Antegrade type A aortic dissection under endoscopic vision during minimally invasive mitral valve repair: a case report

A 68-year-old woman was referred for surgical correction of severe mitral valve regurgitation and underwent minimally invasive mitral valve repair (MIMVS). Per-procedurally, the patient developed an antegrade type A aortic dissection (TAD) under endoscopic vision, while slightly manipulating the ascending aorta. An emergency sternotomy was performed, and the antegrade TAD, as well as the mitral regurgitation were dealt with accordingly. The patient had a normal aortic diameter but an elongated aorta. This case prompted us to alter our method of preoperative planning by implementing computed tomography angiography in the work-up of every patient for MIMVS. Furthermore, following this case we demonstrated aortic elongation to be a potential risk factor for TAD and considered this to be a relative contraindication for MIMVS.