Fatal Type A Aortic Dissection in Young Giving Appearance of Double Aortic Valve with Worms in the Aorta

Abstract

Aortic dissection is a devastating complication which can lead to a fatal outcome. We are here presenting a 25 year old male gentleman presented with history of sudden onset of chest pain and breathlessness of 2 hour duration. Emergency transthoracic echocardiography (TTE) showed dilated aortic root with acute aortic regurgitation and dissection flaps giving the impression of an double aortic valve and worms moving in aorta (Images and Videos 1-3).The cause of the dissection in this patient was previously unrecognised bicuspid aortic valve (Image and Video 4) with aortic root dilatation. The early mortality rate in patients with acute aortic dissection is very high, with up to a 1% per hour death rate reported in the first several hours before surgery for type A dissection. TTE has a sensitivity of 77% to 80% and a specificity of 93% to 96% for the identification of proximal aortic dissection, but it is much less sensitive (31% to 55%) than other modalities for the diagnosis of distal aortic dissection.TEE or CT are imaging modalities of choice. In our patient the entire dissection could be delineated with TTE with classical dissecting flaps seen as worms in aorta.