Evaluation of aortic insufficiency in aortic dissection. Significance of intraoperative echocardiography on the conservation of the valve. A case report

A 34-year old man presented with dyspnea and a new murmur of aortic regurgitation (AR). Two months before he had a episode of acute chest pain. The diagnosis of type A chronic aortic dissection was done on the basis of clinical signs and digital angiography. At surgery, intraoperative two-dimensional echocardiography (Iop Echo) showed a large intimal flap prolapsing into the leaflets during diastole causing AR, without primary involvement of the aortic valve. The aorta was transected just above the valve commissures and a 30 mm woven graft was sutured end to end. The false lumen was closed distally and incorporated into the graft-aorta suture line. Valve replacement was not performed. After the surgical procedure, a Iop Echo indicated competence of the aortic valve by means of contrast injection in the aortic root. AR due to the interference of an intimal flap with the aortic leaflets was not yet been reported. To our knowledge, this is the first case of this mechanism and illustrates the potential value of Iop Echo in diagnosis of aortic dissection.