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PubMed1996

[Aortic dissection after weaning from extracorporeal circulation].

Acute aortic dissection is a rare complication of cardiac surgery. But once it happens, its outcome is often miserable. We experienced this complication after discontinuing cardiopulmonary bypass (CPB). A 56-year old man with mitral regurgitation was referred for mitral valve replacement under CPB. After weaning from extracorporeal circulation (ECC), the right radial artery pressure decreased suddenly and its waveform became flat. After 5 minutes, dissection of the ascending aorta was diagnosed by transesophageal echocardiography (TEE). We started to prevent ischemic brain damage immediately, but a severe brain damage occurred. Its early diagnosis is necessary and the prevention of critical brain damage due to low perfusion of the blood is important for anesthetic management.

Aortic Dissection↗
PubMed1996

[Surgery of type A acute aortic dissection. Past, present and future].

Type A Aortic Dissection is a medical-surgical emergency which requires prompt diagnosis and adequate treatment. Since its inception--more than 40 years ago--the surgical treatment has evolved up until now, when it offers an immediate solution to the high mortality rate due to complications, with acceptable morbidity and mortality rates. This improvement is due also to better diagnostic techniques, postoperative management and profound hypothermia with circulatory arrest. The basic techniques to achieve this consist of resection of the entry tear and closure of the false lumen and repair of the aortic regurgitation when present. Failure of them--proximally or distally--leads to persistence of the false lumen and the possibility of complications or late reoperations. The long-term follow-up, monitorized by non-invasive methods, is mandatory to decide the proper management.

Adult↗
PubMed2006

Painless acute aortic dissection with a left hemiparesis.

BACKGROUND: Patients who present with only neurological symptoms and no pain challenge the recognition of acute aortic dissection. RESULTS: We report three patients with completely painless acute aortic dissection who presented with left hemiparesis. All patients presented with a left-sided weakness of sudden onset. We suspected an ischemic stroke but diagnosed acute aortic dissection (DeBakey Type II, Stanford Type A). We suspect that the innominate artery is occluded when the blood flow of the false lumen is dominant. In our cases, surgical and autopsy findings showed dissection of the innominate artery. CONCLUSIONS: Highly unusual presentations of aortic dissection with acute ischemic stroke exist. A wide mediastinum on plain chest X-ray was present in all cases.

Aged, 80 and over↗
PubMed2003

Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes.

OBJECTIVE: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. METHODS: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. RESULTS: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. CONCLUSION: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

Adult↗
PubMed2004

[Interventional treatment of thoracic aortic dissection with stent-graft placement guided by transesophageal echocardiography].

OBJECTIVE: To evaluate the effect and safety of transfemoral stent-graft placement in combination with transesophageal echocardiography (TEE) in treating DeBakey IIIb aortic dissecting aneurysm. METHODS: Eight male patients [mean age (55.8 +/- 10.2) years, range 28-71 years] with DeBakey IIIb aortic dissection were diagnosed and confirmed by magnetic resonance angiography (MRA). With TEE and fluoroscopy monitoring, transfemoral stent-grafts placement was performed with resulting close of the proximal or both proximal and distal ruptures of aortic dissection. The immediate and follow-up results were assessed. RESULTS: Eleven stent-grafts were placed successfully in the 8 patients, the mean diameter of stents was 29.4 (22-38) mm. Three patients had a mild endoleak and 2 patients had a tiny shunt immediately after operation. Ascending aortic dissection occurred in 1 patient after balloon dilation. The mean stay in hospital was 9 days. All the eight patients were followed up and the mean time of follow-up was 10.5 (6-18) months, 4 residual shunts disappeared. No stents displacement or new endoleak occurred. CONCLUSIONS: Transfemoral stent-graft placement in combination with TEE for the treatment of DeBakey IIIb aortic dissection is a promising method, which is safe, effective and with little injury. Its recent and middle term result is satisfactory, but further observation is needed for long term result.

Adult↗
PubMedDate not supplied

Review of techniques used to image aortic dissection.

This article describes the imaging of aortic dissection from the perspective of a multidisciplinary imaging team. The relative merits of radiography, aortography, computed tomography, magnetic resonance imaging, ultrasound and nuclear medicine are described. Each technique has unique advantages for initial diagnosis, confirmation and follow-up. In recent years, ultrasound, computed tomography and magnetic resonance imaging have seen increased use for diagnosis of the condition.

Aortic Dissection↗
PubMed2004

Acute coronary syndrome following repair of aortic dissection.

Cardiac complications associated with type A aortic dissections are relatively common before and during the surgical repair. A cardiac event occurring a few days after routine recovery is rare though. We describe a case of acute occlusion of the left anterior descending artery by thrombus, 4 days after surgical repair, salvaged by emergency angioplasty and stenting. A possible explanation for the thrombus includes embolisation of a fragment of glue.

Acute Disease↗
PubMed1988

MR imaging of the aorta after surgery for aortic dissection.

