Complex intimal flaps in acute aortic dissection

A 43-year-old man was emergently admitted and diagnosed as acute aortic dissection (Stanford type A). While being prepared for emergent operation he fell into hemodynamic hazard with repeated ventricular fibrillation and loss of consciousness. Massive aortic regurgitation and coronary disturbance due to a back-and-forth movement of an intimal flap through the aortic valve were the causes of the cardiogenic catastrophy. In addition, a completely torn intimal flap was intussuscepted into the origin of the brachiocephalic artery. This was thought to disturb the cerebral perfusion. Acute aortic dissection with such complex intimal flaps is very rare. In such cases cardiopulmonary bypass should be established to maintain the patient's cardiac function as soon as possible after diagnosis and the operation should be performed with sufficient brain protection.