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PubMed1989

Acute aortic dissection due to giant cell arteritis. Report of two autopsy cases.

Two autopsy cases of giant cell arteritis with aortic dissection are reported. One patient was an 87-year-old man, and the other was an 80-year-old woman. In both cases the patient died suddenly, and fatal pericardial bleeding due to the aortic dissection was revealed at autopsy. Histologically, marked inflammation with giant cells was observed in the wall of the aorta and in other arteries including the cranial arteries. The authors therefore consider that giant cell arteritis was one of the preceding lesions that culminated in aortic dissection.

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PubMed1997

[A successful surgical case report of impending rupture of the true thoraco-abdominal aortic aneurysm induced by thrombosed-type acute aortic dissection (Stanford type A)].

Impending rupture of the true aneurysm of the thoraco-abdominal aorta induced by acute aortic dissection (Stanford type A) is very rare, and decision making of the therapeutic plain is difficult. A 88-year-old woman manifested severe back pain with hypotension. Chest computed tomographic examination revealed a true aneurysm of the thoraco-abdominal aorta and acute thrombosed-type aortic dissection (Stanford type A) with cardiac tamponade. Under the diagnosis of impending rupture of the thoraco-abdominal aortic aneurysm induced by acute aortic dissection (Stanford type A), graft replacement of the thoraco-abdominal aortic aneurysm and pericardial drainage were successfully performed. Two months later, computed tomographic examination revealed disappearance of the thrombosed false lumen in the ascending aorta.

Acute Disease↗
PubMed1996

[Obstruction of the true lumen by retrograde perfusion during repair of DeBakey type I aortic dissection: a case report].

Retrograde femoral perfusion is often used during the repair of DeBakey type I aortic dissections, however, it may cause serious ischemic damage of vital organs even though the arterial cannula is properly placed. A 58-year-old woman with chest pain was admitted to our hospital. She was operated on urgently because chest computed tomograms revealed that she suffered from a DeBakey type I aortic dissection. A ringed graft, 22 mm in diameter, was implanted into the ascending aorta using retrograde perfusion through the right femoral artery. Following the removal of the aortic cross-clamp and rewarming, the prosthetic graft remained flaccid and the heart failed to resume beating. We speculated that retrograde femoral perfusion caused the true lumen obstruction while distending the false lumen. This resulted in blocking reperfusion of the coronary arteries. After antegrade perfusion was initiated through an 8 mm Dacron graft which was anastmosed to the ringed graft, the heart soon resumed beating. During the repair of DeBakey type I aortic dissections, this serious complication should be anticipated. If it occurs, retrograde femoral perfusion must be exchanged for antegrade aortic perfusion before irreversible changes occur.

Aortic Dissection↗
PubMed2000

Localized aortic dissection: unusual features by transesophageal echocardiography.

Transesophageal echocardiography relies on the presence of an undulating intimal flap for the diagnosis of aortic dissection. Furthermore, to distinguish true dissection from echo artifacts, the flap has to be identified in more than one view, and it must have a motion independent of the aortic wall. We describe the transesophageal echocardiography appearance of a localized aortic dissection with atypical features for an intimal flap. Awareness of this unusual echocardiographic appearance of an intimal flap will avoid misdiagnosis of the potentially serious acute aortic dissection.

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PubMed2005

Surgical results of acute aortic dissection complicated with cerebral malperfusion.

BACKGROUND: In patients with acute type A aortic dissection complicated by cerebral malperfusion, the surgical treatment remains challenging. This retrospective study reports the results of surgical interventions and the clinical features of these patients. METHODS: From 1999 to 2004, 63 patients underwent surgical treatment for acute type A aortic dissection. Sixteen patients (25.3%) showed preoperative newly developed neurologic deficits (cerebral malperfusion). In patients with cerebral malperfusion, the characteristics, neurologic symptoms, computed tomography findings, interval from onset to operation, and operative details (procedure, arterial cannulation site, method of brain protection) were reviewed. RESULTS: The hospital mortality rate was 43.7% (7 of 16 patients) for the cerebral malperfusion group and 17.0% (8 of 47 patients) for the noncerebral malperfusion group (all patients, 23.8%). Multivariate analysis showed preoperative cerebral malperfusion as the sole risk factor for hospital mortality. Six patients, including all patients in a preoperative coma, died of severe brain damage within 1 month after surgery. Most patients were diagnosed with right hemispheric cerebral infarction by postoperative brain computed tomography. The operative details and the time interval from onset to operation were not significant predictors of death. The cumulative survival rate at 4 years was 75.5% in patients without cerebral malperfusion and 50.1% with cerebral malperfusion (p = 0.091). CONCLUSIONS: The results of surgical treatment for acute type A dissection complicated with cerebral malperfusion demonstrated high hospital mortality, but the long-term survival was similar to patients without cerebral malperfusion, with an acceptable neurologic outcome, excluding preoperative coma patients. Appropriate protection of ischemic brain tissue should be implemented to improve the surgical results in these patients.

