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PubMed1996

[Diagnosis of suspected thoracic aortic dissection. Focused on transesophageal echocardiography].

Over a five-year period (1990-1994), 72 consecutive patients were referred to transoesophageal echocardiography (TEE) on suspicion of thoracic aortic dissection. TEE was performed as the only or last investigation in 42 patients (58%). In 44 patients one or more other investigations were carried out before final clinical decision making: aortography (n = 30), X-ray computer tomography (CT, n = 18), and magnetic resonance imaging (MRI, n = 12). The final diagnosis was based on the combination of clinical information, the available examination results, and findings at surgery or autopsy; 31 of the patients were diagnosed as having aortic dissection. One patient with aortic dissection died during TEE while none of the other patients suffered major complications. The sensitivity (demonstration of dissection including correct classification in type A or B) was 81%, 80%, 45%, and 83% for TEE, aortography. CT, and MRI, respectively. The specificities were 88%, 93%, 71%, and 100%, respectively. Dissection of the thoracic aorta is a life-threatening condition demanding prompt and accurate diagnosis. None of the four techniques employed in the present study is ideal. Although TEE is adequate for immediate bedside examination our results show that more time-consuming and resource demanding investigations are sometimes required. Proper training and improved equipment may, however, increase the usefulness of TEE in patients with suspected aortic dissection.

Adolescent↗
PubMed2004

Atresia of the right vertebral artery in a patient with acute aortic dissection.

A 49-year-old man had severe neurocognitive dysfunction after urgent operation for acute type A aortic dissection. Complete aortic arch replacement with single reimplantation of the arch branches was performed with the patient under deep hypothermic circulatory arrest. Retrospectively, my colleagues and I consider the atresia of the right vertebral artery to be responsible for this complication and discuss whether knowledge of the anomaly and adapting the operative strategy accordingly would have improved the neurologic outcome.

Aortic Dissection↗
PubMedDate not supplied

Changing surgical management for acute aortic dissections type a improves immediate outcomes.

BACKGROUND: Surgical treatment of acute aortic dissection type A is well established. This study analyzes the impact of changing surgical management of Type A dissections on hospital mortality and postoperative complications. METHOD: Between January 1980 and December 2002, 141 consecutive patients were operated for acute Type A aortic dissection. Patients were analyzed in 3 time periods; 1980-1989, n = 26, 1990-1999, n = 71 and 2000-2002, n = 44). Antegrade cerebral perfusion via subclavian cannulation, a more extensive resection as well as valvar repair was introduced as routine procedures from January 2000. RESULTS: Mortality and neurological complications decreased over time; from 31% to 9.1% and from 27% to 2.5%, respectively. During follow-up, 14 patients (12%) required surgical re-intervention for aneurysms (1 to 17 years later) with associated hospital mortality of 21%. CONCLUSIONS: Antegrade cerebral perfusion reduces neurological complications and more extensive surgical approach did not increase mortality and morbidity.

Acute Disease↗
PubMed1992

[Fatal aortic dissection in a young woman at the 32nd week of pregnancy].

Aortic dissection in young women without Marfan disease is unusual. When it occurs it is often related to pregnancy. We report a fatal case of aortic dissection in a 29-year-old woman at the end of her first pregnancy. A prompt diagnosis and surgical treatment usually permits the physician to save both mother and fetus. In this case the delay in the diagnosis was fatal for both. We retain that knowledge of this rare complication of pregnancy is useful in order to refer patients early for surgical treatment.

Adult↗
PubMed1995

[Treatment of acute type A aortic dissection with onset of the right coronary insufficiency].

This is a case report of the successful treatment for acute type A aortic dissection with onset of the right coronary artery (RCA) obstruction due to compression of the dissected lumen. A 50-year-old man, who had been received medical therapy for hypertension for seven years, was admitted with profound cardiogenic shock. The ECG demonstrated complete A-V block and acute myocardial infarction (AMI) of right ventricle and inferior wall. Coronary catheter intervention was scheduled because intra-aortic balloon pumping was not effective, and arteriogram revealed aortic dissection, coronary insufficiency and aortic regurgitation (grade I). Soon after inflation of a perfusion catheter at the origin of RCA, elevation of arterial blood pressure and recovery to sinus rhythm were brought successfully by the coronary reperefusion. Replacement of the ascending aorta involving the intimal tear without surgical closure of RCA ostium, aortic valve resuspension and coronary artery bypass grafting with saphenous vein to RCA were performed 11 hours after the onset, and the postoperative course was uneventful. Although aortic dissection with onset of AMI was uncommon, it is suspected that the generalizing of catheter intervention for AMI increases awareness of such cases and it is emphasised that the application of perfusion catheter as an emergency procedure for the illness like this case is useful to preserve hemodinamic stability until the surgical treatment.

