Authors

• Alma Sijamija — Travnik General Hospital, Travnik, Bosnia and Herzegovina — ORCID: 0000-0003-2818-0501
• Nermir Granov — Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina — ORCID: 0000-0002-6228-6230
• Nedžad Hadžić — Travnik General Hospital, Travnik, Bosnia and Herzegovina — ORCID: 0000-0002-7186-7803
• Omer Perva — Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina — ORCID: 0000-0003-2645-1558
• Alma Agačević — Travnik General Hospital, Travnik, Bosnia and Herzegovina — ORCID: 0000-0003-4671-0991

Keywords

echocardiography, aortic dissection, survival

DOI

Full Text

**Introduction**: Aortic dissection (AD) is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of the aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. It occurs at an estimated rate of 3 per 100,000 people every year, among them 40% die immediately and do not reach a hospital in time. Magnetic resonance imaging is currently the gold standard for the detection and assessment of AD, with a sensitivity and a specificity of 98%, however it has limited availability. Transthoracic echocardiography (TTE) is more commonly available diagnostic tool and has sensitivity of up to 98% and a specificity of up to 97%. (1-3) Aim: To highlight the importance of TTE in the diagnosis of type A dissecting aortic aneurysm. **Case 1**: 67-year-old male was admitted to Internal department due to chest pain and dyspnea. Physical examination showed unmeasurable arterial blood pressure on the right arm and 140/100mmHg on the left; diastolic murmur over precordium. ECG: downsloping ST segment depression in V4-6. Troponin T test was positive. TTE revealed dilated ascending aorta (56 mm) with signs of acute dissection: prolapse of intimal flap into the LVOT and severe AR +4 (**Figure 1**). CT angiography confirmed aneurysm of the ascending aorta starting from the root of LCA and was tracked over the entire aorta to the AIC. Bentall procedure was performed. Figure 1. A transthoracic echocardiogram revealed dilated ascending aorta (56 mm) with signs of acute dissection: prolapse of intimal flap into the left ventricular outflow tract. **Case 2**: 50-year-old male was presented to the internist due to occasional chest pain and shortness of breath, appeared 3 months earlier. Physical examination revealed hypertension, diastolic murmur over precordium. TTE: dilated ascending aorta (48 mm), structure above projection of non-coronary aortic cusp, at the level of sinotubular junction, reminiscent of the intimal flap; severe MR +4 and AR +3/4 (**Figure 2**). CT angiography visualized the hypodensic linear area that separates lumen of thoracic aorta into two parts and extends to the bases of brachiocephalic trunk. Patient received surgical treatment. Figure 2. A transthoracic echocardiogram: dilated ascending aorta (48 mm), structure above projection of non-coronary aortic cusp, at the level of sinotubular junction, reminiscent of the intimal flap. On regular follow-up, 5 years after the procedures both patients feel great. **Conclusion**: Echocardiography has become the preferred imaging modality for suspected aortic dissection. Prompt diagnosis and access to surgical therapy increases survival.

Literature

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