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Chronic ascending aorta dissection

A 72-year-old male presented with a new murmur 12 years following open surgical repair of an atrial septal defect. He denied any chest pain or shortness of breath. A transesophageal echocardiogram revealed a dissection of the ascending aorta and 3+ aortic insufficiency (AI) (Figure 1) which originated 4 cm below the aortic arch on computer tomogram angiography (CTA) (Figures 2 and 3). There were no coronary lesions (Figure 4). At the time of surgery, cardiopulmonary bypass (CPB) was established with right axillary artery and right femoral vein cannulation. A median sternotomy was performed and the patient was cooled to 28°C. The dissection extended to the non-coronary cusp of the aortic valve but the valve itself was intact. It was not possible to determine the location of the previous cardioplegic or cannulation sites to determine the origin of the dissection. The ascending aorta was replaced with a 26 tubular graft (Vascutek Terumo, Glasgow, UK). The surgery was performed without circulatory arrest; the CPB and cross clamp times were 260 and 75minutes. The patient tolerated the procedure well and had an uncomplicated postoperative course. A postop CTA showed no residual dissection flap (Figure 5) and an echo revealed 1 + AI (Figure 6). The histology of the ascending aorta revealed no evidence of any connective tissue disease.