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PubMed1993

[A case of impending rupture of acute aortic dissection with thrombosed false lumen in early phase].

A 73-year-old patient with acute aortic dissection in delayed shock state following sudden onset of chest-back pain and left sided hemothorax was successfully operated. Contrast enhanced CT demonstrated a crescent-shaped low density area in the descending aorta. Aortography showed ulcer-like projection (ULP) with minor leakage into left thorax, however, a flow in false lumen was not visualized. These findings suggested that the false lumen of type III aortic dissection was thrombosed in its early phase. The aneurysm was transected on left heart bypass through left thoracotomy. The entry of false lumen was found in proximal portion of descending aorta, in which fresh thrombus was filled. A graft was anastomosed and reinforced with felt strips in end-to-end. The postoperative course was uneventful. The ULP by aortography provides a possible sign of rupture in clinical course of aortic dissection.

Aged↗
PubMed2000

Delayed onset of amaurosis fugax in a patient with type A aortic dissection post surgical repair.

Stroke is an important complication for the surgical treatment of type A aortic dissection and it occurs immediately post operation. Many surgical techniques such as deep hypothermic circulatory arrest and retrograde cerebral perfusion have been reported to ameliorate this complication. We report here a male Taiwanese patient with type A aortic dissection involving the arch who underwent surgical repair. Amaurosis fugax appeared on the 4th day post operation. Funduscopic findings demonstrated multi focal embolization and carotid sonography revealed normal carotid arteries. The symptoms and signs improved after anticoagulation therapy. This is a rare case of delayed onset of amaurosis fugax in a patient with type A aortic dissection post surgical repair. The thromboemboli might have originated from the internal surface of the sawing area.

Adult↗
PubMed1993

Recreational weight lifting and aortic dissection: case report.

Although there have been previous cases of ascending (type I) aortic dissection recognized in young weight lifters, this is the first reported instance of a descending (type III) dissection in such an individual. Successful treatment included aortic fenestration and an aortoiliac bypass. A new entity of aortic dissection in young weight lifters may be emerging.

Adolescent↗
PubMed2005

Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta.

OBJECTIVE: This study evaluated the prevalence of increased cardiac troponin I (cTnI) in patients with acute aortic dissection of the ascending aorta (type A). METHODS AND RESULTS: In 119 consecutive patients with type A acute aortic dissection, serum cardiac troponin I was measured along with clinical, haemodynamic, electrocardiographic and echocardiographic variables obtained on admission. Cardiac troponin I was positive in 28 patients (23.5%; mean +/- SD: 6.1 +/- 14.7 ng/ml) and above the myocardial infarction threshold (1.5 ng/ml) in 12 (10%). Catecholamine infusion (17.9% vs. 4.4%; p = 0.03) and higher value of creatinine (35.7% vs. 15.4%; p = 0.03) were more frequent in patients with elevated troponin. Total mortality was 29.7% (n = 35) and surgical mortality was 16.8% (n = 17). An increased troponin was discriminatory with respect to mortality (OR: 4.1 (1.6-9.9); p = 0.002) in univariate analysis. However, this association was lost when other markers of death (age, stroke, ST-segment elevation, tamponade, catecholamine infusion, renal failure) were added in a multivariate model (OR: 2.2 (0.7-7.4); p = 0.19) indicating that the myocardial loss associated with troponin increase is not in itself a factor of mortality. CONCLUSIONS: Cardiac troponin I elevation is frequent in patients with type A aortic dissection. It might reflect a higher haemodynamic stress but does not necessarily reflect a negative prognosis.

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PubMed1987

Management of ascending aortic dissection: experience with the USCI intraluminal prosthesis and a method of aortic valve repair.

Ten consecutive cases of acute ascending aortic dissection operated on using the USCI intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intraarterial digital subtraction angiography in one case, by computerized tomography (CT) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to Marfan's disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta-to-right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1-36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance. Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.

Adult↗
PubMed2006

Intraoperative aortic dissection in pediatric heart surgery.

Intraoperative aortic dissection occurred in a 3-year-old-boy undergoing repair of an atrial septal defect. Transesophageal echocardiography was useful for the diagnosis, and conservative medical treatment under close observation was feasible in this case which involved a limited intimal tear.

