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09-11-2017 | Heart Beat | Uitgave 1/2018 Open Access

Netherlands Heart Journal 1/2018

Residual flow in false lumen of chronic descending aortic dissection

Netherlands Heart Journal > Uitgave 1/2018
M. Boulaksil, S. S. Liem, M. Akarkach, J. Timmermans
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-017-1052-6) contains supplementary material, which is available to authorized users.
A 58-year-old male patient has a history of a Stanford type A aortic dissection running up to the left common iliac artery for which a composite aortic valve graft replacement was performed approximately three years ago. This time, the patient presented with fever and chills. We performed a transesophageal echocardiography (TEE), which excluded vegetations.
Upon retracting the TEE probe, the descending aorta showed two compartments (Fig.  1a) separated by a dissected intimal layer (Fig.  1a, arrow heads); the largest compartment is the false lumen (Fig.  1a, hash). Colour Doppler imaging showed laminar flow through the true aortic lumen (Fig.  1a, asterisk). In the false aortic lumen, slow rotating blood flow existed (online video). This phenomenon was not present more proximally in the descending aorta at the aortic arch (Fig.  1b). Residual blood flow may persist in the false lumen years after aortic dissection because of multiple fenestrations in the dissected intimal layer providing entry and exit locations for blood flow. In approximately 70% of patients with acute type A aortic dissection, the dissection extends beyond the ascending aorta [ 13]. After repair, these patients show an increased risk of developing post-dissection aortic aneurysm mainly through false lumen dilatation, requiring late distal aortic re-interventions in up to one-fifth of cases [ 3, 4]. False lumen patency appeared to be a major risk factor for late re-intervention and was associated with an accelerated annual growth rate [ 35]. Therefore, long-term follow-up and close surveillance of these patients are imperative.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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TEE of transversal cross section of the descending aorta at the same level as depicted in Fig. 1a, showing the true and false aortic lumen. Slow rotating blood flow existed in the false lumen.
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