Intimo-intimal Intussusception (III) Teaching Points
III is rare and is caused by circumferential detachment of the intima of the ascending or descending aorta, which then prolapses into the lumen of the aorta.
Complications caused by III can vary based on location of the intussusception.
III must be considered when a patient with suspected aortic dissection acutely develops cardiovascular and concomitant acute neurologic symptoms.
III might not be revealed on CT or MRI, based on anatomic location of the flap, intraoperative TEE exam might be the first and only method of diagnosis; aortography has been used in the limited literature available.
Patients with “ pseudocoarctation” symptoms in the setting of thoracic aneurysmal disease must be carefully assessed for III.
Intraoperative TEE may show the unique features of the intussusception, with a thick, undulating flap that may prolapse retrograde into the LVOT and back through the aortic valve as noted in this patient, coronary ostial occlusion is an associated complication.Antegrade prolapse of an ascending aortic III may lead to occlusion of the ostia as well as extension of dissection into the great vessels (innominate, left common carotid, left subclavian arteries).
Absence of a flap in the ascending aorta does not rule out III, the arch and descending aorta must be carefully imaged with TEE in multiple orthogonal planes.
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