On the table, coronary vessels could not be engaged. Bedside transthoracic echocardiography was later performed and demonstrated intimal flap in the ascending aorta down to the abdominal aorta. Physical examination was reviewed and showed discrepancy of blood pressure between right and left arms (right 96/46 mm Hg and left 123/31 mm Hg). The patient appeared to be tall (185 cm) and thin. He also had pectus carinatum deformity and arachnodactyly which suggested Marfan syndrome.
The patient underwent an emergency Bentall operation. The ascending aorta was dilated, 6 cm in diameter. The intimal flap was demonstrated in the ascending aorta through the descending aorta as limited by the median sternotomy approach. The aortic root was also dilated—annulo-aortic ectasia typical for a Marfan syndrome patient with moderate aortic incompetence. No anomalous or coronary artery dissection was observed, but the right coronary orifice was occluded by the false lumen. The patient survived with no immediate postoperative complications, and the ECG returned to normal postoperatively. Full anthropometric measurement secured the diagnosis of Marfan syndrome without familial history.