Investigations
Laboratory analysis revealed elevated troponin T of 3.3 ng/mL and EKG
revealed new right bundle branch block. CT angiography of the thorax
revealed prominent aortic sinus (image 1), pneumomediastinum, an aortic
root disruption with Stanford type A dissection with hemopericardium
(image 2) and rupture of the epicardium of the right ventricle and
adventitia of the pulmonary artery. The epicardial hematoma was
contained but the patient had significant intrapericardial bleeding and
clot. TTE revealed dissection flap in the ascending aorta extending into
the right sinus of Valsalva (image 6 and media 1) and severe aortic
regurgitation with holodiastolic flow reversal in the abdominal aorta
(image 3, image 4 and image 5, media 2). Intraoperative TEE revealed
dilated aortic root to 4 cm, dissection flap in the ascending aorta
extending into the right sinus of Valsalva and severe aortic
regurgitation (image 7, media 3).