Acute Aortic Intimal Layer and Valvar Apparatus Prolapse Into the Left Ventricle

Abstract

HomeCirculationVol. 123, No. 17Acute Aortic Intimal Layer and Valvar Apparatus Prolapse Into the Left Ventricle Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessBrief ReportPDF/EPUBAcute Aortic Intimal Layer and Valvar Apparatus Prolapse Into the Left Ventricle Gianluca Rigatelli, MD, PhD, Fabio Dell'Avvocata, MD, Massimo Giordan, MD, Luca Conte, MD, Dario Adami, RT and Paolo Cardaioli, MD Gianluca RigatelliGianluca Rigatelli From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author , Fabio Dell'AvvocataFabio Dell'Avvocata From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author , Massimo GiordanMassimo Giordan From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author , Luca ConteLuca Conte From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author , Dario AdamiDario Adami From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author and Paolo CardaioliPaolo Cardaioli From the Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Search for more papers by this author Originally published3 May 2011https://doi.org/10.1161/CIRCULATIONAHA.110.006247Circulation. 2011;123:e422–e423A 73-year-old hypertensive man was referred to our institution for urgent coronary angiography because of typical chest pain, slight increase in troponin level, and ECG signs of inferolateral subendocardial ischemia. An aortic systolic murmur was clearly audible, and pulses were present ubiquitously. The patient was referred for urgent coronary artery angiography, but because of an unsuccessful attempt to cannulate both coronary ostia, an aortogram was obtained in the right anterior oblique projection. A massive intimal flap extending from the left subclavian artery to the entire aortic annulus was observed clearly (Figure 1,left, arrow). The intimal flap and the disrupted aortic valve were deeply prolapsing into the left ventricle (Figure 1, right, arrow and interrupted line; Movie I in the online-only Data Supplement), causing massive aortic valve insufficiency. On the immediate computed tomography scan, massive dissection of the entire ascending aorta and annulus was confirmed (Figure 2A and 2B, arrow) as well as a huge intimal layer flap prolapse into the left ventricle (Figure 2C, arrow). The valvar apparatus prolapse was also confirmed by the preoperative echocardiogram (Figure 3A and 3B and Movies II through IV in the online-only Data Supplement). The patient was referred for emergent aortic surgical repair, which was successfully accomplished.Download figureDownload PowerPointFigure 1. Left, Aortic intimal flap on aortogram in right oblique anterior projection. White arrows indicate the intimal layer. Right, Appearance of aortic intimal layer prolapse into the left ventricle with massive aortic insufficiency. White arrows indicate the valve apparatus prolapsing in the left ventricle.Download figureDownload PowerPointFigure 2. Dissection of the ascending aorta and aortic annulus (A and B) with prolapse into the left ventricle (C) as observed on emergent angiographic computed tomography scan.Download figureDownload PowerPointFigure 3. Prolapse of the entire aortic valve apparatus into the left ventricle as observed on preoperative transthoracic echocardiography on 4-chamber view (A) and subcostal view (B).DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.110.006247/DC1.Correspondence to Gianluca Rigatelli, MD, PhD, Via Mozart 9, 37048 Legnago, Verona, Italy. E-mail [email protected]it Previous Back to top Next FiguresReferencesRelatedDetails May 3, 2011Vol 123, Issue 17 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.110.006247PMID: 21537004 Originally publishedMay 3, 2011 PDF download Advertisement SubjectsComputerized Tomography (CT)EchocardiographyImaging