1313 Unusual Supraannular Aortic Root Intimal Tear in a Patient with Severe Aortic Regurgitation

Abstract We present an extremely rare case of occult supraannular aortic root intimal tear in a patient presenting with acute severe regurgitation (AR) and previously undiagnosed bicuspid valve. A 41-year-old Africo-Carribean female presented to the emergency department pulmonary oedema increasing dyspnea on exertion. She had been treated empirically antibiotics for chest infection. Initial concerns were either dissection or infective endocarditis. Transthoracic echocardiography (TTE) demonstrated normal size left ventricle hyperdynamic systolic function AR. The was transferred tertiary cardiothoracic surgical centre urgent treatment view haemodynamic instability gated computed tomography aortogram identified asymmetrically dilated (maximal diameter 45 mm). Despite advanced multimodality preoperative imaging, diagnosis made intraoperatively prompted Bentall procedure mechanical After median sternotomy initiation cardiopulmonary bypass, starting from right coronary cusp/noncoronary cusp commissure found no extension into aorta. valve AR not amenable repair found. performed using 23/26mm Carbomedics Carbo Seal Valsalva composite graft (Sulzer Inc, Austin, TX, USA). discharged 7th postoperative day sinus rhythm. At 30-day clinical follow-up she symptom free satisfactory TTE.