Fig. 1. (A) Transesophageal echocardiographic midesophageal long-axis images of the aortic valve showing the aneurysmal dilatation of the aortic root and ascending aorta and intimal dissection flap in the ascending aorta. Doppler color-flow imaging reveals severe aortic regurgitation caused by the outward tethering of the aortic valve cusps by aortic root dilatation. (B) Midesophageal short-axis view of the descending thoracic aorta shows an intimal dissection flap. This view confirms that the extent of this type A dissection is compatible with a DeBakey type 1 aortic dissection.