A subtle aortic dissection can be challenging to detect despite the
availability of multiple diagnostic modalities. Whilst rare, the
inability to detect this variant of aortic dissection can lead to a
dismal prognosis. We present an extremely rare case of a subtle aortic
dissection with supraannular aortic root intimal tear and acute severe
aortic regurgitation in a patient with a bicuspid aortic valve. Initial
concerns were either aortic dissection or infective endocarditis.
Despite advanced multimodality preoperative imaging, diagnosis was made
intraoperatively and a Bentall procedure with a mechanical aortic valve
was performed. As current data is limited, a literature review
concerning subtle aortic dissection is provided.