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PubMed2000

Aortic dissection with fistula to right atrium after heart transplantation: diagnosis by transthoracic and transesophageal echocardiography.

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition that may occur after cardiac surgery. We report the case of a 59-year-old woman with a 6-year history of heart transplantation who presented with subacute illness characterized by chest pain and severe cardiac decompensation accompanied by a continuous murmur in the precordium. The diagnosis of aortic dissection complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.

Aortic Dissection↗
PubMed2002

Conventional repair and operative stent-grafting for acute and chronic aortic dissection.

Conventional graft replacement of the ascending aorta and surgically endovascular stent-grafting of the proximal descending aorta were performed concomitantly in a 82-year-old woman with an acute DeBakey type II aortic dissection and a chronic DeBakey type IIIb aortic dissection. Postoperative computed tomography and angiography showed the adequately replaced ascending-aortic prosthesis, the well-expanded stent-graft, and the thrombosed false lumen in the descending aorta.

Acute Disease↗
PubMedDate not supplied

Aortic dissection presenting as spinal cord ischemia with a false-negative aortogram.

This article presents a case of type III aortic dissection presenting as a spinal cord syndrome with a prospectively negative initial aortogram. The patient serendipitously illustrates a multimodality approach to aortic dissection imaging. The advantages and disadvantages of conventional radiography, aortography, computed tomography, echocardiography, and magnetic resonance imaging are discussed.

Aortic Dissection↗
PubMed1998

[Early and late surgical mortality of acute type A aortic dissections by open distal anastomosis with deep hypothermic retrograde cerebral perfusion].

We have analyzed the operative results and the long-term prognosis of Stanford type A acute aortic dissections. Between 1981 and 1997, 57 patients underwent surgical repairs of acute type A aortic dissection. In the earlier period (1981-1990; n = 21), almost all the operations were performed under aortic cross-clamping with conventional cardiopulmonary bypass, while in the later period (1991-1997; n = 36), radical resections and graft replacements under open distal anastomosis with deep hypothermic retrograde cerebral perfusion (RCP) were performed in 24 patients (66.7%) and with selective cerebral perfusion in 3 (8.3%). The hospital mortality rates were 33.3% in the earlier period and 16.7% in the later period. Two (8.3%) of 24 patients employed RCP failed by preoperative rupture to pulmonary artery and myocardial infarction. Reoperations for enlargement of the remained false lumen were performed in 4 in the earlier period, of whom 2 patients were dead. In the later period, 7 patients were reoperated on, and all patients survived. Over all actuarial survival rates were 57.1% at 5 year and 44.4% at 10 year in the earlier period, while it was 70.7% at 5 year in the later group. We concluded that retrograde cerebral perfusion allows resection of the dissected aorta including primary entry as well as open distal anastomosis, which contributes to the improvement of early and long-term results for acute type A aortic dissection.

Acute Disease↗
PubMed2006

[Thoracic aortic dissection revealed by systemic cholesterol embolism].

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

Aged↗
PubMedDate not supplied

Aortic dissection in an infant caused by intraaortic balloon pumping.

The case of an 8-month-old boy with aortic dissection caused by intraaortic balloon pumping is reported. The balloon was inserted during an operation for the anomalous origin of the left coronary artery. It is important to realize the potential risk of aortic dissection even in infants and to select an appropriately sized balloon. Modification of the balloon for use in infants is necessary.

Aortic Dissection↗
PubMed1992

Aortic dissection without intimal rupture: diagnosis and management.

A 59-year-old man had symptoms of aortic dissection. Computed tomography and angiography showed a large intramural hematoma of the ascending and descending aorta without intimal defect or false lumen. The hematoma resolved completely within 7 weeks with medical treatment. His symptoms recurred 6 months later. Computed tomography and angiography demonstrated a type B dissection with a false lumen and an intimal defect. This case illustrated the progressive nature of aortic dissection without intimal rupture. The diagnostic criteria and therapeutic options are discussed.

