• Images in cardiology

A 36 year old man with Marfan syndrome presented at our hospital because of back pain. He had aortic dissection in the ascending aorta with aortic valve regurgitation, and received the Bentall operation in which the ascending aorta was replaced by an artificial vessel with artificial aortic valves. To evaluate the lumen of the aorta and main branch, ECG gated enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric, Milwaukee, Wisconsin, USA) was performed with a 1.25 mm slice thickness and 3.25 helical pitch. Following intravenous injection of 100 ml of iodinated contrast material (350 mgI/ml), CT scanning was performed and volume data were transferred to a workstation (M900, Zio, Tokyo, Japan). The multiple intimal flaps (arrowheads, upper panel, A, B) suggested a huge complex aortic dissection covering a wide range from the native aortic arch to the entire range of the descending thoracic aorta, which continued to the left common carotid artery (CCA). There were also dissections in the right and left CCAs and right and left subclavian arteries in which all true and false lumens were enhanced by contrast material (middle panel, A, B). Observing both CCAs in three dimensional volume rendering images (lower panel), there was re-entry in the proximal portion of the left internal carotid artery (ICA) and confluence of the true and false lumen with good enhancement. Also, there was re-entry at the distal portion of the right CCA and confluence of the true and false lumen with good enhancement, showing separation into the right external carotid artery (ECA) and ICA.