Acute Disease↗
PubMed2002

When zebras run with horses: the diagnostic dilemma of acute aortic dissection complicated by myocardial infarction.

In this issue of the Journal, Pinney and Wasserman describe the case of a patient who survives acute aortic dissection complicated by occlusion of the left main coronary ostium and anterior myocardial infarction (MI), due in part to the fortuitous presence of an anomalous left circumflex artery. The case illustrates the challenges of diagnosing aortic dissection, even in the current era of accurate and rapid aortic imaging, in individuals with concurrent acute MI. These comments are focused in this comment on two key aspects of the case: (1) How commonly do acute aortic dissections lead to myocardial ischemia and MI? and (2) When should clinicians consider ruling out acute aortic dissection in the setting of acute MI?

Aorta↗
PubMed1989

[Hemorrhagic gastric ulcer associated with consumption coagulopathy in the dissecting aortic aneurysm--a case report].

A case of the hemorrhagic gastric ulcer and post-operative stomal ulcer associated with the consumption coagulopathy in the dissecting aortic aneurysm is presented. A 68 year old man, who had diagnosed as having the dissecting aortic aneurysm (DeBakey III) in 1985 and had been attending to our hospital as an outpatient since then, was admitted to our hospital because of the hemorrhagic gastric ulcer on July 3rd, 1987. Although the wide resection of stomach was performed after the admission, the hemorrhagic stomal ulcer was developed 4 weeks after the operation. The administration of heparin in addition to antacids to improve the consumption coagulopathy, having been caused by thrombus formation in the aneurysm, was effective in control of the hemorrhage and also making the stomal ulcer scarred. It is suggested that ischemia of the stomach mucosa, which seemed to have been induced by the dissecting aortic aneurysm, was responsible for the development of the ulcers in this case and the hemorrhage from them was caused mainly by the consumption coagulopathy derived from thrombus formation in the aneurysm.

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PubMed1998

[Type A acute aortic dissection: late reoperations for dilatation of the distal false lumen and aortic regurgitation].

From January 1990 to December 1996, 71 patients aged 33 to 79 years (mean 60 +/- 11) underwent an emergency operation for type A acute aortic dissection. Fifty-three (74.6%) survived, and were followed 7 to 94 months (mean follow up 2.9 +/- 1.8 years) after the first operation. Five patients underwent reoperation for dilatation of the distal false lumen 7 to 52 months (mean period, 25 months) after primary repair. One patient underwent replacement of the arch and descending aorta, three patients underwent replacement of the descending aorta, and one patient underwent the stented graft implantation, resulting in closure of the entry site. Three patients underwent reoperation for severe aortic valve regurgitation 12 to 31 months (mean period, 24 months) after primary repair. Two patients underwent aortic valve replacement, and one patient underwent aortic root replacement. The actuarial freedom from reoperations was 81 +/- 6.9% at 3 years, and 73 +/- 9.9% at 5 years.

Adult↗
PubMed1995

Retrograde aortic dissection after bilateral iliac artery stenting: a case report and review of the literature.

We report a case of retrograde aortic dissection after bilateral iliac artery stenting. A 63-year-old black woman underwent aortography with balloon angioplasty of bilateral common iliac artery lesions and subsequent vascular stent placement. The patient developed an acute aortic dissection from the level of the aortic bifurcation to the left subclavian artery. This case is presented to call attention to the previously unreported complication of retrograde aortic dissection after bilateral iliac artery angioplasty and stent placement presenting as acute chest pain.

Aortic Dissection↗
PubMed1994

[Redo operations for dissecting aortic aneurysm].

We reoperated twenty-four times upon twenty cases of dissecting aortic aneurysm since 1983. Nine of them (45%) were Marfan patients. Reoperations on the same part of the aorta as the prior procedure was done 15 times upon 13 cases with six hospital deaths (40%). Reoperations on the different part of the aorta from the prior operation was done 9 times on 9 cases with one hospital death (11%). Over all hospital mortality rate was 29%. The hospital mortality rate for Marfan patients (8%) was significantly better than that for non-Marfan patients (50%).

