Retrograde ascending aortic dissection diagnosed by intraoperative transesophageal echocardiography

Aortic dissection is a risky but challenging cardiovascular emergency and rapid surgical intervention for life-saving is sometimes inevitable. For detection of aortic dissection, computed tomography, magnetic resonance imaging, aortography all have their advantages but all have their limitations. Transesophageal echocardiography (TEE), which is portable and relatively noninvasive, is a highly sensitive and specific diagnostic tool for evaluation of aortic diseases. We presented a case in which preoperative imaging studies such as MRI and cardiac catheterization were all suggestive of DeBakey's type I aortic dissection. However, it was further proved to be a retrograde ascending aortic dissection during intraoperative TEE imaging study as a retrograde ascending blood flow was demonstrated within the dissected aortic lumen. So the initial operative scheme was changed and sternothoracoabdominal incision was selected for better exposure for one-stage repair of the entire thoracic aorta. Nevertheless, severe intrathoracic adhesion and case to bleed prevented any aggressive intervention to proceed. The operation was called off and the patient was transferred to ICU for further medical treatment.