A 75 year old man with a history of hypertension and coronary artery disease presented with syncope following a cardiac arrest at home. He was sent to our hospital from another centre with a diagnosis of aortic dissection. The patient was unconscious, intubated, and his overall condition was poor. He was sent to the operating room immediately where he suffered a severe hypotensive episode. Transoesophageal echocardiogram (TOE) revealed a linear structure going up and down from the aorta to the left ventricle. In the two chamber view at 90° this structure appeared like a tube extending into the left ventricle (below left). In the left ventricular outflow track view at 120° the complete dissection of the aorta from the aortic arch to the sinotubular junction was observed (below right). The dissection produced a severe aortic regurgitation with dilatation of the left ventricle. We performed a complete repair of the aortic arch with a supracoronary tube. The subsequent echocardiogram revealed only mild aortic regurgitation. However, the patient died five days later because of brain damage caused by the cardiac arrest.

A complete dissection of the aorta is not very common. In this case, the dissection was spectacular due to the complete separation of the intima, which produced these images on TOE.