MR imaging is known to be an effective technique for the noninvasive diagnosis of thoracic aortic disease, but it has not been used to monitor the appearance of the aorta or the fate of the false lumen after surgery for aortic dissection. This study describes our initial experience with postsurgical MR imaging of aortic dissection (nine type A and two type B) to evaluate prognostically important features, including the status of residual false lumen. The most notable findings were (1) aneurysmal dilatation beyond the interposed graft (11/11 cases), (2) residual intimal flap (10/11 cases) with at least partial patency of the false lumen (10/10 cases), and (3) origin of a visceral vessel from the false lumen in persistently dissected abdominal aorta (6/9 cases). Evaluation of residual false lumen by double-spin-echo-intensity and phase-display techniques showed evidence of slow blood flow with variable amounts of thrombus in eight of 10 cases. Differentiation between signal within the false lumen due to slow flow and signal due to thrombus was facilitated by phase display. MR imaging can be used for noninvasive monitoring of the aorta after surgical repair of aortic dissection. Since the false lumen usually remains patent after surgical repair, such follow-up of its status seems necessary for identifying potential complications of the original dissection and/or the therapy.

Adult↗
PubMedDate not supplied

[Dissecting aortic aneurysm as a cause of fever of unknown origin].

Dissecting aortic aneurysm is a clinical syndrome commonly with a dramatic course and a fatal prognosis. The disease often has a fatal ending at the very beginning, a few hours after the onset. High temperature happens sometimes, but is rarely a dominant symptom. We presented a case of a patient with a long term febrile state caused by dissecting aortic aneurysm, where pleuropneumenia covered the real nature of the disease. It has been pointed out that dissecting of aorta should be thought of in patients with unclear febrile states, especially if they have difficulties in the area of thorax.

Aortic Dissection↗
PubMed1996

[Aortic dissection: new diagnostic and therapeutic trends].

The aortic dissection is a relatively infrequent, but very serious event, that needs to be always considered when a thoracic pain with symptoms of ischemia belongs to the origin of the dissection without signs of myocardial infarction. The most simple and commonly accepted classification, includes two variants, according to the Stanford University (A and B). This aspect is very important in order to the treatment which must be preceded by a suitable pharmacological approach followed in any case by the surgery. We outline the importance of the fast diagnostic knowledge and of the therapeutic choice in order to reduce the mortality that is still very high.

Aortic Dissection↗
PubMed1994

Treatment of acute type A aortic dissection with intraluminal sutureless prosthesis.

Sutureless intraluminal aortic graft has been used for substitution of aorta, with the advantages of decreasing the aortic cross-clamp time and decreased blood loss. From January 1991 to December 1992, 10 consecutive patients underwent emergency operations to repair acute type A aortic dissection in which sutureless intraluminal grafts were used for replacement of ascending aorta. There were 5 men and 5 women, with ages that ranged from 40 to 74 years (mean, 51 years). The inclusion method was used in all patients. Modified Cabrol shunts were created in 7 patients. Dacron graft (Meadox Medicals, Inc, Oakland, NJ) was used to wrap the ascending aorta in 7 patients. The circulatory arrest time was 33 +/- 13 (mean +/- standard deviation) minutes, and the cardiac ischemic time was 64 +/- 17 minutes. Retrograde superior vena cava cerebral perfusion during circulatory arrest was performed on 4 patients. All patients survived. One patient had a minor stroke and pneumonia with complete recovery. There was no evidence of pseudoaneurysm formation, graft erosion, graft migration, or aortic bleeding in the postoperative period. No patients had permanent renal deficit. Follow-up (1 to 22 months; mean, 9.6 months) of all patients revealed satisfactory graft function, with no device-related deaths and no known complications attributable to the prosthesis, such as thrombosis, erosion, pseudoaneurysm formation, or hemorrhage. Our experience suggests that grafting of the ascending aorta is less hazardous with the sutureless grafts than with the conventional sutured anastomosis technique. We are now using this method whenever possible in all substitutions of the aorta.

Acute Disease↗
PubMed1996

Aortoesophageal fistula after repair of descending aortic dissection.

The development of aortoesophageal fistula after aortic repair is rare. We describe a patient who presented with hematemesis 4 months after emergent repair of a descending thoracic aortic dissection using a prosthetic graft. Diagnosis was supported by computed tomographic, angiographic, and endoscopic findings. Resection of the involved graft was performed through a left thoracotomy after placement of an ascending aorta-to-abdominal aorta conduit through an anterior approach. The patient died of uncontrollable bleeding a few hours after the procedure. Surgical intervention offers the potential for cure in this otherwise uniformly fatal condition. But like medical therapy, operative management has thus far been associated with 100% mortality.

Adult↗
PubMedDate not supplied

Endovascular treatment of type B thoracic aortic dissections.

