Acute aortic dissection with tear in ascending aorta not diagnosed until necropsy or operation (for another condition) and comparison to similar cases receiving proper operative therapy.

Acute aortic dissection (AD) with a tear in ascending aorta (AA) is recognized to masquerade occasionally as another condition, and therefore the proper diagnosis is never made or made too late. During a recent 3-year period (2009 to 2011) at Baylor University Medical Center at Dallas, 30 patients with acute AD with tear in AA were diagnosed: 23 (77%) were diagnosed clinically and underwent proper urgent operative therapy; the remaining 7 (23%) with AD with tear in AA were not diagnosed until operation (for another condition) or necropsy or retrospectively by review of antemortem computed tomographic scan after death. The number of patients with AD from tear in AA whose cardiac condition was not diagnosed clinically and who died in the hospital but did not have an autopsy is unclear.

Massive acute infarction of the right ventricular wall without or only minimal infarction of the left ventricular wall after aortic valve replacement with or without simultaneous replacement of the ascending aorta.

Certain clinical and cardiac morphologic findings are presented in two men who developed massive right ventricular (RV) infarction with only minimal or no left ventricular infarction early after aortic valve replacement. The ostium of the right coronary artery was severely narrowed in one patient by the ring of the bioprosthesis, and in the other patient the right coronary artery was completely severed at the time of valve replacement without insertion of a coronary bypass conduit. Such massive infarction of the RV free wall has not been reported previously.