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PubMed1994

[CT picture of aortic prosthetic grafts and homografts in patients with aortic dissection treated surgically].

A group of 22 patients with aortic dissection (type I, II and III acc. to De Bakey's classification) and surgically implanted aortic prosthetic grafts was studied, CT scanning is useful in visualizing aortic prosthetic grafts. Dacron vascular prostheses, initially clearly visible give weaker shadows with time, whereas homografts with time, contrast with increasing intensity, with the background on CT scans, due to calcifications.

Aortic Dissection↗
PubMed2006

Risk factors for hypoxemia after surgery for acute type A aortic dissection.

PURPOSE: Postoperative hypoxemia is a frequent complication of surgery for acute type A aortic dissection. We tried to determine the factors associated with postoperative hypoxemia. METHODS: Between 1997 and 2003, 114 patients underwent surgery for acute type A aortic dissection. Multivariate logistic regression analysis was done to identify the independent predictors of postoperative hypoxemia, defined by an arterial partial oxygen/inspired oxygen fraction (PaO(2)/FiO(2)) ratio of 200 or lower. RESULTS: The overall in-hospital mortality was 6.1% (7 of 114 patients), being 5.2% in the hypoxemia group and 6.9% in the non-hypoxemia group. The ventilation time and intensive care unit stay were significantly longer in the hypoxemia group than in the non-hypoxemia group (P = 0.0044, P = 0.038, respectively). Logistic regression identified the following variables as predictors for postoperative hypoxemia: body mass index > or = 25 (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.1-15.01; P < 0.001), preoperative PaO(2)/FiO(2) ratio < or = 300 (OR, 2.6; 95% CI, 1.09-6.13; P = 0.031), and the volume of transfused blood (OR, 1.08; 95% CI, 1.01-1.18; P = 0.037). CONCLUSIONS: Initiating early treatment for hypoxemia and reducing the volume of blood transfused intraoperatively may improve the postoperative clinical course of obese patients with preoperative hypoxemia.

Adult↗
PubMed2004

[Type A acute aortic dissection presenting as mental status confusion: is it an atypically really uncommon presentation?].

The most common initial symptom of acute aortic dissection is chest or abdominal pain. Nevertheless, in a minority of cases, it may have an atypical presentation, making the diagnosis clinically challenging. This article reports on a case of acute type A aortic dissection presenting as mental status confusion. The diagnostic suspicion for a cerebrovascular accident may have catastrophic consequences in a clinical condition, which is associated with a high mortality during the first 48 hours after the onset of symptoms if untreated. The right diagnosis was made by combining a careful physical examination, echocardiography, and computed tomography. The available literature about neurologic manifestations, their pathophysiology and prevalence as the initial symptom of acute type A aortic dissection is reviewed.

Aortic Dissection↗
PubMed1991

Medical vs surgical treatment of acute aortic dissection in an intensive care unit.

To determine which therapeutic procedure is most appropriate for which type of aortic dissection, we investigated 146 cases of acute aortic dissection. In the group with dissection of the ascending aorta, 58.6% of patients given medical therapy and 48.8% of patients given surgical therapy died. In the group with dissection of the descending aorta, 14.0% given medical therapy and 50.0% given surgical therapy died. High mortality in the medical group with type A dissection was caused by delayed operation. Better survival was achieved in treated than surgically treated patients with acute distal dissection. In patients with cardiac tamponade, aortic regurgitation, hemothorax/hemo-mediastinum, visceral ischemia and peripheral ischemia, mortalities following medical treatment were fairly high. Surgical treatment brought on improvement in mortality in these groups. However, in the cases complicated by renal dysfunction, the mortality in the surgical group was higher than that in the medical group. 42 patients (28.8%) had no evidence of any complication and only 6 (14.3%) died. In 20 cases (47.6%) of uncomplicated dissection, no blood flow was observed in the false lumen. In cases with open false lumen, the following abnormal findings were more conspicuous: thrombocytopenia, decreased level of fibrinogen, increased fibrin degradation product and soluble fibrin monomer complex. However, these changes seem to be minimal in cases with thrombosed false lumen. The measurement of coagulation factors may be one useful method to determine which therapeutic procedure is most suitable.

Acute Disease↗
PubMed1985

Flow determination using computed tomography: application to aortic dissection. Part II.

