Aortic Dissection at the Coronary Artery Sinus
Magnetic Resonance Angiography Findings
A 48-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.
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.
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.
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