Aortic Dissection↗
PubMed2003

Contemporary management of acute aortic dissection.

The development of endovascular techniques has introduced a new dimension to the management of acute aortic dissection. Conventional therapy has traditionally been relegated to patients who experience severe clinical sequelae; unfortunately, clinicians have not been able to accurately predict the clinical consequences of a dissection. However, recent attention to true and false lumen characteristics, the distal extent of the dissection, and branch vessel involvement has demonstrated that these independent predictors of outcome can serve as surrogate indications for endovascular or surgical treatment. We review the pathophysiological mechanisms associated with the sequelae of aortic dissection and summarize the treatment paradigms we have developed.

Acute Disease↗
PubMed2000

Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results.

PURPOSE: To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection. MATERIALS AND METHODS: Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention. RESULTS: The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months). CONCLUSION: Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.

Adult↗
PubMed2000

Axillary artery cannulation in acute ascending aortic dissections.

BACKGROUND: Standard cannulation of the femoral artery in preparation for repair of a dissection involving the ascending aorta carries a high risk of malperfusion. Arterial perfusion through the right axillary artery is more likely to perfuse the true lumen and should be advantageous in acute dissections involving the ascending aorta. METHODS: Thirteen patients underwent repair of acute ascending aortic dissections and were perfused through the right axillary artery. All had deep hypothermic circulatory arrest. RESULTS: There was one mild intraoperative cerebrovascular accident with complete recovery and one operative death secondary to low cardiac output. There were no intraoperative problems with perfusion through the axillary artery, and there were no postoperative problems or complications involving the axillary artery, axillary vein, or brachial plexus. CONCLUSIONS: Arterial perfusion through the right axillary artery is a safe and effective means of more reliably perfusing the true lumen. In this regard, it may be superior to femoral artery perfusion and could lead to improved outcomes with repair of acute deBakey type I and II aortic dissections.

Aged↗
PubMed1997

[Familial aortic dissection in a young woman. A clinical case and review of the literature].

A case report of aortic dissecting aneurysm in a 29-years-old woman is described. The father died of rupture of a dissecting aneurysm with acute hemopericardium at the age of 46 years. Histologic examination of the aortic wall revealed a loss of mucopolysaccharide-like material in the media and cystic medial changes. This dramatic familial cluster of aortic dissecting aneurysm suggests a genetically inherited disease although the basic defect remains to be found out.

Adult↗
PubMed1997

A rare presentation of thoracic aortic dissection as detected by transoesophageal echocardiography.

A case of atypical movement of the intimal flap (tear) during aortic aneurysm dissection is reported. Aortic dissection is caused by the sudden development of a tear in the aortic intima, opening the way for a column of blood driven by the force of the arterial pressure to enter the aortic wall, destroying the media and stripping the intima from the adventitia for variable distance along the length of the aorta. Echocardiographically, aortic dissection is characterized by separation of the normal single dominant echo from the aortic wall in the region of the dissection into two discrete echoes. The inner echo arises from the tunica intima, whereas the outer echo arises from the medial and adventitial structures external to the tear and it is possible to identify two lumens separated by an intimal flap within the aorta. The two echoes generally move in unison with one another, i.e. movement of the flap away from the true lumen during systole and recoil during diastole as the blood flows from true to false lumen. The dissection flap can also move inward during systole owing to the suction caused by high-velocity flow (Venturi effect), as shown in this case report. In any instances, motion of the intimal flap during the cardiac cycle is strong evidence of dissecting aneurysm.

Aged↗
PubMed1978

Aortic dissection beginning in the abdomen.

Two cases of aortic dissection beginning in the abdominal aorta are presented, and the angiographic and surgical principles are discussed. Every effort must be made to identify the sites of all intimal tears at aortography and to excise or oversew these sites at surgery; otherwise, dissection may continue. If an intimal tear cannot be identified at aortography, we recommend initial conservative therapy unless the patient's clinical condition forces emergency surgery.

