Valve-sparing procedure for acute aortic regurgitation due to intimal intussusception in a minimally localized aortic root dissection.

Abstract

Background: Acute heart failure due to aortic regurgitation (AR) is a severe comorbidity of type A acute aortic dissection (AAD). Valve-sparing aortic root replacement is typically performed when the aortic valve remains intact.

Case presentation: A 33-year-old male presented to our hospital with chest pain. Initial computed tomography (CT) scans did not clearly identify an aortic dissection. However, subsequent evaluations suggested acute coronary syndrome. Catheter angiography revealed difficulties in catheterizing the coronary arteries, and echocardiography detected aortic insufficiency. Electrocardiogram-gated CT angiography ultimately confirmed a localized aortic root dissection, necessitating urgent surgical intervention. The patient underwent valve reimplantation to preserve the aortic valve. The postoperative course was uneventful, with follow-up echocardiography and CT showing no residual dissection or regurgitation.

Conclusion: This report highlights a case of acute aortic root dissection resulting in acute AR. The primary cause of AR in this case was the intussusception of the disrupted aortic intima. The dissection was confined solely to the aortic root. The patient underwent successful valve reimplantation, with no postoperative complications. Electrocardiogram-gated CT angiography and transesophageal echocardiography proved valuable in identifying localized aortic abnormalities with precision.