A 30-year-old woman with clinical features of Marfan’s disease was referred to our institution with acute chest pain and profound hypotension requiring inotropic and vasoactive support, together with mechanical ventilation. At admission she was haemodynamically unstable, and a grade 2/6 diastolic murmur was heard at the left parasternal area. Transthoracic and transoesophageal echocardiography showed an aneurysmatic ascending aorta with a DeBakey type I aortic dissection causing severe aortic regurgitation. The left ventricle was dilated and left ventricular systolic function severely depressed with an ejection fraction of 10%. Transverse sections of the ascending aorta showed that the dissection affected the 360° of the proximal aortic circumference (fig 1). A large horizontal intimal tear was found to be located 3 cm above the aortic valve plane, and the dissection extended to the distal thoracic descending aorta. Unfortunately, the patient had a cardiac arrest which could not be reversed and died shortly after admission.

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Figure 1 Transoesophageal echocardiography (transverse aortic section) showing a circumferential dissection of the ascending aorta.