Adult↗
PubMed2001

A case of intraoperative acute aortic dissection caused by cannulation into an axillary artery.

Severe atherosclerotic disease of the ascending aorta is one of the risk factors of dissection of the ascending aorta and cerebral embolism during cardiac operations with cardiopulmonary bypass. Aortic dissection is rare, but once it happens, the mortality rate is high. For the patient with severely atherosclerotic or strongly calcified aorta, we should avoid cannulation into the aorta or clamping of it. In this case, we experienced aortic dissection although we chose the arterial cannulations into the axillary arteries because of the strong calcification of the ascending aorta and the abdominal aorta. The dissection was caused by the cannulation into the axillary artery. Transesophageal echocardiography (TEE) showed the dissection during the operation and the ascending aorta was replaced soon. Early diagnosis and treatment saved the patient. This case showed the following points: 1) cannulation into an axillary artery is not always safe; 2) TEE is very useful to detect the complicated dissection during operation; 3) replacement of the ascending aorta alone can be one of the choices for the treatment of aortic dissection caused by cannulation into an axillary artery.

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PubMed1996

Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging.

PURPOSE: To compare the usefulness of spiral computed tomography (CT), multiplanar transesophageal echocardiography (TEE), and magnetic resonance (MR) imaging in the diagnosis of thoracic aortic dissection and arch vessel involvement. MATERIALS AND METHODS: Forty-nine symptomatic patients with clinically suspected aortic dissection were examined with contrast material-enhanced spiral CT, multiplanar TEE, and 0.5-T MR imaging (T1-weighted, cardiac-gated, spin-echo sequences). Imaging results were confirmed at autopsy (five patients), intraoperative exploration (23 patients), angiography (nine patients), and follow-up (12 patients). RESULTS: Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 100%, 94%, and 94% for spiral CT, multiplanar TEE, and MR imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 93%, 60%, and 67%, respectively, and specificity was 97%, 85%, and 88%, respectively. CONCLUSION: Spinal CT and multiplanar TEE are as valuable as MR imaging in the detection of thoracic aortic dissection. In the assessment of the supraaortic branches, spiral CT is superior (P<.05).

Adult↗
PubMed1995

[Spiral computerized tomography, multiplane transesophageal echocardiography and magnetic resonance imaging in the diagnosis of thoracic aortic dissection].

The aim of this study was the evaluation of spiral computed tomography (Spiral-CT), multiplane transesophageal echocardiography (multiplane TEE) and magnetic resonance imaging (MRI) in the diagnosis of thoracic aortic dissection. 41 patients were examined: 30 with clinically suspected acute aortic dissection (14 Stanford A, 7 Stanford B), 11 with aortic repair (7/11 with persisting distal dissection). In 14 patients there was involvement of the supraaortic vessels. Sensitivity of Spiral-CT, multiplane TEE and MRI in the detection of aortic dissection was 100%, specificity was 100, 92, and 91%. In the assessment of involvement of aortic arch vessels sensitivity was 100, 67, and 60%, specificity was 100, 95, and 90%. The new imaging modalities Spiral-CT and multiplane TEE are equal to MRI in the detection of aortic dissection. In the assessment of the supraaortic branches Spiral-CT is superior to multiplane TEE and MRI and might become the method of choice.

Adult↗
PubMed1991

[Diagnosis of aortic dissection with magnetic resonance imaging].

Eight patients with suspected or known aortic dissection were imaged with magnetic resonance (MR). All of them were eventually shown to have dissection. In most instances the diagnosis was established by aortography and/or computed tomography (CT) prior to the MR study. MR demonstrated the intimal flap and determined whether the dissection was type I, type II or type III. In addition, MR differentiated between the true and false lumens. Our early experience suggests that MR can serve as the initial imaging test in clinically suspected cases of aortic dissection and that the information provided by MR obviates the use of iodinated contrast media.

Adult↗
PubMed2003

Existence of abdominal aortic aneurysms in patients with thoracic aortic dissections.

