A patient is admitted to the hospital for an acute coronary syndrome complicated by a ventricular septal defect (VSD). Initially, treatment was performed with primary angioplasty and surgical correction of the VSD. During the procedure, the patient developed cardiogenic shock, requiring an intra-aortic balloon pump and a VA-ECMO. The VSD persisted despite treatment, leading to a heart transplant recommendation at a referral center. Prior to this, a CTA (computed tomography angiography) revealed an image consistent with an ascending aortic dissection (Images 1 and 2), resulting in the transplant being deferred. After reviewing the images at the transplant center, the aortic dissection was ruled out following assessment by transesophageal echocardiography of the aortic arch (Image 3), determining that the image was due to the confluence of ECMO flows, which eventually allowed the transplant to be performed.

Image 1

Image 2

Image 3