Dynamic CT is not only useful in imaging an aortic dissection but may provide additional information concerning the hemodynamic significance of differing flow patterns in the false channel compared with the true channel. Once validated, the computed tomographic (CT) method of flow determination (See Part I) was applied to an experimental animal model with a surgically created aortic dissection. Good correlation was obtained for the flow estimates of cardiac output derived for the true and false channel (r = .82). The shapes of the curves, however, were distinct, reflecting different flow patterns for the true and false channels. Curve parameters, such as peak CT number (P = .0001), variance (P = .006), and, in particular, the number of mixers (a parameter used to quantify the degree of mixing) (P = .0001), demonstrated significant differences between the two channels of the dissection. The curve parameters derived can therefore be used to differentiate the true and false channels and may then predict the long-term outcome of the false channel, and the aortic branches derived from it.

Aortic Dissection↗
PubMed2006

Intimal dehiscence during endovascular treatment of thoracic aortic dissection.

Endovascular treatment of thoracic aortic pathology has become a valuable alternative therapeutic option to open surgery, however complications both during implantation and the postoperative period may occur. In this case report we present an intimal dehiscence during endovascular procedure. Diagnosis was made by transoesophageal echocardiography.

Aortic Dissection↗
PubMed2005

Aortic dissection in a young man with immune thrombocytopenic purpura.

A 36-year-old man who presented with epigastric and back pain was subsequently diagnosed with aortic dissection. Our patient lacked classic risk factors that would have predisposed him to develop this condition at a young age. He did, however, suffer from untreated, chronic immune thrombocytopenic purpura (ITP) and had a platelet count less than 20,000/mm(3) on admission. We postulate that the thrombocytopenia led to spontaneous hemorrhage within the vasa vasorum of the aorta and the subsequent development of aortic dissection. Chronic ITP has been associated with an increased risk of intracranial hemorrhage but, to our knowledge, has not been reported to be associated with aortic dissection. We encourage clinicians to be aware of this potential risk factor for aortic dissection.

Adult↗
PubMed1996

[A case report on concomitant graft replacement of the total aortic root and the transverse aortic arch for type A acute aortic dissection associated with annuloaortic ectasia].

A 49-year-old man with type A acute aortic dissection associated with annuloaortic ectasia (AAE) underwent the concomitant graft replacement of the total aortic root and the transverse aortic arch. This operation was performed with an aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion and open distal anastomosis. The operative technique consisted of total aortic root replacement using a composite graft and total arch replacement using four vessel graft. This case suggests that type A acute aortic dissection associated with AAE involving aortic arch could be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch.

Aortic Dissection↗
PubMed2006

Acute aortic dissection in children and adolescents: diagnostic and after-event follow-up obligation to the patient and family.

Acute aortic dissection in childhood and adolescence is a rare but life-threatening condition with many known risk factors, most of which are heritable. The importance of determining the presence of any predisposing disorders is stressed, since all close relatives can then be screened for any such inherited trait that would make them at risk for a similar catastrophic event. Even with no obvious predisposing disorder, it may still be prudent to evaluate close kin for the presence of aortic root dilatation, since some genetic disorders have no manifestation other than acute aortic dissection secondary to aortic medial pathology. Close monitoring for at-risk family members, including the index patient, may need to be a life-long process.

Acute Disease↗
PubMed1992

Diagnosis of acute thoracic aortic dissection using combined echocardiography and computed tomography.

Acute dissection of the thoracic aorta is a life-threatening emergency requiring a diagnosis which is rapid, accurate and safe, and which will distinguish between dissections involving the ascending and descending aorta. In the absence of any general agreement on the best method of making this diagnosis we studied the use of combined echocardiography and contrast-enhanced computed tomography (CT) to diagnose acute aortic dissection. Over a 3 year period 23 patients were investigated in this way. Aortic dissection was demonstrated in 18 cases, involving the ascending aorta in 15, and the descending aorta alone in three. The diagnosis of aortic dissection was confirmed in 13 patients at surgery, in one at aortography and in one at autopsy. Three patients died without surgery or autopsy being performed to confirm the diagnosis and the subsequently which accounted for their symptoms. This combined approach has proved a valuable and safe means of investigating aortic dissection.

Acute Disease↗
PubMed1999

Type I acute aortic dissection accompanied by ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery.

