TractPreview
Unable to display preview. Download preview PDF.
References
- 1).Fann JI, Glower DD, Miller DC, Yun KL, Rankin JS, Wolfe WG, Shumway NE: Preservation of aortic valve type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg 102: 62–75, 1991PubMedGoogle Scholar
- 2).Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle K: Diagnostic imaging in the evaluation of suspected aortic dissection. New Engl J Med 328: 34–43, 1993CrossRefGoogle Scholar
- 3).Mazzucotelli JP, Deleuze PH, Baufreton C, Duval AM, Hillion ML, Loisance DY, Cachera JP: Preservation of the aortic valve in acute aortic dissection. Long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg 55: 1513–1517, 1993PubMedCrossRefGoogle Scholar
- 4).Come, PC, Bivas NK, Sacks B, Thurer RL, Weintraub RM, Axelrod P: Unusual echographic finding in aortic dissection. Diastolic prolapse of intimal flap into left ventricle. Am Heart J 107: 790–792, 1984PubMedCrossRefGoogle Scholar
- 5).Intimal flap. J Cardiol 15: 895–901, 1985Google Scholar
- 6).Mtsuo T, Ikushima I, Hamada Y, Nakagawa S, Koiwaya Y, Tanaka K: Aortic regurgitation secondary to diastolic Prolapse of a Tubular intimal flap into the left ventricle in a patient with anuloaortic ectasia. Clin Cardiol 11: 719–722, 1988CrossRefGoogle Scholar
- 7).Nakatani S, Beppu S, Miyatake K, Matsuo H, Nagata S, Nimura Y: Interruption of aortic regurgitation by the intimal flap of an aortic dissection. Doppler echocardiographic observations. Am Heart J 117: 486–489, 1989PubMedCrossRefGoogle Scholar
- 8).Takeuchi E, Abe T: A back- and -forth movement of proximal intimal flap through the aortic valve. J Thoracic Cardiovasc Surg 107: 1539, 1994Google Scholar
- 9).Simon P, Owen AN, Havel M, Moidl R, Hiesmayr M, Wolner E, Mohl M: Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection. J Thorac and Cardiovasc Surg 103: 1113–1118, 1992Google Scholar
- 10).Kyo S, Takamoto S, Omoto R, Matumura S, Kimura S, Neya K, Adashi H, Yokote Y: Intraoperative echocardiography for diagnosis and treatment of aortic dissection. Herz 17: 377–389, 1992PubMedGoogle Scholar