Aged↗
PubMed1986

[Combination of color Doppler and transesophageal echocardiography in emergency diagnosis of type I aortic dissections].

We report on the use of colour Doppler- and transesophageal echocardiography in 2 patients with acute type I aortic dissection according to DeBakey. Using transesophageal echocardiography we obtained information on the extension and the entry site of the dissection without interfering with respiration and external thorax configuration. Using colour Doppler we were able to differentiate between the true and false lumen in the thoracic and abdominal aorta due to characteristic phasic flow patterns. In one patient the site of the entry tear of the intimal flap was localized by this method. Furthermore, a noninvasive semiquantitative evaluation of accompanying aortic regurgitation was possible. Colour Doppler gives additional information in the emergency diagnosis of patients with aortic dissection.

Adult↗
PubMed1994

[Magnetic resonance in postoperative evaluation of aortic dissection].

The value of MRI was investigated in the demonstration of residual alterations and postoperative complications of aortic dissection. October 1988 to December 1992, fifty-nine patients were examined with MRI. The series consisted of 53 patients affected with type A and 6 with type B aortic dissection, all of them surgically treated. The following parameters were studied: 1) aortic dilatation above and 2) below the prosthesis, 3) redissection, 4) persistent intimal flap, 5) origin of abdominal vessels from the false lumen and 6) study of supra-aortic vessels. Twelve of 59 patients were considered normal since all parameters were negative. The aorta was dilated in 19 patients distal to the graft and in 4 proximal to it. Redissection was observed in 33 of 59 patients. Residual intimal flap was clearly demonstrated in 33 of 59 patients; the state of the false lumen was clearly depicted in 12 patients with SE images alone and in 18 of the extant 21 with phase imaging. In 11 of 59 patients abdominal vessels originated from the false lumen. In 53 of 59 patients supra-aortic vessels were clearly demonstrated and appeared to be involved in 10 patients. In 6 cases MRI failed to yield enough information. In our experience MRI is the method of choice for monitoring the aorta after surgical dissection to detect changes and complications and therefore choose the most appropriate treatment.

Adult↗
PubMed1996

[Aortic dissection: clinical evaluation, comparison of diagnostic techniques and treatment election].

Aortic dissection is a life-threatening disease with a high mortality in the first hours. The diagnosis must be established as promptly as possible and a high index of suspicion is needed. Then, a thorough evaluation of the patient is necessary for an adequate clinical decision making. In this article, the definition, classification, predisposing factors, clinical signs and symptoms, diagnostic methods and treatment are reviewed.

Aortic Dissection↗
PubMed1985

Localization of aortic dissection intimal flap by intraoperative two-dimensional echocardiography.

Ascending (type I) aortic dissection carries a high morbidity and mortality. Proper identification of the proximal origin of the dissection and determination of concomitant aortic valve involvement significantly facilitate surgical repair, which may improve survival. In this case, intraoperative two-dimensional echocardiography with contrast injections was used to image the heart and great vessels before and after cardiopulmonary bypass. The proximal origin of the intimal flap of a type I dissection was identified, and primary aortic valve disease was excluded. Postprocedure intraoperative echocardiography demonstrated that the site of repair was imaged and that aortic regurgitation was absent. Intraoperative contrast two-dimensional echocardiography may be a valuable new tool to provide information otherwise unavailable by routine techniques.

Aged↗
PubMed1988

[Painless aortic dissection: the problem of early diagnosis. A case report].

Painless aortic dissections occur very rarely, the absence of the important cardinal symptom "pain" may cause a delayed establishment of diagnosis. As early operation improves prognosis, this delay may have harmful consequences for the patient. The case reported presented initially only with neurological symptoms and later with blood pressure instabilities. Nevertheless, the diagnosis has been established within 48 h, but the patient did not survive operative emergency treatment.

Aged↗