CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
e8
AFRICA
Case Report
Spontaneous retrograde dissection of the ascending
aorta in a patient with a bicuspid aortic valve
CAGDAS AKGULLU, TOLGA HEKİM, UFUK ERYILMAZ, TÜNAY KURTOĞLU, UĞUR GÜRCÜN
Abstract
Bicuspid aortic valve (BAV) is a congenital anomaly associ-
ated with structural weakness of the aortic wall. Sudden
onset of symptoms in patients with BAV, such as sudden
severe back pain, and pulse inequality between the extremi-
ties or tension disparity should alert clinicians to acute aortic
syndromes, as they require prompt diagnosis and manage-
ment. Retrograde aortic dissection, which is a rare form of
acute aortic syndrome, is an uncommon life-threatening
entity and may produce atypical computed tomography (CT)
or magnetic resonance imaging findings, leading to difficulty
in diagnosis. We report on a 51-year-old male patient with
BAV and spontaneous retrograde ascending aortic dissection.
CT findings were confusing and the diagnosis was made via
transoesophageal echocardiography. After the diagnosis, the
patient was treated with a modified Bentall procedure. He
did not have any complications and was stable four months
after the operation.
Keywords:
spontaneous, retrograde ascending aortic dissection,
transesophageal echocardiography, bicuspid aortic valve
Submitted 11/1/13, accepted 10/5/13
Cardiovasc J Afr
2013;
24
: e8–e10
DOI: 10.5830/CVJA-2013-036
Retrograde dissection of the ascending aorta is a rare disease that
usually arises as a complication of some invasive manoeuvres.
1,2
Mostly the entry tear starts in the descending aorta and expands
retrogradely to the ascending aorta.
3
The spontaneous form is
extremely rare and the aetiology is controversial.
A bicuspid aortic valve is the most common congenital
heart disease, with an incidence rate of 1.3% in the general
population.
4
In patients with a bicuspid aortic valve, one of
the suggested mechanisms of aortic dissection is associated
constitutional weakness of the aortic wall.
5
Valvulopathy is the
most frequent complication, however, and in Marfan syndrome,
aortopathies may be associated as well.
6,7
The latter is important
as it may lead to aortic dissection and sudden death.
8
We report here on a 51-year-old male patient with a bicuspid
aortic valve and spontaneous dissection of the retrograde
ascending aortic. To the best of our knowledge, spontaneous
retrograde dissection limited to the ascending aorta in a patient
with a bicuspid aortic valve has not been reported in the literature
before.
Case report
A 51-year-old male patient presented with retrosternal angina and
severe back pain for the previous eight hours. He was referred
from another centre where aortic dissection was suspected, and a
computed tomography (CT) scan was performed. There was no
sign of aortic dissection but an ascending aortic aneurysm was
recognised.
On physical examination, his blood pressure was 120/60
mmHg on the left arm and 115/60 mmHg on the right. His pulse
was 95 beats/minute. The lung examination was normal. There
was no difference between the right and left side pulses. He had
reported no trauma or back pain during the last few days. He was
not a smoker and had a clear medical history.
Cardiac auscultation revealed grade 2/6 diastolic murmur
in the aortic area. His electrocardiogram (ECG) and cardiac
markers were normal. A telecardiogram revealed a normal
cardiothoracic index but there was a slight mediastinal widening.
Aortic dissection was suspected, however CT angiography of the
aorta showed a 50-mm aortic aneurysm in the ascending aorta
without any signs of dissection (Fig. 1).
Faculty of Medicine, Adnan Menderes University, Aydin,
Turkey
CAGDAS AKGULLU, MD,
TOLGA HEKİM, MD
UFUK ERYILMAZ, MD
TÜNAY KURTOĞLU, MD
UĞUR GÜRCÜN, MD
Fig. 1. A CT angiography scan with contrast administra-
tion was not demonstrative of aortic dissection. The faint
intra-aortic line seemed more like an artifact (asterisk).
