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The “Double-Valve” Sign in Acute Type A Aortic Dissection
The “Double-Valve” Sign in Acute Type A Aortic Dissection Ioannis Loumiotis, MD, William A. Jakobleff, MD, and Mei L. Chau, MD Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Fig 1.
Fig 2.
Fig 3.
A
61-year-old man with a complex cardiac history presented with severe “tearing” chest pain. On the physical examination there were no signs of malperfusion. Computed tomographic angiography of the chest confirmed the diagnosis of aortic dissection with dilatation of the ascending aorta up to 7 cm in size. There was no pericardial effusion, and the aortic root was not involved (Figs 1, 2). On the preoperative transthoracic echocardiogram (Video) a dissection flap was identified involving the ascending aorta circumferentially above the level of the sinotubular junction, acting like a “second valve,” opening in systole and closing in diastole (Fig 3). Upon initiation of cardiopulmonary bypass, the heart arrested, and retrograde cardiologic protection was immediately initiated. A 30-mm Gelweave graft was used
Address correspondence to Dr Loumiotis, Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave, Bronx, NY 10467; email: iloumiot@ montefiore.org.
Ó 2017 by The Society of Thoracic Surgeons Published by Elsevier Inc.
for the repair during deep hypothermic circulatory arrest. The patient had an uneventful recovery. Type A aortic dissection carries a dismal prognosis if left untreated [1]. The coronary arteries can be directly involved, or, as in this case, the flap can act as a “second valve” obstructing them. Induction of general anesthesia or initiation of cardiopulmonary bypass can decrease the transvalvular flow, collapsing the dissection flap and potentiating cardiac arrest.
Reference 1. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg 2016;5: 275–95.
The Video can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2017.05. 051] on http://www.annalsthoracicsurgery.org.
Ann Thorac Surg 2017;104:e347 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2017.05.051
Fig 1.
Fig 2.
Fig 3.
A
61-year-old man with a complex cardiac history presented with severe “tearing” chest pain. On the physical examination there were no signs of malperfusion. Computed tomographic angiography of the chest confirmed the diagnosis of aortic dissection with dilatation of the ascending aorta up to 7 cm in size. There was no pericardial effusion, and the aortic root was not involved (Figs 1, 2). On the preoperative transthoracic echocardiogram (Video) a dissection flap was identified involving the ascending aorta circumferentially above the level of the sinotubular junction, acting like a “second valve,” opening in systole and closing in diastole (Fig 3). Upon initiation of cardiopulmonary bypass, the heart arrested, and retrograde cardiologic protection was immediately initiated. A 30-mm Gelweave graft was used
Address correspondence to Dr Loumiotis, Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave, Bronx, NY 10467; email: iloumiot@ montefiore.org.
Ó 2017 by The Society of Thoracic Surgeons Published by Elsevier Inc.
for the repair during deep hypothermic circulatory arrest. The patient had an uneventful recovery. Type A aortic dissection carries a dismal prognosis if left untreated [1]. The coronary arteries can be directly involved, or, as in this case, the flap can act as a “second valve” obstructing them. Induction of general anesthesia or initiation of cardiopulmonary bypass can decrease the transvalvular flow, collapsing the dissection flap and potentiating cardiac arrest.
Reference 1. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg 2016;5: 275–95.
The Video can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2017.05. 051] on http://www.annalsthoracicsurgery.org.
Ann Thorac Surg 2017;104:e347 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2017.05.051