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Frederic Pinaud, Mickael Daligault, Bernard Enon, Jean-Louis de Brux, Endovascular treatment of inoperable acute type A dissection via the transapical approach, European Heart Journal, Volume 34, Issue 41, 1 November 2013, Page 3236, https://doi.org/10.1093/eurheartj/eht318
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An 83-year-old female patient was admitted to our department for thoracic pain. Her medical history composed of hypertension, atrial fibrillation, two thoracic aortic endoprostheses for penetrating aortic ulcer, an aorto-bi-iliac endoprosthesis for subrenal aortic aneurysm, as well as a right ilio-femoral bypass. (Panel A). At admission, the computer tomography (CT) scan showed a dissecting haematoma of the ascending aorta, with heavy calcifications of the aortic arch. The aortic tear was located 1 cm in front of the brachiocephalic trunk (Panels B and C). Echocardiography revealed a non-compressive pericardial effusion, a normal aortic valve, and good left ventricular (LV) function. A multidisciplinary staff deemed the patient to be inoperable, but determined that the lesions might be accessible using endovascular treatment. The transapical approach, commonly used for transcatheter aortic valve implantation (TAVI), was chosen due to the inaccessible peripheral vessels. Because made-to-measure endoprostheses are inaccessible in emergency situations, two conventional endoprostheses were ordered following the sizing of the ascending aorta, and was made available the following day.