Is a dissection in the middle of the aortic arch complicating this large ascending thoracic aortic aneurysm?

摘要

A 78-YEAR-OLD, 98-kg, 188-cm man with a past medical history of essential hypertension and hyperlipidemia was evaluated in the preoperative clinic of the authors' institution in preparation for an elective right inguinal herniorrhaphy. The patient denied cardiovascular complaints. The physical examination revealed a grade II of VI diastolic murmur that was heard along the right sternal border; the patient was referred for transthoracic echocardiography as a result. This study revealed a large ascending thoracic aortic aneurysm, moderately severe aortic insufficiency, mild left ventricular (LV) enlargement, and an estimated LV ejection fraction of 45%.