Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Aortic Dissection”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources
PubMed1992

[Asymptomatic aortic dissection associated with a mitral prosthetic leak: a clinical case report].

A case of aortic dissection ("DeBakey type III") in an asymptomatic 78-year-old woman is described. The patient underwent a mitral valve replacement (bioprosthesis Sorin) in June 1990 for severe mitral stenosis; in October 1990 she was admitted to our hospital for severe dyspnea and cardiac failure with good response to medical treatment. The routine echo color Doppler examination showed only a hint of paraprosthetic leak, which required further investigation by transesophageal echocardiography. This approach revealed the presence of a regurgitant jet extending from the prosthetic mitral valve toward the atrial septum. The examination of the thoracic aorta revealed the presence of a dissection flap; the color Doppler technique showed a bidirectional flow through the site of communication between the two lumina. The extension of the dissection from the aortic arch to the origin of the renal branches was confirmed by computerized axial tomography. We emphasize the importance of the transesophageal approach in elderly patients with aortic dissection, often asymptomatic.

Aged↗
PubMedDate not supplied

Postmortem computed tomographic (PMCT) findings of pericardial effusion due to acute aortic dissection.

PURPOSE: To describe the appearance of pericardial effusion in deceased acute aortic dissection patients using postmortem computed tomography (PMCT). MATERIALS AND METHODS: PMCT examinations were performed within 2 hours of death in 30 patients with pericardial effusion due to aortic dissection who arrived at our hospital in a state of cardiopulmonary arrest. RESULTS: Pericardial effusion in 18 of 30 patients (60%) showed double concentric rings on PMCT with striking differences in density, a low-density outer ring along the pericardium and a high-density inner ring on the epicardial surface (hyperdense armored heart). Pericardial effusion in two patients (7%) showed a high-density fluid level (hypostasis). Pericardial effusion in the remaining 10 patients (33%) showed no such stratification. CONCLUSION: A "hyperdense armored heart" is the most frequently seen PMCT finding in deceased cases of pericardial effusion due to acute aortic dissection.

Adult↗
PubMed2002

[Anesthesia for cesarean section in a Marfan patient with complicated aortic dissection].

We report the anaesthetic management of a 32-year-old pregnant women with aortic dissection and Marfan syndrome for caesarean section. The patient has presented at 31 weeks gestation of a first pregnancy an aortic dissection that required an emergency aortic replacement. Three years later, she presented at 31 weeks gestation with aortic dissection, mitral valve dysfunction and acute pulmonary oedema. She was treated in intensive care unit with deslanoside, diuretic and twice a day echographic examination. Delivery was planned by caesarean section after haemodynamic stabilisation on the sixth day. Combined spinal and epidural anaesthesia was performed after monitoring. The initial intrathecal injection of bupivacaine, morphine and fentanyl provided rapid onset of analgesia. Epidural anaesthesia was used with diluted lidocaine and fentanyl boluses. With appropriate preoperative care and monitoring, uneventful combined spinal and epidural anaesthesia for Caesarean section was achieved in a patient with Marfan syndrome in the presence of aortic dissection complicated by mitral valve dysfunction and acute pulmonary oedema.

Adult↗
PubMed2002

Acute type B aortic dissection: surgical therapy.

BACKGROUND: Surgery for acute type B aortic dissection is associated with significant mortality. We report the results for 34 consecutive patients who underwent urgent surgery because they met criteria for operation during the acute phase (< 14 days) of acute type B dissection. METHODS: The average patient age was 64 (32 to 88) years. Indications for surgery were persistent pain (12), threatened exsanguination (18), malperfusion (renal [3], limb [3]), rapid aortic enlargement (4), and uncontrolled hypertension (1). The mean interval from onset of pain to operation was 7 (1 to 14) days. Resection included the proximal descending aorta in 32, the distal aortic arch in 10, extension to the diaphragm in 10, and involved a thoracoabdominal procedure in 3. Surgical techniques included hypothermic circulatory arrest (16 [47%]), distal bypass, monitoring of somatosensory-evoked potentials, sequential intercostal sacrifice (average, 5.6 pairs), cerebrospinal fluid drainage, and steroid administration. RESULTS: There was no hospital mortality. Important complications occurred in 16 patients (47%): 10 respiratory requiring tracheostomy, six infectious, four dialysis, two myocardial infarctions, and two neurologic (one transient stroke, one paraplegia). Mean intensive care unit and hospital stays were 10 (3 to 32) and 35 (7 to 107) days. Survival at 5 and 10 years was 80% and 57%, respectively (mean follow-up, 5.8 years). CONCLUSIONS: Patients meeting criteria for urgent surgery have a low perioperative risk for mortality and paraplegia, and are relatively free from long-term aorta-related complications. These findings warrant consideration of earlier surgery for appropriate patients with acute type B aortic dissection.