Aortic Dissection↗
PubMed2005

[The endovascular repair of aortic dissection: early clinical results of 178 cases].

OBJECTIVE: To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection. METHODS: From June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation. RESULTS: 10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later. CONCLUSION: The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.

Adult↗
PubMed1994

[Usefulness of imaging methods in the diagnosis of aortic dissecting aneurysms].

Based upon personal experience and literature the authors briefly discuss the usefulness of arteriography, ultrasonography, CT and MR in the diagnosis of aortic dissecting aneurysms. In the diagnostic algorithm concerning aortic dissection type I and II acc. DeBakey, the initial diagnostic method should be echocardiography, followed by CT or MR or eventually aortography. In the case of type III aortic dissection the authors recommend transesophageal echocardiography and CT or MR or eventually aortography as the last examination.

Aortic Dissection↗
PubMed2003

Acute aortic dissection developing acute myocardial infarction diagnosed by accidentary inserting the catheters into the false lumen during catheterization: a pitfall and rare image.

A case of acute aortic dissection complicating acute inferior myocardial infarction diagnosed by accidentally inserting the catheters into the false lumen during the emergency cardiac catheterization is reported. Although the incidence of acute aortic dissection developing acute myocardial infarction is not very rare, an aortogram and coronary angiogram via the false lumen has never been seen before. This case also illustrates how myocardial infarction can mask aortic dissection. Cardiologists should pay more attention to this severe complication of acute aortic dissection and perform transthoracic echocardiography prior to catheterization or fibrinolysis.

Acute Disease↗
PubMed1995

Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.

UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

Adult↗
PubMed2005

Fatal hemopericardium caused by retrograde acute abdominal aortic dissection: an autopsy report and morphological consideration.

A case of acute aortic dissection in which entry is formed at the abdominal aorta is unusual. In addition, an autopsy case of cardiac tamponade caused by spontaneous acute retrograde abdominal aortic dissection is extremely rare and such a report has never previously been published to our knowledge. We herein present an autopsy case of sudden unexpected death due to retrograde extension that originated from the abdominal aorta, together with our considerations regarding the etiology and the unfortunate course of the victim.

Aortic Dissection↗
PubMed2004

Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections.

BACKGROUND: The purpose of this study was to examine the long-term outcome and the prognostic predictors related to the development of complications associated with acute type B aortic dissection. METHODS: Seventy-six medically treated patients with acute type B aortic dissection were examined between 1990 and 2001. The events associated with aortic dissection included dissection-related death, rupture, visceral ischemia, lower limb ischemia, an increase in the maximum aortic diameter greater than 50 mm, and a mean enlargement rate of greater than 5 mm per year. RESULTS: Among the 76 patients 10 (13%) underwent chronic phase surgery and 25 (33%) presented with an event. A statistically significant difference was observed between patients with and without events with regard to atherosclerotic factors, blood flow status in the false lumen, maximum aortic diameter upon admission, mean aortic enlargement rate, and blood pressure control during follow-up. Of these factors a patent false-lumen and a maximum aortic diameter greater than 40 mm upon admission were the most strongly associated factors with regard to the development of events. Patients with a patent false-lumen and a maximum aortic diameter greater than 40 mm upon admission were determined to exhibit significantly higher event rates than other patients. CONCLUSIONS: In determining the appropriate therapeutic approach for acute type B aortic dissection, it is important to pay careful attention to the predictors of a patent false-lumen and a maximum aortic diameter greater than 40 mm at onset to improve the long-term outcome.

Acute Disease↗
PubMed2003

A case of acute aortic dissection type A in a patient with situs inversus.

We report a case of acute aortic dissection type A in a patient with situs inversus. A 33-year-old male, complaining of sudden chest pain, visited our institute. Contrast-enhanced computed tomography and echocardiography suggested Stanford type A acute aortic dissection and dextrocardia. Aortic root and ascending aortic replacement were successfully performed. Antegrade brain-isolated extracorporeal circulation was established. The aortic branch arteries were mirror-image reversed. Anatomic positional relationships and presence or absence of concurrent anomalies should be sufficiently investigated preoperatively in patients with dextrocardia. His postoperative course was uneventful and a postoperative computed tomographic scan confirmed a good result.

Acute Disease↗