June 2006
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Question: This video clip and picture represent short axis view of the aortic valve; they were captured intra-operatively from a 60 years old hypertensive male patient whose complaint was severe chest pain.
In your opinion:
1-What are structures 1 and 2 shown in the picture?
2-What diagnosis can you make from the video clip?
3-Few minutes later, urgent bypass was instituted because of hemodynamic instability, what may be the cause?
Answer: Structures 1 is a dissection flap involving non coronary cusp while structure 2 is the right coronary artery. As we see it is an aortic dissection affecting the aortic valve and approaching the right coronary artery so, involvement of the right coronary artery is the most probable cause of hemodynamic instability in this patient.