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PubMed1991

Management and long-term outcome of aortic dissection.

All 163 patients admitted to one institution between 1975 and 1988 with aortic dissection were reviewed. Type I and type II patients received grafting of the ascending aorta, with an intraoperative mortality rate of 11%. For type III dissection, management was medical in 53 patients, while 19 required surgery for aortic rupture or expansion, with an intraoperative mortality rate of 11%. The 9- or 10-year survival rates were 29%, 46%, and 29% for types I, II, and III respectively. Of 135 patients with primary aortic dissection, 17 (13%) required subsequent aortic surgery. Cause of late death was other cardiovascular disease in 38%, rupture of another aortic segment in 18%, sudden death in 24%, and other medical conditions in 21%. Although operative therapy for types I and II dissections and reserving operation for selected type III dissections provides acceptable long-term survival, careful follow-up is necessary due to concurrent cardiovascular disease and residual aortic disease.

Academic Medical Centers↗
PubMed1995

Aortic dissection in Taiwan.

We retrospectively reviewed all patients with a final diagnosis of spontaneous thoracic aortic dissection treated at Linkou Chang Gung Memorial Hospital between January 1989 and December 1994. There were a total of 109 patients with a mean age of 55 +/- 11 years ranging from 19 to 88 years. The male-to-female ratio was 2 to 1 (73 to 36). There was a predilection to present during the colder months, with 69% seen between September 1 and February 28 and only 31% during the warmer half of the year. In most patients, hypertension (85%) was the major predisposing factor with another 7% having Marfan syndrome. The remaining 8% had no obvious underlying disease except for one patient who had an atrial septum defect. Presenting chief complaints in order of frequency included: anterior chest pain 58.7% (64/109), back pain 19.2% (21/109), abdominal pain 10.1% (11/109), consciousness change 3.7% (4/109), neck pain 2.7% (3/109), paraparesis 2.7% (3/109), dyspnea 1.8% (2/109), and hemoptysis 0.9% (1/109). The diagnostic breakdown revealed 46% to be type A (50/109) and 54% type B (59/109). A total of 26 (24%) patients died in hospital (16% were type A and 8% were type B). (Type A included all proximal dissections and those distal dissections that extend retrograde to involve the arch and ascending aorta; Type B refers to the other distal dissections without proximal extension; proposed by Daily et al.) Thoracic aortic dissection remains an important concern in patients with a history of hypertension. Patients seem particularly susceptible during cold weather months. The average age of our patients was only 55 years and 24% of them died during hospitalization. Earlier identification and more aggressive antihypertensive treatment is required.

Adult↗
PubMed2004

[Acute aortic dissection in a patient with advanced coronary artery disease--a case report].

A case of a 58-year-old male with acute aortic dissection is presented. A few months earlier the patient underwent transmyocardial laser revascularisation and implantation of venous graft to the left anterior descending coronary artery due to three-vessel disease. Acute aortic dissection was successfully treated by surgery. Therapeutic options in patients with acute aortic dissection and advanced coronary artery disease are discussed.

Acute Disease↗
PubMed2006

Spontaneous aortic dissection limited to sinus of Valsalva and involving the left main coronary artery.

Aortic dissection limited to one sinus of Valsalva has been described exclusively as an iatrogenic complication during catheterization interventions. This life-threatening subtype had a very small area of dissection, when coronary ostia are frequently involved. We report a 43-year-old man with dissection limited to left sinus of Valsalva, involving the left main coronary artery and causing non-ST-myocardial infarction, including severe reversible ST-depression, maximum of 9 mm in V5 lead. Dissection was suggested by cineangiography, transesophageal echocardiogram, and contrast-enhanced multidetector computed tomography. Surgical treatment was successful. There were not any associated diseases in the sinuses of Valsalsa, aortic valve or coronary arteries. Unlike previous reported cases of aortic dissection with such limited localization, the present case was spontaneous, and not iatrogenic.

Adult↗
PubMed2006

Coma might not preclude emergency operation in acute aortic dissection.

