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(Circulation. 2000;102:597.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Aortic Dissection at the Coronary Artery Sinus

Magnetic Resonance Angiography Findings

Agnes E. Holland, MD; Jelle O. Barentsz, MD, PhD; Frans M. J. Heijstraten, MD, PhD; Stefan Skotnicki, MD, PhD; Maciej S. Pruszczynski, MD, PhD; Freek W. A. Verheugt, MD, PhD; James W. Goldfarb, MS

From the Departments of Radiology (A.E.H., J.O.B., F.M.J.H., J.W.G.), Cardiothoracic Surgery (S.S.), Pathology (M.S.P.), and Cardiology (F.W.A.V.), University Hospital Nijmegen, Nijmegen, Netherlands.

Correspondence to Agnes E. Holland, MD, Department of Radiology, University Hospital Nijmegen, Geert Grooteplein 18, 6500 HB Nijmegen, The Netherlands. E-mail Agnes_Holland{at}hotmail.com

A48-year-old previously healthy woman was admitted with a 4-month history of acute pain between the shoulder blades, which she initially developed while performing household chores. Since the development of this pain, she also suffered from persistent complaints of claudication. Her son had a history of dissection of the thoracic aorta for which he had been treated surgically.

On transesophageal ultrasound, a dissection of the ascending aorta (Stanford type A) was suspected. Magnetic resonance angiography (MRA; Figure 1) confirmed a Stanford type A dissection that involved only the proximal part of the ascending aorta. In addition, MRA demonstrated a 6-cm ascending aortic aneurysm and showed a separate descending aortic dissection (Stanford type B) as well. Surgery revealed a localized calcified supracoronary dissection (Figure 2) and confirmed that this dissection only involved the proximal part of the ascending aorta. A supracoronary ascending aortic reconstruction with a 24-mm gel-weave prosthesis was performed. The patient had an uneventful postoperative recovery, and the type B dissection is currently being managed conservatively.

View larger version (80K): [in this window] [in a new window]   Figure 1. Single breath-hold gadolinium-enhanced MRA image, not synchronized with the cardiac cycle, depicts the aneurysm (arrows in A) and type A dissection (B). Axial MRA images, synchronized with the cardiac cycle (C), show the dissection of the ascending aortic aneurysm and its relationship with the origins of the coronary artery. LM indicates left main coronary artery; RCA, right coronary artery.

View larger version (80K): [in this window] [in a new window]   Figure 2. Low-power histology demonstrates the calcified intimal tear (arrows), which contains a blood clot. This tear caused a dissection of the aortic wall (Masson trichome stain).

Surgical repair of aneurysms and dissections of the ascending aorta and/or aortic root has become an increasingly popular and feasible technique. An accurate preoperative diagnosis is essential for defining the strategy and technique of surgical treatment. Therefore, there has been an increased demand for diagnostically accurate imaging techniques. This not only involves exact delineation of the extent of the aneurysm, but also involves determining the relation of the aneurysm to other vital structures, such as the coronary arteries. Newer MRA techniques can provide this information both noninvasively and without radiation exposure.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

(Circulation. 2000;102:597.)

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Holland, A. E. Articles by Goldfarb, J. W. Search for Related Content PubMed PubMed Citation Articles by Holland, A. E. Articles by Goldfarb, J. W. Related Collections Cardiovascular imaging agents/Techniques CT and MRI CV surgery: aortic and vascular disease