Acute Disease↗
PubMedDate not supplied

Use of Doppler ultrasound in dissecting aortic aneurysm.

Immediate intensive therapy is of major importance in the initial management of patients with dissecting aortic aneurysm. The Doppler ultrasound stethoscope is a noninvasive tool which may be used in the diagnosis and management of this disease. A case is presented in which this instrument was used to diagnose and follow the progress of a patient with acute aortic dissection. Further use of this device for similar disorders can be expected.

Aortic Aneurysm↗
PubMed2006

Unusual rapid evolution of type B aortic dissection in a marfan patient following heart transplantation: successful endovascular treatment.

A patient with Marfan syndrome with previous Bentall operation for mitral and tricuspid valve repair, required orthotopic cardiac transplantation for end stage cardiomyopathy. Postoperatively he suffered type-B aortic dissection, despite normal aortic diameters. Following sudden increase of aortic diameters, two years later, he underwent successful stent graft implantation. In patients with Marfan syndrome, post transplantation morbidity is high, with a 40% incidence of thoracic aortic dissection. This case highlights the potential of endovascular approach for treating post-transplantation aortic dissection.

Adult↗
PubMed2002

Acute aortic dissection with side branch vessel occlusion: open surgical options.

Acute aortic dissection is one of the most common catastrophes affecting the aorta. Because dissection can involve any aortic segment, the disease can manifest itself through a variety of clinical presentations. The most spectacular manifestation is frank rupture, usually into the pericardial or pleural cavity. Dissections of the ascending aorta are associated with rapidly fatal complications such as cardiac tamponade, major stroke, or massive myocardial infarction, justifying emergent operation. Dissections of the descending aorta are managed medically with surgery reserved for those patients with aortic rupture, aneurysmal dilatation, or ischemic symptoms. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk of early death and serious complications. The therapeutic armamentarium of the vascular surgeon has evolved during the last 20 years to include endovascular (balloon fenestration or branch stenting) and surgical options. This article will focus on the open surgical management of patients with acute aortic dissection complicated by side branch occlusion and organ or limb malperfusion.

Acute Disease↗
PubMed1999

A review of aortopulmonary fistulas in aortic dissection.

Aortopulmonary fistula is an exceedingly rare complication of aortic dissection. Only 4 cases in acute dissection and 8 cases in the chronic one have been published previously. We report the thirteenth case and a review of the literature. A man underwent an operation for type A aortic dissection. At surgery, a fistula was discovered between the false lumen and the main pulmonary artery, although the preoperative investigations did not suggest such a complication.

Aortic Dissection↗
PubMed2002

Acute aortic dissection in a patient with idiopathic dilated cardiomyopathy.

Surgical treatment of acute aortic dissection in a patient with idiopathic dilated cardiomyopathy is rare. A 57-year-old man diagnosed with idiopathic dilated cardiomyopathy with left ventricular dimension of 59 mm in diastole, left ventricular dimension of 47 mm in systole, and fractional shortening of 0.19 on echocardiography developed type A acute aortic dissection. Emergency surgery was conducted for ascending aorta and hemiarch repair for ascending aorta redissection and dilation. The postoperative course was uneventful under appropriate hemodynamic control. Standardized criteria for aortic dissection in a patient with poor left ventricular contraction have not established, but surgery should be considered for all patients in good preoperative condition when it is the only effective life-saving alternative.

Aortic Dissection↗
PubMed1990

Fenestration revisited. A safe and effective procedure for descending aortic dissection.

Although it was initially performed in 1935, aortic fenestration has been infrequently employed and reported in recent years. We have continued to use fenestration for descending aortic dissection with complicating organ ischemia (lower-extremity ischemia, renal ischemia, and paraplegia). Our technique involves complete transection of the infrarenal abdominal aorta, removal of a generous intimal flap proximally, and reconstitution of layers distally. We report our experience with 12 patients, all of whom survived the operative procedure. Nine patients were discharged from the hospital, and with a mean follow-up of 6.8 years, 7 are still alive. Fenestration immediately restored organ perfusion in all but 1 of the patients, and no patient died of late rupture. We recommend fenestration for descending aortic dissection in patients presenting with organ ischemia. Fenestration is not recommended for acute dissection with rupture or for chronic enlarging dissection.