Aortic Dissection↗
PubMed2005

Aortic dissection mimicking subarachnoidal hemorrhage.

In this report we describe a comatose patient with proximal aortic dissection who presented with the signs of subarachnoidal hemorrhage. Shortly before losing consciousness, the patient complained of an excruciating headache. Upon initial examination, neck stiffness and opisthotonos were present. The cardiovascular examination, chest radiograph, and cerebral computed tomography were normal. Eight hours later, the aortic dissection was verified by a thoracic computed tomography. This case shows that aortic dissection, which causes severe pain and possibly transient malperfusion of the carotid arteries, may present with the misleading signs of subarachnoidal hemorrhage but without classical symptoms of aortic syndromes.

Aortic Rupture↗
PubMed1980

Aortic dissection with "normal" chest roentgenogram.

Two patients were studied who had aortic dissections and chest roentgenograms not suggestive of that diagnosis. Since a normal chest roentgenogram does not necessarily exclude this diagnosis, aortography is indicated, if aortic dissection is strongly suspected clinically.

Aged↗
PubMed1997

[Increased serum concentration of myosin heavy chain in aortic dissection: discussion of 2 cases].

Despite the availability of diagnostic modalities such as transesophageal echocardiography, computed tomography or magnetic resonance imaging up to 30% of patients with acute aortic dissection remain undiagnosed before death. A novel immunoassay of serum smooth muscle myosin heavy chain was recently developed as a potential diagnostic tool for the detection of aortic dissection. The immunoassay was applied in two patients with an acute chest pain syndrome but no initial clinical suspicion of aortic disease. In both patients myocardial ischemia was ruled out by laboratory, electrocardiographic and echocardiographic examinations. In the first patient both dilation of the aorta and long-standing arterial hypertension were known; however, it was not before 48 h until dissection was suspected and a spiral-CT was performed demonstrating a localized ascending aortic dissection. At this time (48 h after onset of symptoms) the smooth muscle myosin heavy chain concentration in the serum was close to normal. In the other patient there was neither a suggestive history nor any clinical sign of aortic dissection. Widening of the abdominal aortic wall on an ultrasound examination was the key to the incidental diagnosis of a clinically unsuspected type B dissection. The serum test 12 h after onset of pain revealed elevated (diagnostic) serum levels of smooth muscle myosin heavy chains. Both cases exemplify important gaps in the diagnostic strategy for the detection of acute aortic dissection. A novel immunoassay for smooth muscle myosin heavy chains provides rapid and reliable diagnostic information especially in patients without clinically suspected aortic dissection and may avoid limitations in the diagnostic work-up of patients with acute aortic disease, if used early in the evaluation of patients with chest pain syndromes.

Aged↗
PubMed1995

[Surgical treatment of type A aortic dissection based on the location of the entry].

From 1987 to February of 1994, 42 cases of acute aortic dissection and 31 cases of chronic dissection have been operated in out institution. Our surgical technique for the treatment of aortic dissection is a tubular graft replacement following a resection of the segment of aorta containing the intimal tear. The location of the entry was, therefore, important to determine the extension of graft replacement and to select the circulatory support method during operation. 52%, 33% and 14% of cases in acute aortic dissection had entries in ascending, arch and descending aorta, respectively. Entries of 52%, 32% and 16% of cases in chronic dissection located in ascending, arch and descending aorta, respectively. In cases with the entry in ascending aorta, ascending aorta and partial aortic arch replacement was performed in 12 and 10, respectively, for acute dissection, whereas more extensive graft replacement procedure was selected for chronic dissection including complete arch replacement in three cases and two of them had concomitant Bentall type operation. Likewise, with the entry in aortic arch, partial arch replacement was performed more often in 9 than complete arch replacement in 5 for acute dissection, on the other hand, complete arch replacement procedure tended to be preferable in 6 cases for chronic dissection. For retrograde dissection with the entry in descending aorta, ascending aorta and complete arch replacement were performed in 4 and 6 cases, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Synthetic polymer tissue adhesive in the surgery of ascending aortic dissection. Report of two cases.

