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DOI: 10.1055/s-0030-1268928
Re-dissection of the sinus of Valsalva: An underestimated complication after supracoronary aortic replacement in patients with Stanford type A aortic dissection
Objectives: To determine the presence and the extent of re-dissection (RD) of the sinus of Valsalva in patients with Stanford type A dissection treated by supracoronary aortic replacement.
Methods: 52 asymptomatic patients with treated Stanford type A dissection of the aorta underwent contrast enhanced ECG-gated MDCT and TTE. Examinations were obtained 7–68 month after supracoronary aortic replacement. The presence and the extent of a RD and the diameter of sinus of Valsalva (SV) were assessed and MDCT findings correlated to the type of surgical procedure, to the time interval after operation and to the TTE findings.
Results: In 14 of 52 asymptomatic patients (26.9%) MDCT revealed a RD. This extended in 12 cases into the non-coronary sinus and in two further cases into the right coronary sinus as well. The diameter of the SV was significantly larger in patients with RD (47±11mm) compared to those without (39±8mm; p<0.05). In patients treated with tissue glue the number of RD was higher (7 vs. 1) in the late follow-up group (25–68 month) compared to the early follow-up group (7–24 month). However TTE was suspicious in 5 of 14 patients, at last it did not reveal RD in any patient.
Conclusions: RD is an underestimated complication of supracoronary aortic replacement. A potential cause for delayed RD in our study may be the failure of tissue glue used to fix dissected membranes. ECG-gated MDCT is superior to TTE depicting RD.