MDCT findings of acute aortic dissection with diastolic prolapse of the intimal flap into the left ventricle

Sm, Ko

doi:10.1259/bjr/28896686

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…On the rare occasion, massive aortic valve regurgitation can occur owing to a circumferential intimal disruption and prolapse of the cylinder-shaped intimal flap into the left ventricle. 46 Rarely, flap continuity is not clearly visible on axial scans. In such cases, volume rendering reconstructions may be of value, showing greater sensitivity ( Figure 11).…”

Section: Classic Multidetector Ct Findings Of Aortic Dissectionmentioning

confidence: 99%

MDCT evaluation of acute aortic syndrome (AAS)

Valente¹,

Rossi²,

Lassandro³

et al. 2016

BJR

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Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.

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Section: Classic Multidetector Ct Findings Of Aortic Dissectionmentioning

confidence: 99%

MDCT evaluation of acute aortic syndrome (AAS)

Valente¹,

Rossi²,

Lassandro³

et al. 2016

BJR

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“…Nevertheless, there have been reports that angiography can reveal aortic dissection with an intimal flap prolapsing into LVOT during diastole [ 2 ]. Currently, multidetector row CT and electrocardiography gated CT can produce clear images and allow detection of aortic dissection with circumferential intimal flap prolapsing into LVOT during diastole and differentiate the intimal flap from aortic valve [ 6 , 9 ]. Preoperative TTE is also a convenient and practical tool to determine aortic dissection with proximal intimo-intimal intussusception [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

Pan

Sun

2021

J Cardiothorac Surg

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Background Acute 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 presentation We 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. Conclusions Intraoperative 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.

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“…Acute aortic regurgitation is a complication that occurs in patients with aortic dissection involving the ascending aorta. Aortic regurgitation may result from three different mechanisms: (1) the dissection may cause progressive aortic root and annular dilatation, which prevents central leaflet coaptation; (2) the dissection may disturb the aortic root geometry in an asymmetric fashion, with consequent prolapse of one leaflet; and (3) diastolic prolapse of the intimal flap into the left ventricle, which sticks to the aortic valve [1]. In this case, the entry was at the proximal site of the ascending aorta and circumferential dissection extended both anterogradely and retrogradely.…”

Section: Discussionmentioning

confidence: 99%

“…2B and Supplementary video 2). These images suggested that the circumferential intimal flap stuck to the aortic valve, resulting in severe aortic regurgitation (Supplementary video 3) [1]. One day after the admission, the patient underwent resuspension of the commissure between NCC and RCC and replacement of ascending aorta with a prosthetic graft.…”

Section: Case Reportmentioning

confidence: 99%

“…Acute aortic regurgitation is a well-recognized complication that occurs in patients with aortic dissection involving the ascending aorta. However, diastolic prolapse of the aortic intimal flap into the left ventricle is a rare cause of aortic regurgitation [1]. We report here a case of aortic dissection with severe aortic regurgitation due to back-and-forth intimal flap movement detected by both multidetector computed tomography (MDCT) and transesophageal echocardiography (TEE).…”

Section: Introductionmentioning

confidence: 96%

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Aortic regurgitation due to back-and-forth intimal flap movement detected by both multidetector computed tomography and transesophageal echocardiography

Hara

Tanabe

Tanimoto

et al. 2013

Journal of Cardiology Cases

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A 46-year-old man with a history of hypertension, chronic kidney disease, and chronic aortic dissection classified as DeBakey type IIIB was referred to our hospital with chest and back pain. The patient underwent 64-row multidetector computed tomography (MDCT), which revealed new-onset DeBakey type II aortic dissection. The intimal flap prolapsed into left ventricle in the diastolic phase of cardiac cycle and stuck to the right coronary cusp (RCC) of the aortic valve. He also underwent transesophageal echocardiography (TEE) to assess the relationship between the intimal flap and aortic valve in detail. The intimal flap overlaid the RCC and prolapsed into the left ventricle outflow tract in the diastolic phase. These images suggested that the circumferential intimal flap stuck to the aortic valve, resulting in severe aortic regurgitation. One day after the admission, the patient underwent replacement of ascending aorta with a prosthetic graft. Intraoperative observation exhibited the intimal flap inverted to the left ventricle. MDCT could detect the flat movement, as well as TEE, in addition to the extent of aortic dissection.

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MDCT findings of acute aortic dissection with diastolic prolapse of the intimal flap into the left ventricle

Cited by 7 publications

References 9 publications

MDCT evaluation of acute aortic syndrome (AAS)

MDCT evaluation of acute aortic syndrome (AAS)

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

Aortic regurgitation due to back-and-forth intimal flap movement detected by both multidetector computed tomography and transesophageal echocardiography

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