PURPOSE: To evaluate the initial experience of endovascular repair of aortic dissections from a single center. MATERIALS AND METHODS: From June 1999 to March 2002, endovascular stent grafting was performed in 20 high-risk patients (16 to 80 years). Eighteen patients had a type B dissection (14 acute and 4 chronic). Two patients had chronic type A dissection. Preoperative work-up included CT and MRI to evaluate the extent of the dissection, the relation to the left subclavian artery, the size of false and true lumen, and branch complications. RESULTS: Stent-graft deployment was technically successful in all cases. None was converted to open repair. Three patients died within 30 days, i.e., a 15% mortality rate. Four patients (20%) had a perioperative stroke. Paraplegia was observed in one case. No migration of the stent grafts or endoleaks was observed during the mean follow-up period of 13 months. In all but two patient thrombosis of the false lumen was noted. CONCLUSIONS: Endovascular treatment of thoracic dissections is feasible. Early results are encouraging. While endovascular repair with stent-grafts is progressing rapidly as a viable strategy for aortic dissections in selected patients careful investigations must continue to focus on its safety. Randomized controlled trials are urgently needed.

Adolescent↗
PubMed2005

Is there a relationship between weather conditions and aortic dissection?

BACKGROUND: Bleeding and rupture of blood vessels has been correlated with weather conditions in the past. This is the first study in the world literature with the aim of investigating the relationship between atmospheric pressure and temperature with the presentation of aortic dissection. METHODS: The dates of all emergency aortic dissection repairs from 1996-2002 in a regional cardiothoracic unit at Blackpool Victoria Hospital were obtained. Hourly temperature and pressure data from a regional weather station for this time period was supplied by the Meteorological Office. The mean and standard deviation of hourly temperature and pressure data for that month were compared to the mean and standard deviation of the data 24 and 48 hours prior to the aortic dissection. RESULTS: 26 patients were found to have been operated on during the time period studied. There was no statistically significant correlation between temperature or atmospheric pressure readings, and the incidence of aortic dissection, using a Bonferonni-corrected significance p-value of 0.005 CONCLUSION: This study is the first to examine the relationship between atmospheric pressure, temperature and dissecting thoracic aorta. No statistically significant relationship was demonstrable.

Aortic Dissection↗
PubMed1996

Aortic dissection in puerperium: a case report.

An acute type A aortic dissection, complicated by massive aortic regurgitation, was diagnosed in the case of a 32-year-old woman, thirty-three days post partum. Emergency operation (Cabrol II) was performed with an uneventful postoperative course. We draw attention to this high risk event, which is particularly apt to involve women within a short time after an otherwise uneventful pregnancy.

Adult↗
PubMed1990

Acute dissecting aortic aneurysm: community hospital experience in 20 cases.

Of 20 patients with dissecting aortic aneurysm managed at our community hospital, 16 had type A (ascending) dissection and four had type B (descending) dissection. Twelve of the patients with type A dissection were operated on; six of them survived and six died postoperatively. The remaining four patients with type A dissection had cardiopulmonary arrest and died before surgical intervention was attempted. All four patients with type B dissection were treated medically and all survived. Although acute aortic dissection is not commonly seen at community hospitals, expedient management of such patients can have a major impact on their survival. Patients at extreme risk are those with type A dissection, particularly those with cardiopulmonary arrest.

Acute Disease↗
PubMed2001

A preoperative index of mortality for patients undergoing surgery of type A aortic dissection.

BACKGROUND: The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. METHODS: From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. RESULTS: The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas non-emergent operations had an in-hospital mortality rate of 13.7% (p<0.01). Univariate analysis revealed among 39 preoperative and operative variables, age (years), age >70 years, remote myocardial infarction, cerebrovascular dysfunction, diabetes, preoperative renal failure, shock, cardiopulmonary bypass time (minutes), emergency operation as factors associated to in-hospital death (p<0.05). Stepwise logistic regression analysis selected as independent predicting variables (p<0.05), remote myocardial infarction (p=0.006), preoperative renal failure (p=0.032), shock (p=0.001), age >70 years (p=0.007). Finally, a probability table of death risk was obtained with the logistic regression coefficients. The lower death probability (10.6%) was calculated in absence of risk variables; the higher one in presence of all of them (79.7%). Between these extremes, a total of 64 combinations of death risk were obtained. CONCLUSIONS: Increasing age, shock, coronary artery disease and renal failure are variously associated to a high risk of in-hospital death after surgical correction of type A aortic dissection. This predictive model of death probability allows to collocate preoperatively patients with type A aortic dissection at different levels of risk for in-hospital death.

Acute Disease↗
PubMed2002

Transient paraplegia as a presenting feature of aortic dissection in a young man.

This report describes a case of aortic dissection in a 32 year old man who presented with mild central chest pain and transient paraplegia. Complete recovery of paraplegia in aortic dissection has previously been reported but this is the first case report in which full resolution of the paraplegia occurred within half an hour of presentation. The case emphasises the importance of careful history taking and eliciting subtle clinical signs, which helped in arriving at the correct diagnosis in this unusual presentation.

Adult↗