RUPTURED AORTIC DISSECTION INTO THE LEFT ATRIUM WHICH PRESENTED AS CONGESTIVE-HEART-FAILURE AND WAS DIAGNOSED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY

A 72 year old man was admitted with severe dyspnoea. Ten days before h e had had intense thoracic pain with loss of consciousness that was fo llowed by increased dyspnoea. A continuous murmur was heard in the pre cordial and the left infrascapular regions. Lung auscultation showed s tasis over the lower half of both lungs. Transthoracic echocardiograph y showed a bicuspid aortic valve and a dissection of the proximal aort a, which was considerably enlarged. Transoesophageal echocardiography confirmed dissection of the proximal aorta and showed a communication from the false lumen of the aortic dissection to the left atrium; and colour flow Doppler showed a continuous shunt to the left atrium. Afte r transoesophageal echocardiography the patient had emergency surgical repair, which was successful. He had no complications in the postoper ative period.