Abstract:
Background. Ascending aortic aneurysm represents a severe cardiovascular pathology
with a high risk of dissection or rupture, and nonspecific clinical manifestations, such as
epigastric pain, may delay accurate diagnosis and initiation of treatment, significantly
worsening the patient’s prognosis.
Objective(s). Presentation of a case of ascending aortic aneurysm with atypical onset,
complicated by acute dissection undetected on imaging and severe valvular insufficiency,
successfully treated surgically.
Materials and methods. A 50-year-old hypertensive man was admitted to a regional
hospital with severe abdominal pain, chills, nausea, and vomiting. After 9 days he was
transferred to a tertiary care center due to progressive heart failure and poor response to
treatment. He was evaluated by laboratory tests, echocardiography, thoracic CT
angiography, coronary angiography.
Results. Echocardiography revealed an aneurysm of the ascending aorta and Valsalva sinus
(61 mm), grade IV aortic regurgitation, grade III mitral regurgitation, grade II tricuspid
regurgitation, with preserved ejection fraction. Angio-CT confirmed the aneurysm without
dissection. Coronary angiography showed no ischemic lesions. Intraoperatively, a Stanford
type A, DeBakey type II dissection was found in the proximal ascending aorta with
involvement of the aortic valve, which was not detected by imaging. A Bentall procedure was
performed, including valve replacement, reimplantation of the coronary arteries, and repair
of the aortic dissection.
Conclusion(s). Atypical onset with epigastric pain and heart failure may delay the diagnosis
of aortic aneurysms. Imaging may be inconclusive in the early detection of dissection, and
intraoperative assessment remains essential for establishing the diagnosis and appropriate
therapeutic approach.
