Severe left main stem stenosis in preoperative cineangiography - acute aortic dissection as intraoperative final diagnosis

Acute aortic dissection occurs in 0.5-2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. Initial diagnosis of acute coronary syndrome was confirmed by electrocardiography (ST segment depression in V-1-V-5 leads), transthoracic echocardiography (anterior wall dyskinesis) and laboratory tests (Tn-I: 6.92 mu/L, CK-MB: 226.24 ng/mL). Due to aortic aneurysm history, computer tomography (CT) was performed. Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation.