Ascending aortic aneurysm with severe valvular insufficiency and atypical onset with epigastric pain, case report

Abstract

Background. Ascending aortic aneurysm remains a severe condition with high risk of dissection or rupture. Atypical clinical presentation may delay diagnosis. Objective(s) of the study. To present a case of ascending aortic aneurysm with atypical onset, complicated by dissection and severe valvular insufficiency. Materials and methods. A 50-year-old hypertensive male was admitted on May 6 to the district hospital with severe abdominal pain, chills, nausea, and vomiting. After 10 days of unfavorable evolution, he was transferred to a tertiary center with dyspnea, fatigue, and edema. Transthoracic echocardiography, thoracic angio-CT, coronary angiography, and interdisciplinary consultation were performed. Results. Aneurysm of the ascending aorta and Valsalva sinus (61 mm) was identified, with severe aortic regurgitation (grade IV), mitral regurgitation (grade III), tricuspid regurgitation (grade II), and preserved ejection fraction. Angio-CT confirmed the aneurysm without dissection. Coronary angiography showed no lesions. Intraoperatively, a Stanford A, DeBakey II dissection was found in the proximal ascending aorta, involving the aortic valve, which was not visible on imaging. A Bentall procedure with valve prosthesis, coronary artery reimplantation, and dissection repair was performed. Postoperative evolution was favorable. Conclusion(s). An atypical onset with epigastric pain and signs of heart failure may delay the diagnosis of ascending aortic aneurysms. Limited dissections may be missed by imaging, making intraoperative assessment crucial for accurate diagnosis and treatment.