“Spades” Sign in Acute Type A Aortic Dissection

Abstract

Multiplanar reconstructed computed tomography (CT) scan through the left ventricular outflow tract in a 30-year-old patient with acute complicated Stanford type A dissection (Figures 1A-1C). Notably, the intima-media cylinder of the sinus of Valsalva is circumferentially detached and prolapses into the left ventricular outflow tract forming a reversed spades sign (Figure 1B). Volume rendered CT reconstruction of the vascular system (Figure 1D). In patients with suspected aortic dissection, we routinely perform these CT angiography scans in at least 1.0-mm slices. It allows optimal three-dimensional reconstruction of the entire aorta as well as evaluation of the dissection’s extension and location of the primary entry tear. The location of the primary entry tear as well as the number and location of further communications between the true and false lumen that will influence the surgical procedure. Despite an acute aortic dissection and an aortic root and ascending aneurysm, this patient had a severe aortic regurgitation and a torn-out right coronary ostium. We performed an aortic root and hemiarch replacement with a mechanical valve conduit including a saphenous vein graft to the right coronary artery.