Abstract
Retrograde aortic dissection occurred at the start of cardiopulmonary bypass (CPB) in a patient undergoing aortic valve replacement. This life-threatening complication was strongly suspected due to sudden unexplained hypotension and white discoloration of the aortic root. Transesophageal echocardiography (TEE) immediately established the diagnosis by the emergence of the intimal flap in the ascending and descending aorta. The retrograde aortic dissection extended from the left femoral artery to the aortic root. CPB was interrupted while the cannulation site was changed to the right subclavian artery. CPB was resumed and the closure of the dissection and ascending aortic reconstruction was performed. TEE was particularly useful to guide the surgical repair this complication.
