Intimal flap of ascending aortic dissection with valve-like motion diagnosed by transesophageal echocardiography.

showed pulmonary congestion and transthoracic echocardiography showed aortic valve regurgitation without ascending aortic dissection. Computed tomography (CT) demonstrated aortic dissection from the aortic arch to the bilateral common iliac arteries, but there was no evidence of dissection in the ascending aorta (Fig. 1A, B). A transesophageal echocardiography was performed and revealed a circumferential intimal flap with valve-like motion in the dilated aortic root (Fig. 1 C, D) and severe aortic valve regurgitation. Urgently, the Bentall procedure was performed and about 3/4 circumferential dissection above the sinus of Valsalva was confirmed. CT is selected most frequently as the initial test of acute aortic dissection, but there are some variants of aortic dissection which are not visualized on CT scans. Transesophageal echocardiography is useful for the diagnosis and it is reported to be