A patient on oral anticoagulation with dabigatran presented with chest pain and 
dyspnoea. A CT scan of the chest revealed an intramural haematoma of the 
ascending aorta with a large pericardial effusion. The patient underwent a 
modified Bentall procedure. In the absence of a specific antidote for this novel 
oral anticoagulant medication, even in an emergency situation, successful 
surgical treatment was possible with an aggressive use of available 
prohaemostatic agents.