Dear Editor, Totonchi et al. ’ s study (1) explores the account of a 45-year old male patient who was using digoxin and warfarin and had undergone an antecedent valve replacement due to aortic insufficiency approximately 35 years before. It is particularly noteworthy that a femorofemoral bypass was performed prior to the Bentall surgery and that no sedative, muscle relaxant, or endotracheal intubations were applied. In spite of the successful surgical procedure, the patient died as a result of a repeat aortic dissection that occurred on the 30th day of the postoperative period (1). . . .

Classically, ascending aortic dissection (AD) presents as sudden, severe chest pain that is tearing type and radiates to the back. Herein, we present a rare case of severe aortic regurgitation with silent ascending AD, which had no chest pain symptoms. The aortic valve apparatus probably masked this AD; therefore, it was not detected by echocardiography.

Acute aortic dissection (AAD) is the most frequent catastrophic event of the aorta; it occurs nearly three times as frequently as the rupture of abdominal aortic aneurysm. Sixty percent of dissection cases are classified as proximal or type A and 40% as distal or type B, according to the Stanford Classification. The most frequent causes of death in acute type B dissection are aortic rupture and malperfusion syndrome.We herein review recent data suggesting different management modalities of type B aortic dissection, including medical, surgical, and endovascular treatments. Although medical therapy is still the standard approach in uncomplicated cases, there are subgroups of patients who may benefit from endovascular management. Endovascular techniques or surgery are valuable options for complicated cases. Hybrid suites, multidisciplinary approaches, and good imaging techniques can be considered as the key to success in this regard.

Introduction: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’ s funeral. The patient did not have any chest pain. she was referred to our emergency department by emergency medicine service due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did rapid ultrasound for shock and hypotension (RUSH) exam in the emergency department to detect aortic dissection. After doing the computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery. Conclusion: Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, acute coronary syndrome, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.

Background: Aortic dissection (AD) is considered to be one of the life-threatening diseases. Quick diagnosis has great significance so that a one-hour delay in treatment leads to a 1-2% increase in mortality. Case Report: The 55-year old obese woman with epigastric pain and right upper quadrant pain referred to the emergency department of our hospital. The acute coronary syndrome was our initial diagnosis but an image similar to a Perl in one cut and a crescent in another cut of computed tomography (CT) drew our attention in the mediastinal view of CT without intravenous contrast that was performed to rule out coronavirus disease-19 (COVID-19). Finally, CT-angiography was requested and AD diagnosis was approved accordingly. Conclusion: The presence of calcification on a non-contrast chest CT in the middle of the aorta or away from the artery wall can be a sign of AD. Thus, special attention should be paid to the atypical symptoms of AD.

Open total arch replacement is allied to high rates of mortality and morbidity; surgeons, therefore, tend to choose hybrid aortic arch repair as a less invasive operative procedure for the treatment of aortic arch aneurysms, especially in high-risk patients. However, studies on the early and late outcomes of patients undergoing hybrid aortic arch repair have revealed high rates of reintervention and reoperation compared with open total arch replacement. Here, we describe a male patient with late retrograde aortic dissection after hybrid thoracic endovascular aortic repair for aortic arch aneurysms. The patient returned 3 years after the procedure with signs of dyspnea on exertion and chest pain. Transthoracic echocardiography and computed tomography showed dissection of the ascending aorta, for which he underwent a redo Bentall procedure. The patient was weaned from cardiopulmonary bypass without any problem and discharged after 7 days.

Acute dissection of the ascending aorta requires immediate surgical intervention. Without surgical treatment I% of the patients will die every hour. In this study we report the result of operations on patients with Stanford type a aortic dissection. From 1997 to 2003, 26 patients (16 males, 10 females) aged 30 to 71 years (mean age 48.9 ET 2.3 years) underwent surgical treatment. In all of them ascending aorta was replaced and in 16 patient's aortic valve was also replaced with prosthetic valve. In 3 patients the aortic valve was repaired, in 7 patients valve was normal. Hospital mortality amounted to 23.07% (6 patients). Only 13 patients could be followed and the rest of the patients did not return for follow up. During this period of time no patient had to be reoperated upon for late complications of the disease and none of these patients died in the follow up. Presence of Marfan's syndrome, renal failure, stroke, cardiac failure, and reoperation were determinant risk factors for mortality. With early diagnosis and surgical treatment about 77% of these patients survived postoperatively.