Figure 5: (A) Intraoperative photograph showing a circumferential ascending aortic dissection (indicated by the white arrow). (B) Intraoperative photograph showing repair of the aortic dissection with pledgeted horizontal mattress sutures (indicated by the white arrow) and resuspension of the native aortic valve.
dissectionmay cause intimal intussusception. An antegrade prolapse into the aortic arch causes obstruction of the great supra aortic vessels, 2 whereas a retrograde prolapse into the LV causes aortic regurgitation 3 and obstruction of the coronary artery. 4 Our case describes a retrograde prolapse into the LVwith an accompanying AR. Thus, a type-A aortic dissection should be part of the differential diagnosis in a patient presenting with an acute coronary syndrome and newly diagnosed AR, even in the absence of typical signs and symptoms for the same. ACKNOWLEDGEMENTS The authors would like to thank Mr. John Cyrus who provided us editorial assistance. REFERENCE 1. Hillemanns A, Möller-Hartmann W, Miche E, et al. Circular dissection of the ascending aorta with intimo – intimal invagination. CT diagnosis of a rare form of aortic dissection. Radiologe 1996;36(5):446-8. 2. Ishii H, Nakamura K, Yano M, et al. Circumferential dissection of the ascending aorta “intimo-intimal intussusception”. Ann Vasc Dis 2012;5(4):466-8. 3. Yang EH, Kwon MH, Mahajan A, et al. Circumferential type A aortic dissection and intimal intussusception of the aorta causing severe aortic regurgitation and obstruction of the left main coronary artery. Echocardiography 2013;30(3):E81-4. 4. Lajevardi SS, Sian K, Ward M, Marshman D. Circumferential intimal tear in type A aortic dissection with intimo-intimal intussusception into left ventricle and left main coronary artery occlusion. J Thorac Cardiovasc Surg 2012;144(2):e21-3.
Drs. Patel, Morris, and Akkus are with the Division of Cardiology at the Louisiana State University Health Sciences Center in Shreveport. Drs. Hamidian Jahromi and Rao are with the Department of Surgery at LSUHSC-Shreveport.
J La State Med Soc VOL 166 November/December 2014 253
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