In Type A aortic dissection preservation of the aortic valve is an attractive proposition. Potential prosthetic valve endocarditis is avoided and there is a low reported incidence of late aortic regurgitation. We report a technique of resuspension of the valve using a synthetic polymer tissue adhesive. This technique allows for the two layers of the dissection to be firmly glued together leaving a good vessel wall for suture placement.

Adult↗
PubMed1999

Stent grafting for aortic dissection.

We report the successful treatment of a patient with Stanford type B aortic dissection, "thrombosed" type with ulcer-like projections, by insertion of a stent-graft. The false lumen completely disappeared within 1 year after surgery. This maturing procedure is promising in the treatment of thrombosed, aggravated aortic dissection.

Aortic Dissection↗
PubMed2000

Abnormal Peripheral Vasodilatory Reserve Without Endothelial Dysfunction in Patients With Aortic Dissection.

Structural changes in the aortic wall have been reported to be present in aortic dissection (AD), while there have been no investigations concerning peripheral vasomotion characteristics. Peripheral arterial stiffness is an important factor in the regulation of the central aortic pressure because it produces excessive wave reflection. The present study investigated in AD patients endothelium-dependent peripheral vasodilation and the reactive hyperemic response which is considered to be altered by the structural abnormality of the peripheral resistance artery. Forearm blood flow (FBF) changes induced by intra-arterial infusion of acetylcholine (ACh), sodium nitroprusside (SNP), and by occlusion-induced reactive hyperemia (RH) were measured plethysmographically in 10 AD patients, 7 healthy volunteers, and 7 patients with uncomplicated hypertension (UHT). There were no significant differences in the peak FBF response to ACh and SNP infusion for the three groups (ACh, 14.2 +/- 1.8 vs 17.2 +/- 4.5 vs 15.7 +/- 2.3 ml/min/dl tissue, NS; SNP 9.5 +/- 1.3 vs 10.6 +/- 1.7 vs 11.9 +/- 0.8 vs ml/min/dl tissue, NS). In the case of RH, however, peak FBF and maximum conductance were significantly lower in AD patients than in healthy volunteers and UHT patients (21.1 +/- 2.6 vs 36.1 +/- 4.7 and 32.4 +/- 2.6 ml/min/dl tissue volume, p < 0.01, and 0.25 +/- 0.03 vs 0.46 +/- 0.06 and 0.37 +/- 0.03 ml/min/dl per mmHg, p < 0.05, respectively). Peripheral vasodilatory function depending on the endothelium and smooth muscle in AD patients was not significantly different from that in healthy volunteers and UHT patients. However, reactive hyperemic vasodilatory reserve, which is a well-established, noninvasive measure of arterial structure, was significantly impaired in AD. These findings indicate that arterial structural abnormalities rather than systemic atherosclerotic changes represented by endothelial dysfunction may be present. We speculated that this aspect of peripheral resistance artery might possibly have an unfavorable effect on the postonset aortic conditions in AD patients.

Journal Article↗
PubMed1998

[A case of graft replacement of the ascending aorta to the aortic arch and the partial descending aorta in a single stage for thrombosed aortic dissection (DeBakey type II + IIIb)].

We report here a case of graft replacement of the ascending aorta to the aortic arch and the middle portion of the descending aorta in a single stage for thrombosed aortic dissection. The patient was a 53-year-old male who was transferred to our hospital with a diagnosis of thrombosed aortic dissection. Conservative therapy was continued but three weeks after the onset, chest enhanced CT scan and digital subtraction angiography revealed an opacified false lumen in the ascending aorta and a ulcer like projection in the middle portion of the descending aorta. He was therefore diagnosed as having redissecction in DeBakey type II + IIIb thrombosed aortic dissection. Graft replacement of the ascending aorta, the aortic arch, and a part of the descending aorta was performed in a single stage via median stenotomy with the aid of extracorporeal circulation and selective cerebral perfusion. Postoperative digital subtraction angiography showed satisfactory reconstruction of the thoracic aorta. The patient is still leading a normal life two years after the operation.

Aortic Dissection↗
PubMed1989

Surgical management of acute aortic dissection complicated by stroke.