We report a case of acute type I aortic dissection with ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. The patient was a 52-year-old man who visited the hospital with major complaints of sudden low back pain and melena. Mesenteric ischemia was suspected, and angiography revealed type I aortic dissection with accompanying blood flow insufficiency in the superior mesenteric artery. Because catheterization during angiography improved the blood flow disorder and prevented intestinal necrosis, it was possible to replace the ascending aorta with a prosthetic graft. Arterial pulsation in the mesentery was recovered by the operation and the patient's life was saved without bowel resection. This case demonstrates that prompt surgical or percutaneous relief of ischemia in major organs is important to save lives in the cases of acute aortic dissection with ischemic complications.

Acute Disease↗
PubMed1987

Diagnosis of aortic dissection: the value of transesophageal echocardiography.

Using the transesophageal approach the descending part of the aorta can be imaged by two-dimensional enchocardiography in cross sections comparable to computer tomograms. The value of combined transesophageal and transthoracic echocardiography was evaluated in 53 patients who were studied consecutively from 1983 to 1986 with symptoms of aortic dissection and compared with computed tomography, angiography, surgery and/or autopsy. In all patients the transthoracic aorta could be visualized and the dissection could be classified according to DeBakey: in 9 of 29 patients (34%) type I dissection, in 4 (14%) type II dissection and in 16 (55%) type III dissection was found. Operation was carried out because of acute symptoms in 11 of the 29 patients, and 3 additional patients died before operation. In 24 patients aortic dissection could be ruled out. A sensitivity of 97% for transthoracic and transesophageal echocardiography, of 80% for computed tomography and of 78% for angiography was calculated. The specificity for echocardiography was 100%, for computed tomography 100% and for angiography 95%. The positive predictive accuracy for echocardiography and computed tomography was 100% and 95% for angiography. The negative predictive accuracy for echocardiography was 96%, for computed tomography 77% and for angiography 79%. In no patient was an aortic dissection found by computed tomography or angiography which was not detected by echocardiography. In 1 patient with a large ectasia of the aorta ascendens aortic dissection was overlooked as retrospective analysis demonstrated. Signs of aortic insufficiency and pericardial effusion were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Spiral CT artifact that simulates aortic dissection: image reconstruction with use of 180 degrees and 360 degrees linear-interpolation algorithms.

PURPOSE: To evaluate a computed tomographic (CT) artifact that simulates aortic dissection. MATERIALS AND METHODS: Two groups of 65 patients underwent spiral CT of the chest for reasons other than suspected aortic dissection. In each group, two series of images (10-mm sections) were reconstructed with use of a 180 degrees or 360 degrees linear-interpolation algorithm. Series of images were read by two radiologists, and variance between interpretations was statistically measured. RESULTS: Among series of images, artifacts were seen on 21-26 (32%-40%) with use of a 180 degrees algorithm and 41 (63%) and 44 (68%) with use of a 360 degrees algorithm. Concordance between reviewers was fair (kappa = 0.58, 0.59) or good (kappa = 0.65) with use of a 180 degrees algorithm and excellent (kappa = 0.92) with use of a 360 degrees algorithm. In one group, with use of a 180 degrees algorithm, two series of reconstructed images were separated by 5 mm; artifact was observed on seven (11%) CT studies (on both series of images) and was located along the left or left anterior side of the aorta. CONCLUSION: To reduce the frequency of a spiral CT artifact that simulates aortic dissection, two series of segmented images can be reconstructed with a change of image position along the z axis of the aorta and use of a 180 degrees linear-interpolation algorithm.

Adult↗
PubMed2001

Determinants of early and late outcome after surgery for type A aortic dissection.

