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Subtle aortic dissection in a patient with severe aortic regurgitation and undiagnosed bicuspid aortic valve: A case report with a literature review

Background and aim of the study: A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supra- annular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve. Methods: Case report and literature review conserning subtle aortic dissection is provided. Results: Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed. Conclusions: Our case along with the review of current literature emphasizes that current imaging techniques may be inadequate for diagnosis of this rare variant of aortic dissection.

Subtle aortic dissection ; aorta ; aortic regurgitation ; aortic root replacement ; misdiagnosis

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