Circumferential Stanford Type A Acute Aortic Dissection with Proximal Intimo-Intimal Intussusception: A Case Report and Literature Review.

Abstract

BACKGROUND Circumferential acute aortic dissection is a rare and fatal condition. We present a surgical case of a 76-year-old woman presenting with Stanford type A acute aortic dissection with intimo-intimal intussusception. CASE REPORT A 76-year-old woman living on a remote island with no significant medical history visited a local general hospital because of sudden anterior thoracic strangulation. Contrast-enhanced computed tomography revealed Stanford type A acute aortic dissection, and the patient requested helicopter transport to our hospital for surgery. During preparation for transport, the patient's level of consciousness decreased, shock vitals were observed, and she was intubated at the hospital. The patient arrived at the hospital approximately 5 h after the request for transportation, and surgery was started immediately. Following anesthesia induction, transesophageal echocardiography showed that the intima was in a to and fro state. Inspection of the ascending aorta revealed that the intima was completely circumferentially dissected and that the inverted intima was entrapped in the left ventricle. The dissection extended into the sinus of Valsalva; however, because the intima of the bilateral coronary arteries was normal, Bio-Glue was applied to the false lumen of the sinus of Valsalva for adequate repair, and ascending aortic replacement was performed using a 26-mm graft. CONCLUSIONS In this case, the dissection progressed during transport, and the patient experienced intimo-intimal intussusception, leading to shock. In such cases, swift transportation should be prioritized, and immediate surgical intervention is necessary.