Limited Iatrogenic Dissection of the Aortic Root: To Treat or Not to Treat?

The treatment of aortic dissections of iatrogenic etiology still requires evaluation on a case-by-case basis, as the prevalence of these problems in the past was low, but has grown in recent years due to the exponential increase in hemodynamic procedures. Patients undergoing percutaneous hemodynamic procedures today are often elderly and also frail. Proposing "conventional" surgery to treat an acute aortic dissection may represent a request for "surgical stress" that is too high for their "biological reserves." In addition to this, we assume that the physio-pathological mechanism that creates this type of dissection with a flap in the intima, compared to that of classic noniatrogenic dissections, is different in the angle of entry of the flap with formation of the false lumen, which has a consequent greater tendency to spontaneous "self-resolution" favored by physiological blood flow. In this paper, we present two cases of patients who underwent hemodynamic procedures (coronary angiography with angioplasty and transcatheter aortic valve implantation) both with limited iatrogenic dissection of the ascending aorta treated in a conservative nonsurgical manner. This approach resulted in the closure of the dissection line in both cases, demonstrating in one case the disappearance of the flap even at a 6-month follow-up.