Unexpected limited chronic dissection of the ascending aorta

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We report a rare case of a limited chronic dissection of the ascending aorta that was accidentally discovered at operation performed for severe aortic stenosis and moderate to evere dilatation ofthe ascending aorta. Preoperative investigations such as transoesophageal echocardiography andcardiac catheterization missed the diagnosis of dissection. ntraoperative findings included a 3.5 cmeccentric bulge of the ascending aorta and a 5 mm circular shaped intimal tear comunicating with a limited hematoma or small dissection f he media layer. (The rarety of the report is that thechronic dissection is limited to a small area (approximatively 3.5 ─éÔÇö 2.5 cm) of the ascending aorta).


Chronic dissections of the ascending aorta are very rare because of the catastrophic natural history of the acute ones. Among chronic dissections of the ascending aorta, report of a very limited extension of the haematoma is only anecdotal 2.

Case report
A 83 years-old woman was referred to our department for surgical treatment after being diagnosed a severe aortic stenosis associated with a dilatation of the ascending aorta. The patient had recently been hospitalized for congestive heart failure. Patient history included permanent atrial fibrillation and no previous episodes of chest or back pain suggestive of aortic dissection.

Chest X ay showed a slightly enlarged mediastinum and moderate calcifications of the aortic arch; a transthoracic echocardiogram revealed a severe aortic stenosis (aortic valve area: 0.6 m2) together with moderate aortic and tricuspid valve regurgitation. Cardiac catheterization showed a markedly calcified aortic valve with moderate to severe insufficiency and .5 to 5 cm dilatation of the ascending aorta above the sino-tubular junction without any other pathologic findings including the presence of an eccentric bulge; coronary arteries ere normal (Figure. 1).


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