Two Different Cause of Acute Heart Failure Due to Localized Aortic Dissection

Case 1: A 78-year-old man was admitted to our hospital with chest pain and dyspnea. Chest X ray showed congestive heart failure (CHF). Transthoracic echocardiography (TTE) and plain chest CT revealed severe aortic valve regurgitation (AR) and aortic root dilation without apparent flap. Despite treatment of heart failure CHF was worsened, in order to stabilize his respiratory status, mechanical ventilation was started. We diagnosed cause of his heart failure was acute AR, and then, performed surgical operation. Operation finding showed localized dissection of aortic root which was the cause of acute AR. Case 2: A 66-year-old man was admitted to our hospital with chest pain in a shock state. ECG showed ST elevation in II, III and aVf, and TEE showed severe dilation of right ventricular and severe asynergy of the left ventricular inferior wall. We diagnosed acute myocardial infarction (AMI) with right heart failure, coronary angiogram (CAG) was performed. However CAG did not showed occlusive coronary disease, enhance CT and TEE restudy revealed localized aortic dissection of the sinus of valsalva and dilation of ascending aorta. Operation was performed and the finding showed localized dissection of aortic root which was the cause of AMI and right heart failure. We report these rare cases, two different type of acute heart failure due to local dissection of aortic root.