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Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 141

Stanford type A aortic dissection: Three-dimensional echocardiography


Department of Cardiology, MaxCure Mediciti Hospitals, Hyderabad, Telangana, India

Date of Web Publication6-Sep-2018

Correspondence Address:
Dr. Pankaj Jariwala
Department of Cardiology, MaxCure Mediciti Hospitals, Opposite Secretariat Road, Hyderabad - 500 063, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_74_17

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How to cite this article:
Jariwala P. Stanford type A aortic dissection: Three-dimensional echocardiography. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:141

How to cite this URL:
Jariwala P. Stanford type A aortic dissection: Three-dimensional echocardiography. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2018 [cited 2018 Dec 13];2:141. Available from: http://www.jiaecho.org/text.asp?2018/2/2/141/240643

A 59-year-old male with a history of hypertension presented to emergency room with acute chest pain radiating to the back. Electrocardiogram showed left ventricular hypertrophy with repolarization abnormalities. His chest X-ray with increased interstitial markings suggested acute pulmonary edema with mediastinal widening. Laboratory parameters revealed elevated creatinine of 3.5 mg%, mild anemia (Hb 8211; 10.5 gm%). Two-dimensional (2D) transthoracic echocardiography in short-axis view at the level of great vessels demonstrated a dissection flap in the ascending aorta starting above the aortic valve [Figure 1]a and [Figure 2]a with moderate aortic regurgitation [Figure 2]c. 3D transthoracic echocardiography differentiated true lumen from false lumen [Figure 1]a. There was bicuspid aortic valve [Figure 1]b with dilatation of aortic annulus, ascending aorta with intimal flap [Figure 2]b extending across the arch of aorta into the descending aorta [Figure 2]d and [Video 1]. Contrast-enhanced computed tomography angiography was not performed in view of elevated creatinine. Bentall procedure was performed with a biologic aortic prosthesis along with a hemiarch replacement. Postoperatively, the patient had improvement in serum creatinine without need for the dialysis.
Figure 1: Three-dimensional transthoracic echocardiography differentiated true lumen from false lumen (a). There was bicuspid aortic valve (dashed arrow; b) with dilatation of aortic annulus, ascending aorta with intimal flap extending across the arch of aorta into the descending aorta. The entire length of the flap from the entry point at the level of aortic sinus can be seen. FL: False lumen

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Figure 2: (a-d) Two-dimensional echocardiography demonstrating aortic dissection starting above the aortic valve in a short axis view at the level of great vessels (a, solid arrows); the extension of the dissection flap from the ascending aorta (b, chroma color, multiple dashed arrows) to the descending thoracic aorta (d, arrowheads) which separated the aortic lumen into false and true lumen; parasternal view in color compare demonstrated eccentric moderate aortic regurgitation (c)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2]



 

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