BACKGROUND: Syncope or new onset focal neurologic deficits are described in as many as one fifth of patients with acute aortic dissection referred for surgery. Coma or stroke caused by involvement of the arch vessels and secondary brain malperfusion is considered a major contraindication for emergency aortic repair. Initial experience with emergency operation in selected patients with acute type A aortic dissection complicated by coma is described. METHODS: Five comatose (median Glasgow coma score, 5.5), hemodynamically stable (systolic blood pressure > or = 100 mm Hg) patients with preserved pupillary reactivity and coma duration of less than 12 hours underwent emergency surgical repair. The ascending aorta was always replaced using profound hypothermic circulatory arrest. RESULTS: There were no operative deaths. No hemorrhagic brain infarction developed postoperatively. Ischemic strokes were documented by radiology in 3 patients, and were always right-sided. Four patients returned to normal life with no neurologic sequelae, whereas 1 patient showed partially recovered left hemiparesis and mild cognitive impairment. CONCLUSIONS: Coma may not represent an absolute contraindication for resuscitative surgery in hemodynamically stable patients with acute type A aortic dissection. A larger experience is necessary to draw more definitive conclusions.

Acute Disease↗
PubMed2003

[The application of intravascular ultrasound imaging in identifying the visceral artery in aortic dissection].

OBJECTIVE: To study the role of intravascular ultrasound (IVUS) imaging in identifying the visceral artery in aortic dissection. METHODS: Twenty-two patients with aortic dissection were studied by IVUS via a femoral approach. The relationship between the visceral artery origin and the true and false lumens were differentiated by IVUS. The detection rate of visceral artery by IVUS was compared with those of CT and digital subtraction angiography (DSA). The cause of visceral ischemia was determined by the relationship between the intimal flap and the visceral artery origin in IVUS findings, and compared with routine examinations. RESULTS: The outer wall of the true lumen had a three layer structure while that of the false lumen had only one layer structure in IVUS imaging. There was an acute angle between the outer wall of the false lumen and the intimal flap at the true and false lumen junction. The thrombosis in the false lumen could be detected by IVUS. These features can assist in the differentiation of the true and false lumen. The relationship between the visceral artery origin and the true and false lumen could be determined in 81 out of 84 arteries, among which 54 were originated from the true lumen, and 27 from the false lumen. The detecting rate of visceral arteries by IVUS was 96.4%, higher than CT (70.2%) and DSA (84.5%), chi(2) = 20.74 and 6.91, P < 0.01. Static narrowing in 6 arteries and dynamic narrowing in 1 artery were visualized by IVUS, while only 2 static narrowings could be detected by CT. CONCLUSIONS: IVUS has an advantage over routine examinations at detecting visceral artery origin and clarifying the mechanism of visceral ischemia.

Adult↗
PubMed1985

Lower-extremity ischemia in aortic dissection. Report of three cases.

Reports are presented of three hypertensive men with aortic dissection and signs of peripheral (leg) ischemia. The dissection was of type III b in two cases and type I in one case. Hypotensive medication was given in all cases, but in two of them peripheral vascular surgery became necessary to re-establish the circulation, while in the third case the hypotensive treatment sufficed for improvement of the leg circulation. Collaboration between thoracic and vascular surgeons can be of value in cases of aortic dissection with peripheral ischemia.

Aged↗
PubMed1993

[Acute aortic dissection due to cross-clamp injury during coronary artery bypass grafting--a report of successfully repaired case].

A case with successfully repaired acute aortic dissection due to cross-clamp injury during coronary bypass surgery was reported. A 54-year-old man had usual coronary artery bypass surgery by using 3 saphenous vein grafts (4 distal anastomosis). Immediately after the completion of cardiopulmonary bypass, acute aortic dissection, which was caused by aortic cross-clamp, was noted. Cardiopulmonary bypass was resumed and the injured ascending aorta was replaced with prosthetic graft under profound hypothermia and circulatory arrest. An "Island flap" of the ascending aorta (3 x 4 cm in diameter), containing 3 proximal anastomotic positions of vein grafts, was excised from the aortic wall, and was re-implanted into the frontal wall of the aortic prosthesis. The patient well tolerated the operative procedure, and fully recovered from the serious condition after 6 days of IABP support and 11 days of inotropic support. He is doing quite well one year after the surgery. This case is believed to be the first reported one of such reconstructive method for acute aortic dissection during the coronary bypass surgery.

Acute Disease↗
PubMed1994

Use of glutaraldehyde solution in the treatment of acute aortic dissections.

