Subtle aortic dissection in a patient with severe aortic regurgitation and undiagnosed bicuspid aortic valve: A case report with a literature review.

Sef, Davorin; Brown, Stewart; Jarral, Omar A; Hussain, Azhar; Haslam, Elizabeth; Rajakaruna, Cha; McAloon, Christopher J

BACKGROUND AND AIM OF THE STUDY A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supra-annular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve. METHODS Case report and literature review conserning subtle aortic dissection is provided. RESULTS Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed. CONCLUSIONS Our case along with the review of current literature emphasizes that current imaging techniques may be inadequate for diagnosis of this rare variant of aortic dissection.