Adult↗
PubMed1987

Color Doppler evaluation of aortic dissection.

Color Doppler studies were performed in 16 adult patients with proven DeBakey type I and III aortic dissection. Simultaneous opacification of both aortic lumina with oppositely directed flow was noted by color Doppler in at least one aortic segment in 14 of 16 patients (12 type I, two type III). In two patients (one type I, one type III), flow was seen in one lumen only, with clot demonstrated in the other lumen in one of them. Of 12 patients in whom communication between two aortic dissection channels was shown by angiography/surgery, color Doppler correctly identified them in nine patients (four ascending aorta, two aortic arch, and three descending aorta), either by direct visualization of flow moving from one lumen into the other (six patients) or indirectly by analyzing differences in timing of opacification of the two lumina and flow direction (three patients). Also, color Doppler correctly diagnosed aortic regurgitation as severe (aortic regurgitation jet occupying more than 75% of left ventricular outflow) in three patients and moderate in four patients. Color Doppler provides comprehensive evaluation of flow dynamics in aortic dissection.

Adult↗
PubMed2000

Phase-contrast cine MR angiography detection of thoracic aortic dissection.

PURPOSE: To assess prospectively the accuracy of phase-contrast cine MR angiography in the detection of thoracic aortic dissection with operative correlation. MATERIALS AND METHODS: One hundred and ninety-seven symptomatic patients suspected of having thoracic aortic dissection or aneurysm as well as 13 patients suspected of having thoracic aortic coarctation and 20 asymptomatic normals (as controls) were examined prospectively with phase-contrast cine MR angiography on a 1.5-T MR imager. Seventy-eight of these patients had operative correlation, and only these 78 patients were included in the statistical analysis. RESULTS: There were 51 true positive and 27 true negative findings of thoracic aortic dissection in this study for an accuracy of 100%. CONCLUSION: Phase-contrast cine MR angiography is an accurate non-invasive imaging technique for evaluating patients suspected of having thoracic aortic dissection.

Adolescent↗
PubMed2003

Diagnosis of an intraoperative aortic dissection by transesophageal echocardiography during routine coronary artery bypass grafting surgery.

UNLABELLED: Acute aortic dissection during coronary artery bypass grafting (CABG), though rare, causes significant morbidity and mortality. We report a case of postcardiopulmonary bypass aortic dissection in a 73-yr-old man who presented for CABG. The diagnosis was made by transesophageal echocardiography and allowed immediate treatment of the potentially lethal complication. IMPLICATIONS: Acute aortic dissection during coronary artery bypass grafting (CABG), though rare causes frequent morbidity and mortality. We report a case of postcardiopulmonary bypass aortic dissection in a 73-yr-old man who presented for CABG. Diagnosis made by transesophageal echocardiography allowed immediate treatment of the potentially lethal complication.

Aged↗
PubMed1999

Factors influencing outcome after emergency surgical repair of acute type A aortic dissection.

OBJECTIVE: We retrospectively reviewed our more recent experience with acute type A aortic dissection in order to identify possible risk factors influencing current surgical results. METHODS: Between January 1990 and January 1998, 122 patients (86 males and 36 females; mean age 60 +/- 12 years) underwent emergency repair of acute type A aortic dissection using a standard surgical approach. Seventy-four (61%) patients required isolated replacement of the dissected ascending aorta, 27 (22%) required additional replacement of the aortic arch and 21 (17%) required total aortic root replacement. Surgical outcome was evaluated in terms of operative mortality and morbidity. Results of patients presenting with preoperative complications (Group C) (i.e. cardiac tamponade, cerebral stroke, cardiogenic shock, acute myocardial infarction, anuria or visceral ischemia) were compared with those of uncomplications cases (Group U) and with a calculated risk of expected operative mortality (EOM-rate) based on an analysis of each patient set of preoperative risk factors. Sixteen preoperative and 18 perioperative variables were also analyzed to identify conditions influencing morbidity and mortality. RESULTS: Fifty-seven patients (47%) presented with preoperative complications (Group C) and 65 (53%) did not (Group U). Overall operative mortality was 22% (27 patients). Mortality within subgroups was 40 and 6% for complicated and uncomplications cases, respectively (p < 0.001). The 85% of the overall mortality occurred in Group C patients. During the experience, the operative mortality rate actually observed ranged from 0 to 38% and was similar to the calculated expected risk, thus proving a direct relationship with the amount of complicated cases operated on each year. Multivariate analysis revealed that older age and hemopericardium significantly increased the risk of operative death, while male gender, preoperative complications, postoperative bleeding, duration of circulatory arrest and aortic cross-clamp time significantly predicted morbidity (p = 0.02). CONCLUSIONS: Current results of emergency repair of acute type A aortic dissection are strictly dependent on the number of complicated cases referred for operation. Earlier diagnosis and prompt referral before development of preoperative complications appear essential to improve surgical results.