We report on a promising method for toughening and strengthening the fragile aortic wall that involves the direct application of a 25% glutaraldehyde solution and that has proved to be both technically simple and safe. The operation was successfully employed in 5 patients with acute aortic dissections, 3 with a Stanford type A and 2 with a type B dissection. Histologic examination of the glutaraldehyde-treated portions of the aortic wall showed no detectable difference between them and the sections of untreated aortic wall. All patients survived the operation. The duration of follow-up ranged from 9 to 31 months (mean, 14.0 months). All 5 patients were in good condition at the time of the last follow-up. The preliminary results indicate that the use of a 25% glutaraldehyde solution to strengthen the aortic wall during operations for the repair of acute aortic dissections, regardless of whether they are type A or type B, may reduce the incidence of catastrophic perioperative bleeding and promote favorable results.

Acute Disease↗
PubMed1982

[Evaluation of aortic dissection by transverse computerized tomography (CT scan)].

Twenty patients with dissection of the thoracic aorta were studied by CT-scanning. In 9 patients the diagnosis was previously documented by aortography, while in the other 11 patients the diagnosis of aortic dissection was first established by CT-scanning. The latter demonstrated the characteristic signs of aortic dissection and particularly the following features: a) the false channel (95%) and the intimal flap (90%), b) the displacement of aortic wall calcifications (60%), especially when the false channel is partially thrombosed (80%). In 19 patients, a bolus injection of contrast medium was performed. In the majority of cases opacification of the false channel occurred only partially, with some delay and with a non-homogeneous pattern. Six out of the 20 patients underwent one or more follow-up examinations performed between 15 days and 2 years later. CT-scanning clearly demonstrated the late persistence of a patent false channel and particularly the delayed thrombosis, even after surgical treatment of aortic dissection. CT-scanning appears to be a reliable non-invasive method for - establishing the diagnosis of aortic dissection, - delineating the extent of dissection, - follow-up of evolution after surgical or medical therapy.

Aged↗
PubMedDate not supplied

Aortic dissection without intimal tear: case report and findings on transesophageal echocardiography.

Transesophageal echocardiography (TEE) relies on the presence of an intimal flap for diagnosing aortic dissection; however, a small percentage of cases of dissection can occur without apparent intimal disruption. This case reviews unusual echocardiographic features of aortic dissection and previously undescribed echocardiographic findings in a patient with aortic dissection without intimal flap.

Aged↗
PubMed1995

[Factors affecting the occurrence of anastomotic leakage after graft replacement of type A aortic dissection].

Fifty-seven patients of type A aortic dissection were underwent operations from Jan. 1985 to Nov. 1994. The number of patients who underwent graft replacement of the aorta and received aortogram after the operation was twenty-nine. To investigate factors affecting the occurrence of anastomotic leakage after graft replacement of the aorta, the aortograms of the 29 patients were examined retrospectively. The aortograms revealed leakage at the distal anastomotic site on 11 of the 29 patients. Eight factors: the kind of graft, Marfan's syndrome, the use of felt at the anastomotic site, the clamping method, distal anastomotic site, acute or chronic, the state of the aortic wall at the anastomotic site and the blood pressure control after operation, were examined relating to the occurrence of anastomotic leakage. The results showed 3 factors; acute or chronic, the state of the aortic wall and the blood pressure control, affected the occurrence of anastomotic leakage. In short, the anastomotic leakage easily occurred in patients who underwent in the acute stage and whose blood pressure was uncontrolled after the operation. Therefore, strict control of the blood pressure after the operation is the most effective for preventing anastomotic leakage.

Anastomosis, Surgical↗
PubMed1986

Diagnostic difficulties in aortic dissection. Retrospective study of 89 surgically treated patients.

During the years 1964-1985, a total of 89 patients were operated on for aortic dissection: 55 were treated for proximal dissection and 34 for distal dissection of the aorta. In the former group a diagnostic delay more than 24 hours after hospitalization occurred in 17 instances (31%), and in the latter group in 18 instances (53%). The most common incorrect diagnosis in both groups was myocardial infarction. In the proximal group of aortic dissection, other cardiac diseases suspected were pericarditis, endocarditis and congestive heart failure. In the distal group of aortic dissection, acute surgical abdomen was the most common cause of incorrect diagnosis after ischaemic heart disease. Four case reports with diagnostic delay are presented.

Aortic Dissection↗