Antegrade and Retrograde Stanford Type A Intimal Intussusception

Abstract

We read with great interest the article by Shah and associates [1Shah P.J. Singh S.S. Chaloob S.S. Lang C. Taylor J. Edwards J.R. Intimo-intimal intussusception of the aorta.Ann Thorac Surg. 2006; 82: 2274-2276Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] regarding Stanford type A intimal intussusception. Prior to the publication of their article we submitted two case reports [2Sanders L.H. Newman M.A. Gara K.L. Price R.A. Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception.Int J Cardiovasc Imaging. 2007; 23: 659-665Crossref PubMed Scopus (9) Google Scholar] of antegrade and retrograde Stanford type A intimal intussusception with a literature review of the diagnosis of this condition. To come to a uniform diagnosis and raise awareness of these conditions, which have been reported with many descriptive terms, we advised classification as antegrade and retrograde Stanford type A intimal intussusception rather than intimo-intimal intussusception. The often used term “intimo-intimal intussusception” can be described as a tautology or misnomer, because, as in antegrade intussusception, the intima can only intussuscept into intima (or at least no reports contradict this concept). Also, in retrograde intussusception, the intima intussuscepts into the endocardium rather than the intima. Shah and colleagues [1Shah P.J. Singh S.S. Chaloob S.S. Lang C. Taylor J. Edwards J.R. Intimo-intimal intussusception of the aorta.Ann Thorac Surg. 2006; 82: 2274-2276Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] report on a 50-year-old man, consistent with a mean age of 52.4 years, which we encountered in the review of 29 reported cases. In addition to computed tomographic (CT) scan features reported by Nelsen and colleagues [3Nelsen K.M. Spizarny D.L. Kastan D.J. Intimointimal intussusception in aortic dissection: CT diagnosis.Am J Roentgenol. 1994; 162: 813-814Crossref PubMed Scopus (32) Google Scholar], we described new CT scan features of a circular radiolucency in the contrast-filled aortic arch on coronal reconstruction and arch vessel obstruction. We believe that the diagnosis of antegrade intimal intusussusception can be made confidently with computed tomographic scan. Transesophageal echocardiogram does not add further sensitivity, but it can be performed intraoperatively. However, in retrograde intussusception, the diagnosis is best confirmed with echocardiogram. Present day computed tomographic scanners are unable to identify the to-and-fro movement of the intussusceptum through the aortic valve. Further investigations delay the treatment of these life-threatening conditions. Aortic regurgitation in retrograde intussusception is caused by a “stenting action” of the intussusceptum on the aortic valve leaflets in diastole rather than prolapse of the leaflets itself. We congratulate Dr Shah and colleagues [1Shah P.J. Singh S.S. Chaloob S.S. Lang C. Taylor J. Edwards J.R. Intimo-intimal intussusception of the aorta.Ann Thorac Surg. 2006; 82: 2274-2276Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] on their result.