A Case of Circumferential Type A Aortic Dissection with Intimo-Intimal Intussusception

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute aortic dissection is a life-threatening condition requiring prompt diagnosis and treatment.
• The ascending aorta is a common site for aortic dissection, often involving an intimal flap.
• Atypical presentations of aortic dissection pose diagnostic and therapeutic challenges.

Purpose of the Study:

• To report a unique case of acute aortic dissection involving circumferential intimal dissection and inversion in the mid-ascending aorta without a distinct intimal flap.
• To discuss the diagnostic and surgical implications of this rare aortic pathology.

Main Methods:

• A comprehensive review of the patient's clinical presentation, diagnostic imaging (contrast-enhanced computed tomography), and operative findings.
• Description of the emergent surgical intervention performed for ascending aorta replacement.

Main Results:

• Contrast-enhanced computed tomography initially suggested aortic dissection extending from the distal ascending aorta to the aortic arch.
• Operative findings revealed circumferential intimal dissection and inversion of the mid-ascending aorta into the aortic arch.
• Emergent replacement of the ascending aorta was technically successful.

Conclusions:

• This case highlights a rare variant of aortic dissection characterized by circumferential intimal involvement and inversion without a clear intimal flap.
• While surgical repair of the ascending aorta can be successful, the risk of catastrophic complications like global intestinal ischemia remains significant.
• Accurate pre-operative diagnosis and meticulous surgical technique are crucial in managing complex aortic dissections.