CTICasesType A Aortic Dissection with Retrograde Valve Prolapse and Intimal Intussusception
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Imaging findings
Chest CT and transesophageal echocardiography (TEE) demonstrate a proximal type A aortic dissection. TEE reveals a redundant intimal flap in the aortic root that dynamically prolapses retrogradely through the aortic valve during diastole, keeping the valve open and causing severe aortic regurgitation. A separate, large, circumferential intimal tear (intimal intussusception) is visible in the distal arch and descending aorta, creating a windsock-like appearance.
Key takeaways
Aortic valve insufficiency in type A aortic dissection can be caused by retrograde prolapse of the intimal flap across the valve during diastole. Intimal intussusception is a rare and severe complication where a circumferential tear of the intima forms a dynamic windsock-like flap that can prolapse and potentially occlude distal arch vessels or the descending aorta.
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