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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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Stanford Type A Acute Aortic Dissection with Intimal Intussusception.

Yohsuke Yanase¹, Akihito Ohkawa¹, Satomi Inoue¹

¹Department of Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Hokkaido, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia

|March 20, 2018

Summary

Intimal flap intussusception in Stanford type A acute aortic dissection (AAD) can cause severe complications. This flap folding into the left ventricular outflow tract can lead to aortic regurgitation and pulmonary edema, impacting patient outcomes.

Keywords:

aortic dissection aortic regurgitation thoracic aorta

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Medical Imaging

Background:

Stanford type A acute aortic dissection (AAD) involves the ascending aorta.
Complete circumferential dissection can lead to intimal flap complications.
Intimal flap intussusception into the left ventricular outflow tract is a rare but serious event.

Observation:

Two cases of Stanford type A AAD with intimal flap intussusception into the left ventricular outflow tract are presented.
Transthoracic echocardiography (TTE) was crucial in visualizing the intussuscepted flap.
Case 1 involved severe aortic regurgitation and pulmonary edema, leading to mortality despite salvage surgery.
Case 2 demonstrated a protective effect of the intussuscepted flap, preventing severe aortic regurgitation and allowing successful surgical rescue.

Findings:

Intimal flap intussusception can cause significant hemodynamic compromise, including severe aortic regurgitation.
The degree of aortic regurgitation and clinical outcome appear related to the flap's mobility and position.
Surgical intervention, such as the modified Bentall procedure, can be lifesaving in select cases.

Implications:

This phenomenon highlights a critical complication of AAD that requires prompt recognition and management.
Echocardiography plays a vital role in diagnosing and assessing the severity of intimal flap intussusception.
Tailored surgical approaches may be necessary to address the unique challenges posed by intussuscepted intimal flaps in AAD.