Although patients with acute type A aortic dissection are best managed by emergency surgical intervention, preoperative stroke is known to be an independent predictor of late mortality and is considered by some to be a contraindication to operation because of the risk of precipitating hemorrhagic cerebral infarction and poor long-term outcome. In a series of 272 consecutive, unselected patients with aortic dissection undergoing surgical treatment during a 25-year span (1963-1987), 128 (47 +/- 3% [+/- 70% confidence level (CL)]) had an acute type A dissection. A total of seven patients with acute type A dissection (2.6 +/- 1% of all patients, 5.5 +/- 2% of the acute type A cohort) developed a new stroke preoperatively. Thirteen (4.8 +/- 1%) patients had a diminished or absent carotid pulse, only four (31 +/- 13%) of whom sustained a stroke. One patient died in the immediate postoperative period due to severe brain injury, yielding an operative mortality rate of 14 +/- 14%. Two patients had persistent neurological deficits and died within 4 months of operation; the actuarial survival estimate at 1 year was 57 +/- 19% (mean +/- SEM). One patient recovered function of one upper extremity (preoperative left hemiparesis compounded by paraplegia) but died 6 years later. The remaining three long-term survivors (43 +/- 19%) had major resolution of their neurological deficits and are clinically well 2-8 years postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2003

Clinical analysis of 51 cases of aortic dissection.

OBJECTIVE: To evaluate the effects of different treatments on the prognosis of aortic dissection. METHOD: Different treatment modalities including drug therapy, surgical resection and stent implantation were performed in 37, 9, and 5 cases of aortic dissection (AD) respectively, and the clinical outcome of the patients was observed during the follow-up study. RESULTS: The survival rate in drug therapy group was 70.3% (26) while death occurred in 11 cases (29.7%). Four (44.4%) of the nine cases were cured surgically, leaving a mortality of 55.6%. Stent implantation yielded cures in 4 cases, with death occurring in 1 case, and complications arose in none of the cases. CONCLUSION: Surgical resection is superior to drug therapy in the treatment of type A AD cases, while stent implantation should be the first choice for type B AD cases for causing less complications and injuries and resulting in high cure rate.

Adult↗
PubMed1999

[Ischemic complications in aortic dissection--percutaneous treatment with balloon fenestration and stent implantation].

PURPOSE: To describe principles and results of percutaneous treatment of ischemic complications of aortic dissection. MATERIALS AND METHODS: In five cases (four patients) aortic dissection was clinically complicated by renal (n = 4), iliofemoral (n = 2) or mesenterial ischemia (n = 1). After evaluation by means of computed tomography, angiography, and manometry, treatment consisted of balloon fenestration of the intimal flap, stent placement or both. RESULTS: Eleven of 25 vascular beds were classified as ischemic. Treatment consisted of 11 balloon fenestration procedures in 3 patients, in one case supported by stent placement across the dissection membrane. Stents were placed in five renal arteries, one stent was placed in the true lumen of the aorta. One iliac artery was treated with balloon dilatation. One renal artery dissection became symptomatic after balloon fenestration and was treated successfully by stent placement. In all cases ischemia was resolved by endovascular treatment. All patients had persistent relief of symptoms. Mean follow-up time is 5.8 months. CONCLUSION: Ischemic complications of aortic dissection can be effectively and safely treated with stent placement and balloon fenestration.

Adult↗
PubMed1996

[Successful surgical repair of acute DeBakey type I aortic dissection complicated by acute occlusion of the suprarenal abdominal aorta].

We reported a case of acute DeBakey type I aortic dissection presented with occlusion of the suprarenal abdominal aorta, who was successfully treated by simultaneous graft replacement of the ascending aorta and total aortic arch. The patient was a 68-year-old man who complained of chest pain and symptoms of acute arterial occlusion of bilateral lower extremities, and who had consciousness disturbance due to stroke caused by aortic dissection. He underwent simultaneous graft replacement of the ascending aorta and total aortic arch under selective cerebral perfusion during an emergent operation. For reconstruction of the arch vessels, we used three separate grafts that were connected to the aortic prosthesis before use. Although postoperative course was complicated by myonephropathic metabolic syndrome, the patient subsequently recovered and was discharged on foot. Early vascular reconstruction and appropriate management of reperfusion injury are extremely important in the setting of malperfusion phenomena complicating acute aortic dissection.

Aged↗