[Aortic dissecting aneurysm in a patient with Marfan syndrome and an artificial aortic valve]

We present patient with the Marfan syndrome in whom the dissecting abdominal aortic aneurysm comprising the left iliac and femoral artery was diagnosed two years after the implantation of an artificial aortic valve. The chest CT showed the extention of the ascending aorta without the aortic dissection features. The patient was taken into the clinic in a very bad general condition with sinus tachycardia, the left ventricular failure together with pulse absence in all standard places of pulse measurement in the left lower limb. During the TEE examination the dissecting aneurysm of type I according to De Bakey's classification and the normal function of the artificial aortic valve were recognized. Colour Doppler revealed the primary entry site above the sinus of Valsalva. The patient was qualified for an urgent surgical intervention. The diagnosis was confirmed during the operation. The patient had resection of aneurysm with Dacron tube replacement. After the cardiosurgical intervention the ischaemic symptoms of the left lower limb retreated, the size of the heart diminished in the chest X-ray and TTE examination. The left ventricular ejection fraction increased from 45% to 62%. The TEE of the patient proved the most accurate and precise method of the diagnosis of the aortic dissection. The obtained information was sufficient to decide on the surgical intervention.