Images in vascular medicine

Abstract

The standard operation for an aortic root dissection is an aortic root replacement with direct re-implantation of the coronary arteries. In some cases, such as acute dissection and redo surgery, this approach can be difŽ cult. The Cabrol technique was developed to overcome this and involves the use of a Dacron interposition graft to connect both coronary oriŽ ces to the aortic graft. This was found to carry the risk of right coronary artery thrombosis. The subsequent modiŽ ed Cabrol’s technique involves the direct re-implantation of the right coronary artery and the re-implantation of the left coronary artery by the utilization of a Dacron graft anastomosed to the left coronary artery ostium. This is then passed posterior to the ascending aortic graft and anastomosed to the right side of the aortic graft. This 74-year-oldmale recently had redo aortic root surgery with a composite carbosealprosthesis.He originally had an aortic valve replacement and presented 19 years later with chronic aortic dissection. In this case, because of the scarring caused by previous surgery, the left coronary artery could not be adequatelymobilized and was attached using the modiŽ ed Cabrol’s technique described. A 6-month postoperative contrast-enhanced computed axial tomography (CAT) scan at the level of the ascending aorta reported a small residual dissection  ap. The large Dacron interposition graft (arrow) lies at the right postero-lateral aspect of the root replacement. The appearances strongly resemble an aortic dissection (Panels A and B). The incidence of aortic dissection after aortic root surgery is 0.7% . CAT scans are highly sensitive and speciŽ c for aortic dissection. The appearance of two lumens separated by an intimal  ap is speciŽ c for aortic dissection, but care must be taken not to misdiagnose an extra-aortic structure as a false lumen. The left innominate vein, the superior vena cava, the left superior intercostal vein, the left superior pulmonary vein and the superior pericardial recesses can mimic a false channel as can adjacent pleural or pericardial thickening and adjacent atelectasis of the lung. This CAT Ž nding highlights a less considered differential diagnosis of an aortic intimal  ap.