OBJECTIVE: The objective of this study was to determine the coexistence or later development of pararenal and infrarenal abdominal aortic aneurysms (AAAs) in patients with thoracic aortic dissections. METHODS: One hundred forty-five patients (95 men, 50 women) encountered from 1992 to 2001 with thoracic aortic dissections-excluding those associated with trauma, those with Marfan's syndrome, and those with thoracoabdominal aortic aneurysms-were studied. The most common risk factors included hypertension (59%) and a history of tobacco use (52%). Type III dissections affected 86 patients (59%), and type I dissections affected the remaining 59 patients (41%). Aortic computed tomography (CT) scans were obtained annually. Data were assessed by univariate and multivariate analyses. RESULTS: Five patients (3%) had a history of AAA repair prior to their thoracic aortic dissection diagnosis-3 were type III dissections and 2 were type I dissections. Twelve patient's (8%) AAAs were diagnosed with the initial CT study of their thoracic aortic dissection. Type III dissections accounted for all but one of these (11 of 12, 92%). Ten additional AAAs (7%) developed in the 128 patients with no initial evidence of an AAA being recognized from 1 to 48 months (average 16 months) after the thoracic aortic dissection was diagnosed. Type III dissections affected 8 of these 10 patients. Among the total 27 AAAs noted in this series, 74% (20 AAAs) were not continuous with the thoracic aortic dissection. In the univariate analysis, age (P =.0002), male gender (P =.044), history of smoking (P =.01), chronic obstructive pulmonary disease (P <.001), duration of dissection (P =.05), and presence of type III dissection (P =.009) were associated with the presence of an AAA. In the multivariate analysis, both chronic obstructive pulmonary disease (odds ratio 5.4, 95% CI, 1.3 to 22.3; P =.02) and age (OR 1.06, 95% CI, 1.02 to 1.11; P =.004) were significant predictors of the development of AAAs. CONCLUSION: This study documented that patients with thoracic aortic dissections are at risk to harbor or develop a later AAA. This finding supports the tenet that abdominal CTs or ultrasound scanning should be mandatory in the follow-up of patients with known thoracic aortic dissections.

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PubMed2003

Chronic aortic dissection complicated by disseminated intravascular coagulation: successful treatment with endovascular stent-grafting.

PURPOSE: To report endovascular repair of a chronic aortic dissection complicated by disseminated intravascular coagulation (DIC). CASE REPORT: A 61-year-old man developed DIC associated with a chronic Stanford type B aortic dissection that occurred during cardiac catheterization 12 years earlier. At the current admission, computed tomography showed a partially thrombosed false lumen extending from the aortic arch to the left common iliac artery. On angiography, entry and re-entry tears were identified at the right subclavian and left common iliac arteries, respectively. After stent-graft implantation at the entry and re-entry sites, not only was the false lumen completely thrombosed but the DIC also resolved. The patient is doing well with no complication at 16 months after treatment. CONCLUSIONS: Endovascular stent-grafting is an acceptable alternative to surgical repair for aortic dissection accompanied by DIC.

Aortic Dissection↗
PubMed2002

Bicuspid aortic valve stenosis complicated by descending aortic dissection mimicking coarctation of the aorta.

We report a rare case of bicuspid aortic stenosis complicated by an ascending aortic aneurysm and aortic dissection of DeBakey type IIIb. A 35-year-old woman was admitted to our hospital to examine her systolic murmur identified at birth. Severe aortic stenosis, dilatation of the ascending aorta, and the narrow color flow signal in the descending aorta were detected by transthoracic echocardiography. Initially, coarctation of the descending aorta was suspected, but aortic dissection, DeBakey type IIIb, was revealed by transesophageal echocardiography. Transesophageal echocardiography is indicated when only insufficient information is available on valve and aortic morphology in patients with bicuspid aortic valve.

Adult↗
PubMed1994

Left pleural hemorrhagic effusion. A presenting sign of thoracic aortic dissecting aneurysm.

Left hemorrhagic pleural effusion was the presenting sign of painless aortic dissecting aneurysm in two elderly hypertensive patients. Computed tomography (CT) of the chest revealed the aneurysmal dilatation of the thoracic aorta and an intimal flap connecting its descending part with the left pleural space. The patients were treated conservatively with blood transfusions and drugs directed to control blood pressure. The first reported 71-year-old patient remains in stable condition for 16 months without evidence of recurrent active aortic dissection. The second 85-year-old patient remained in stable condition for 28 days, but finally had a second fatal episode of dissection into the left pleural space. The differential diagnosis of nontraumatic left hemorrhagic pleural effusion in an elderly hypertensive patient should include dissecting aneurysm of the descending thoracic aorta and CT of the chest should be performed as the next preferable diagnostic procedure.

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