A case of subacute thoracic aortic aneurysm dissection presenting as congestive heart failure with reduced ejection fraction due to severe aortic regurgitation and right coronary artery dissection, treated with the Hemi-Yacoub technique with recovery of left ventricular ejection fraction to 50% at 6-month follow-up.
Key Findings
Background
Subacute TAAD can present with progressive dyspnoea and congestive heart failure with reduced left ventricular ejection fraction, mimicking common cardiac conditions and risking diagnostic delay.
The patient presented with progressive dyspnoea as the initial symptom
The clinical presentation culminated in congestive heart failure with reduced left ventricular ejection fraction
The subacute presentation was distinct from the acute form of TAAD
This presentation risked diagnostic delay due to its resemblance to common cardiac conditions
Results
Severe aortic regurgitation was identified as the mechanism driving heart failure in this case of subacute TAAD.
The patient developed severe aortic regurgitation (AR) as a complication of the dissection
Echocardiographic evidence of significant AR was present
A new diastolic murmur was a notable clinical feature
The AR was the primary cause of the progressive dyspnoea and heart failure
Results
Diagnosis of subacute TAAD was confirmed with CT angiography, which also revealed right coronary artery dissection.
CT angiography was the confirmatory diagnostic modality
The dissection involved the right coronary artery in addition to the thoracic aorta
The combination of aortic valve insufficiency and right coronary artery dissection was present
Results
Surgical repair using the Hemi-Yacoub technique was performed to treat the subacute TAAD with severe aortic regurgitation.
The Hemi-Yacoub technique was the specific surgical approach used
This technique was selected in the context of aortic root involvement causing severe AR
Surgical repair was the definitive treatment for this case
Results
The postoperative course was complicated by paroxysmal atrial fibrillation necessitating pacemaker implantation.
Paroxysmal atrial fibrillation developed following surgical repair
The atrial fibrillation was severe enough to necessitate pacemaker implantation
This represented a significant postoperative complication
Results
Left ventricular ejection fraction recovered to 50% at 6-month follow-up after surgical repair.
Recovery of left ventricular ejection fraction was documented at 6-month follow-up
Ejection fraction recovered to 50% from a reduced baseline at presentation
This demonstrates meaningful cardiac functional recovery following treatment of the underlying aortic pathology
Conclusions
The case highlights the importance of considering aortic pathology in patients with heart failure of unclear origin, particularly when accompanied by a new diastolic murmur or echocardiographic evidence of significant aortic regurgitation.
Heart failure of unclear origin should prompt consideration of aortic pathology as an underlying cause
A new diastolic murmur is identified as a key clinical clue warranting further investigation for aortic pathology
Echocardiographic evidence of significant AR is highlighted as another important trigger for aortic evaluation
Diagnostic delay is a recognized risk when subacute TAAD mimics common cardiac conditions
What This Means
This research reports a case of a rare and potentially life-threatening condition called subacute thoracic aortic dissection — a tear in the wall of the main artery leaving the heart — that disguised itself as ordinary heart failure. Instead of presenting with the classic sudden, severe chest pain typically associated with aortic dissection, this patient gradually developed worsening shortness of breath caused by a leaky aortic valve and a dissection extending into one of the heart's own arteries (the right coronary artery). The diagnosis was eventually confirmed using CT imaging of the blood vessels, and the condition was treated with a specialized heart surgery called the Hemi-Yacoub technique.
After surgery, the patient experienced an irregular heart rhythm (atrial fibrillation) that required implantation of a pacemaker, illustrating that recovery from this type of surgery can involve additional complications. Despite this, at six months after the operation, the patient's heart pumping function had recovered to 50%, suggesting meaningful improvement from the reduced function seen at the time of diagnosis.
This research suggests that doctors should consider aortic dissection as a possible cause when a patient develops heart failure without an obvious explanation, especially if a new heart murmur or significant aortic valve leakage is detected on ultrasound. Missing this diagnosis can be dangerous, since aortic dissection is a surgical emergency, but its symptoms can closely resemble those of more common heart conditions. Early recognition of these warning signs could help prevent delays in treatment for patients with this atypical presentation.
Vaseli H, Groenewoud R, Percy E, Luong C. (2026). Subacute aortic dissection presenting as heart failure due to aortic valve insufficiency and right coronary artery dissection.. BMJ case reports. https://doi.org/10.1136/bcr-2026-272319