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BMJ Case Reports 2017; doi:10.1136/bcr-2017-221399
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The telescoping aorta: a case of circumferential aortic dissection with intimo-intimal intussusception into the left ventricle

  1. Sudhir Mungee
  1. Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center., Peoria, Illinois, USA
  1. Correspondence to Dr Majd Ibrahim, ibrahim_majd{at}yahoo.com
  • Accepted 16 August 2017
  • Published 2 December 2017

Description 

A 67-year-old man with history of tobacco smoking presents to the emergency department with sudden onset, retrosternal chest pain radiating to the neck and associated with diaphoresis and nausea. On examination, his blood pressure was 106/42 mm Hg, pulse of 73 beat/min. He was pale, diaphoretic with IV/VI diastolic blowing murmur of unknown chronicity heard at the left sternal border. His distal pulses were faint but symmetric in all extremities. No marfanoid features. ECG showed sinus rhythm with ST segment elevation in leads aVR and V1, with widespread ST segment depression (figure 1). He underwent emergent coronary angiogram with initial diagnosis of acute coronary syndrome and impending cardiogenic shock. Angiogram revealed type-A aortic dissection extending to the aortic arch with concomitant aortic regurgitation (AR) (videos 1 and 2). On prompt recognition of aortic dissection, he was transferred to the operating room for emergent surgical repair. Intraoperative transoesophageal echocardiography (TEE) showed circumferential dissection of the proximal aorta with diastolic prolapse of a cylinder-shaped intimal flap into the left ventricle causing severe AR (videos 3–5). The dissection was successfully repaired using 30 mm Hemashield Platinum …

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