Adult↗
PubMed1992

[Total aortic arch graft replacement using a prosthetic graft with three branches for acute type A aortic dissection].

Between March 1991 and August 1991, six consecutive patients underwent the replacement of the both ascending aorta and total aortic arch using a prosthetic graft with three branches for acute type A aortic dissection involving the aortic arch. Preoperative complications included cardiac tamponade in 5 cases, aortic regurgitation in 2, and shock state in 3. All operations were performed with the aid of extracorporeal circulation, selective cerebral perfusion, and open aortic anastomosis within 3 days after the onset. One patient died of rupture of the aortic anastomosis secondary to mediastinitis two weeks after the operation. All patients gained their own consciousness after the operation without any serious cerebral complications. The present data suggest that acute type A aortic dissection involving the aortic arch could be treated by replacing both the ascending aorta and aortic arch using a prosthetic graft with three branches with an aid of the extracorporeal circulation, selective cerebral perfusion and open distal anastomosis.

Acute Disease↗
PubMed2003

Aortic dissection in pregnancy: analysis of risk factors and outcome.

Aortic dissection during pregnancy is a life-threatening event. Recent studies have revealed similar histologic changes in the wall of the ascending aorta in patients with bicuspid aortic valve disease (BAVD). Based on a review of the literature, including the experience from two institutions, we looked at the patient's characteristics in patients with thoracic aortic dissection during pregnancy. We found that aortic root enlargement (> 4cm) or an increase of aortic root size during pregnancy in patients with BAVD, and Marfan syndrome is associated with a considerable risk for the occurrence of Type A dissection.

Adult↗
PubMed1996

[Operative results and long-term prognosis of aortic dissections].

We retrospectively analyzed the operative results and the long-term prognosis of aortic dissections. Between 1966 and 1996, we operated upon 137 patients with aortic dissection. According to the date of the first operation, they were classified into early (1966, 1985), middle (1985, 1992), and late (1992, 1996) cases. The hospital mortality rates of Stanford type. A patients were 40% (12/30) for early cases, 21 (6/28) for middle cases, and 13% (3/24) for late cases. Those of type-B patients were 10% (3/30) for early cases, 21% (3/11) for middle cases and 6% (1/16) for late cases. Actuarial survival rates for the all operative survivors of type-A patients (n = 60) were 77% at five year and 63% at 10 year. Those of type-B patients were 63% at five year and 20% at ten year. The difference of the two survival curves was significant (p < 0.01). In conclusion, the operative mortality rates for both type-A and type-B aortic dissection have reduced. But the more extended and rationale operation is recommended especially for type-B dissection in order to improve long-term prognosis.

Adult↗
PubMed2001

[Surgical considerations in type-B aortic dissection].

Inspite of remarkable progress in both diagnostic and therapeutic development in treating aortic dissections this continues to be one of the most severe vascular catastrophies complicated by high mortality. While aortic dissections Type A are to treat surgically in our days, in majority of patients with Type B dissections hypotensive treatment is the method of choice providing better chance for survival preventing effectively aneurysm formation and rupture at the site of intimal tear. However in certain cases Type B dissection produces either isthmic aneurysm formation, or with distal progression may afflict long segmental thoracic, thoracoabdominal or abdominal deterioration of the aorta and its side branches. The spinal, visceral, renal and lower limb ischemia threatens viability of these organs and hypotensive medication may enhance risk. Prompt evaluation and selection of these cases with proper surgical reconstruction help us to reduce mortality. At our department we have performed 33 thoracoabdominal endoaortectomies with meticulous reconstruction of renal and visceral orifices. The mortality rate in this subgroup of patients was 6%, meanwhile almost 70% in those, treated medically but had the severe distal branch involvement. Based on our experiences in selected patients with Type B aortic dissections we recommend this procedure in order to achieve improvement of results.

Adult↗