LAUSR

suggestive of critical left-main stem disease and triggering CCL activation. While preparing for emergent angiography in the CCL, revisitation of clinical history revealed symptoms of both transient visual disturbance at onset of chest pain and examina-tion findings included a loud holodiastolic murmur. Rapid TTE was performed showing dilated aorta (5.8 cm) with mobile dissection flap intermittently compromising coronary ostia alongside free AR. Immediate onward transfer to cardiothoracic theatre occurred. At operation, dissection involvement of the left main ostium was observed, and treatment was with a 32 mm aortic interpositional graft.