The aim of this study was to identify the most important variables associated with early and late mortality in patients operated on for type A aortic dissection over a 15-year period. From January 1984 to March 1999, 110 patients underwent surgery for type A aortic dissection. The 88.1% of patients had an acute type A dissection (AD) and 11.8% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 21.8% and 14.5% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 70.9% of cases, in the arch in 17.2%, and in the descending aorta in 7.2%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. Kaplan-Meier and Cox regression analyses and hazard function for death risk were used to analyze factors influencing overall and surgical survival. The overall in-hospital mortality rate was 20.9% (23/110 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas nonemergent operations had an in-hospital mortality rate of 13.7% (p < 0.01). Univariate analysis revealed 41 preoperative and operative variables, including 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 for in-hospital death selected as independent predicting variables (p < 0.05) remote myocardial infarction [p = 0.006, odds ratio (OR) = 1.9], preoperative renal failure (p = 0.031; OR = 0.8), shock (p = 0.001; OR = 3.1), and age >70 years (p = 0.007; OR = 1.7). Follow-up ranged from 9 to 172 months (median 78 months), with Kaplan-Meier survivals for all the patients and hospital survivors of 42% and 54% at 10 years, respectively. Cox regression analysis has identified postoperative stroke [relative risk (RR) = 3.7; p = 0.012), intimal tear in the aortic arch (RR = 2.3; p = 0.036), and postoperative renal failure (RR = 4.5; p = 0.007) as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, preoperative renal dysfunction (RR = 1; p = 0.013), reoperation (RR = 1.7;p = 0.004) and intimal tear in the aortic arch (RR = 1.2; p = 0.002) emerged as risk factors. The actuarial freedom from reoperation was 85.4% at 5 years. Multiple factors still influence early and late survival after surgery for type A aortic dissection. Preoperative renal impairment both affects early and late outcome. Early postoperative course affects late outcome in hospital survivors. The presence of the intimal tear in the aortic arch has a negative impact on late survival.

Adult↗
PubMed1997

Acute dissecting aortic aneurysm in an operational environment.

Acute dissecting thoracic aortic aneurysm is a rare cause of chest pain in young adults. Patients require prompt surgical treatment to reduce the high risk of early mortality. This report describes the case of a young Army officer who developed a dissecting aortic aneurysm in Mogadishu, Somalia, during Operation Continue Hope. Moving the patient from an isolated hostile country to a location where definitive surgical treatment could be quickly performed presented a significant challenge. Military physicians who may be deployed to isolated locations should be familiar with this unusual cause of chest pain and be prepared to rapidly evacuate patients to facilities that can treat them.

Acute Disease↗
PubMed2000

True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow.

PURPOSE: To discover and evaluate the effective treatment methods to prevent or relieve true-lumen collapse in models of aortic dissection. MATERIALS AND METHODS: Two phantoms were built to simulate type B aortic dissection. After true-lumen collapse was induced, experiments were conducted to evaluate the effectiveness of clinically relevant variables in relieving the collapse. Variables included entry-tear size, branch-vessel flow distribution, distal reentry communication between the true and false limbs, aortic fenestrations, and pump output. To test the effect of closing the entry tear, a stent-graft was deployed over the entry tear under physiologic conditions in a mock-flow loop. The difference in the effect of each variable on the prevention and relief of true-lumen collapse was also investigated. RESULTS: It was more difficult to relieve true-lumen collapse than it was to prevent it. Placement of a stent-graft over the entry tear was the most effective method of relieving true-lumen collapse. Less-effective procedures included opening a false-lumen outflow branch and opening the distal reentry branch. Opening the fenestration-branch loops, meant to simulate the creation of artificial fenestrations in the intimal flap, did not relieve true-lumen collapse. CONCLUSION: The definitive treatment for true-lumen collapse in aortic dissection is direct repair of the entry tear to decrease false-lumen inflow. Otherwise, increasing the false-lumen outflow and/or creating distal fenestrations between the true and false lumina distal to the level of the compromised aortic branch are less-effective alternatives.

Aortic Dissection↗
PubMedDate not supplied

Missed acute ascending aortic dissection.

We describe a patient who presented with classic symptoms and signs of acute aortic dissection that escaped detection despite state-of-the-art imaging techniques. We review the pertinent literature concerning the diagnosis of acute dissection of the ascending aorta and describe the types of dissection that might be missed with conventional diagnostic techniques. Repeated efforts should be made to diagnose aortic dissection even though initial studies may be negative in patients with clinical evidence of dissection.

Acute Disease↗
PubMed2006

Interventional strategies for treatment of aortic dissection.

Endovascular treatment of chronic aneurysmatic diseases of the thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy. The emerging of endovascular strategies for acute thoracic aortic dissection is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined at present as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture have shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as all technical aspects of this fascinating new therapeutic alternative. Moreover, the currently available data from small studies and registries are commented and analysed. Based on the available information the cardiovascular community is in the early phase of integrating a new rapidly evolving interventional concept into the care of patients with type B aortic dissection that so far lacked a reasonable therapeutic option other than blood pressure lowering medication. With the use and interpretation of current information the reader will understand the potential of interventional stent-graft induced thoracic aortic repair in type B aortic dissection.

Aortic Dissection↗