Published in:
01-09-2014 | Images in Cardiovascular Ultrasound
Intimo-intimal intussusception–circumferential aortic dissection: a rare mechanism of severe acute aortic regurgitation
Published in: Journal of Echocardiography | Issue 3/2014
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A 55-year-old hypertensive man presented with acute onset of retrosternal pain and dyspnoea. On admission, he had tachypnoea, tachycardia and blood pressure of 190/100 mmHg. All peripheral pulses were normally felt. Auscultation revealed a long, early diastolic murmur along the left sternal border; the electrocardiogram showed normal sinus rhythm with no ischaemic changes. Chest X-ray revealed pulmonary congestion and mediastinal widening. An emergency transthoracic echocardiogram showed a dilated ascending aorta with a flap arising just above the aortic leaflet prolapsing into the left ventricular outflow tract producing severe aortic regurgitation (Fig. 1a–c; movie file 1, 2, 3). While awaiting emergency surgical repair, he collapsed and could not be resuscitated.
Fig. 1
Transthoracic echocardiogram a parasternal long-axis view showing the dissection flap prolapsing into the LVOT (arrow), b parasternal short axis view showing a circular dissection flap (arrow) and c colour Doppler image showing severe aortic regurgitation (arrow). LVOT left ventricular outflow tract, LV left ventricle, LA left atria, Ao aorta, AR aortic regurgitation
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