Ann Thorac Surg 2009;87:2003. doi:10.1016/j.athoracsur.2008.12.015
© 2009 The Society of Thoracic Surgeons
Correspondence
Antegrade and Retrograde Stanford Type A Intimal Intussusception
Lucas H.A. Sanders, MD, FCS (SA),
Mark A.J. Newman, MD, FRACS
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
(Email: lucmedi{at}hotmail.com).
To the Editor:
We read with great interest the article by Shah and associates [1] regarding Stanford type A intimal intussusception. Prior to the publication of their article we submitted two case reports [2] of antegrade and retrograde Stanford type A intimal intussusception with a literature review of the diagnosis of this condition. To come to a uniform diagnosis and raise awareness of these conditions, which have been reported with many descriptive terms, we advised classification as antegrade and retrograde Stanford type A intimal intussusception rather than intimo-intimal intussusception. The often used term "intimo-intimal intussusception" can be described as a tautology or misnomer, because, as in antegrade intussusception, the intima can only intussuscept into intima (or at least no reports contradict this concept). Also, in retrograde intussusception, the intima intussuscepts into the endocardium rather than the intima. Shah and colleagues [1] report on a 50-year-old man, consistent with a mean age of 52.4 years, which we encountered in the review of 29 reported cases. In addition to computed tomographic (CT) scan features reported by Nelsen and colleagues [3], we described new CT scan features of a circular radiolucency in the contrast-filled aortic arch on coronal reconstruction and arch vessel obstruction. We believe that the diagnosis of antegrade intimal intusussusception can be made confidently with computed tomographic scan. Transesophageal echocardiogram does not add further sensitivity, but it can be performed intraoperatively. However, in retrograde intussusception, the diagnosis is best confirmed with echocardiogram. Present day computed tomographic scanners are unable to identify the to-and-fro movement of the intussusceptum through the aortic valve. Further investigations delay the treatment of these life-threatening conditions. Aortic regurgitation in retrograde intussusception is caused by a "stenting action" of the intussusceptum on the aortic valve leaflets in diastole rather than prolapse of the leaflets itself. We congratulate Dr Shah and colleagues [1] on their result.
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References
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- Shah PJ, Singh SS, Chaloob SS, Lang C, Taylor J, Edwards JR. Intimo-intimal intussusception of the aorta Ann Thorac Surg 2006;82:2274-2276.[Abstract/Free Full Text]
- Sanders LH, Newman MA, Gara KL, Price RA. Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception Int J Cardiovasc Imaging 2007;23:659-665.[Medline]
- Nelsen KM, Spizarny DL, Kastan DJ. Intimointimal intussusception in aortic dissection: CT diagnosis Am J Roentgenol 1994;162:813-814.[Free Full Text]
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