Key result
Intraoperative TEE reveals a Type A aortic dissection flap masquerading as a bicuspid valve.
Why the study?
Aortic dissection can mimic a bicuspid aortic valve on echocardiography, complicating diagnosis and management.
Case Report (n=1)
Clinicians should confirm aortic valve morphology intraoperatively in Type A dissection despite preoperative bicuspid appearance; this case leaves open the frequency of such imaging mimicry.
A 37-year-old male presented to the Emergency Department with acute worsening of back pain and new onset dyspnea. Transthoracic echocardiography revealed moderate left ventricular dysfunction and a bicuspid aortic valve (BAV). In addition, he was noted to have a dilated thoracic aorta concerning for a dissection, severe aortic insufficiency (AI), and both a pericardial and pleural effusion. Magnetic resonance imaging revealed a Type A ascending aortic dissection. He was taken emergently to the operating room for repair. An intraoperative transesophageal echocardiography examination was performed which revealed a normal trileaflet AV with a Type A aortic dissection flap masquerading as a BAV. The dissection flap interfered with both the valve's function, causing severe AI, as well as the valve's appearance, causing it to look bicuspid on echocardiography.
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Kumar et al. (2015) conducted a case report in Type A aortic dissection (n=1). Intraoperative transesophageal echocardiography (TEE) vs. Transthoracic echocardiography (TTE) was evaluated. Intraoperative transesophageal echocardiography and surgical inspection correctly identified a normal trileaflet aortic valve, revealing that a Type A aortic dissection flap had masqueraded as a bicuspid aortic valve on initial imaging.
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