Stanford type A acute aortic dissection with proximal intimo-intimal intussusception: a case report and literature review

BackgroundAcute aortic circumferential dissection with proximal intimo-intimal intussusception is a rare and potentially lethal occurrence. We here report a case and review previous works to better understand this particular condition and help surgeons to determine accurate diagnosis and optimal intervention strategies by intraoperative transesophageal echocardiography (TEE).Case presentationWe report a case of a 46-year-old male who complained of sudden substernal chest pain. Stanford type A acute aortic dissection with proximal intimo-intimal intussusception was confirmed by contrast-enhanced computed tomography (CECT), transthoracic echocardiography (TTE), and TEE. We found the intimal flap prolapsed into the left ventricle outflow tract (LVOT), which caused severe aortic regurgitation (AR) and obstructed the ostia of the coronary arteries. Given the preexisting aneurysmal dilatation of aortic sinus and severity of aortic root and arch dissection, Bentall procedure and Sun's procedure were performed for our patient.ConclusionsIntraoperative TEE used by anesthesiologists here played an increasingly valuable role in the determination of acute aortic dissection. Hence, it is necessary that TEE screening is routinely performed in patients with acute aortic dissection to provide valuable information for facilitating surgical strategies.

Automated summary

The case illustrates the rare and potentially lethal occurrence of acute aortic circumferential dissection with intimo-intimal intussusception. Intraoperative transesophageal echocardiography plays a crucial role in determining accurate diagnosis and optimal intervention strategies for acute aortic dissection, highlighting the importance of routine screening in patients with this condition.