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PubMed2004

Partial pericardial defect associated with ruptured aortic dissection of the ascending aorta: a rare feature presenting severe left hemothorax without cardiac tamponade.

We report a very rare case of acute aortic dissection of the ascending aorta, which ruptured to the left pleural cavity through the left-side congenital pericardial defect. A preoperative computed tomographic scan and a roentgenogram showed localized dissection of the ascending aorta and severely deteriorating left hemothorax, which required emergency operation. Intraoperative findings revealed the ruptured aortic dissection of the ascending aorta and the defect at the left-side pericardium, and a graft replacement of the ascending aorta was performed. It was considered that congenital pericardial defect complicates the diagnosis in a case of catastrophic intrapericardial hemorrhage.

Aged↗
PubMed1997

[Extrinsic compression of the left atrium as an infrequent and fatal form of type B aortic dissection: value of ECG].

We present an infrequent case of extrinsic compression of the left atrium caused by a type B aortic dissection diagnosed by echocardiography. The transthoracic echocardiography showed the obliteration of the left atrium by a heterogeneous mass with two circular images of low echogenicity. The TEE study identified the mass as a huge hematoma surrounding the true and false lumen of the aneurysm. The case demonstrated the value of echocardiography in the diagnosis of type B aortic dissection.

Aged↗
PubMed1995

Diagnosis of aortic dissection: value of helical CT with multiplanar reformation and three-dimensional rendering.

OBJECTIVE: Twenty-three patients with suspected aortic dissection were evaluated in this preliminary study of helical CT to determine the usefulness of axial sections, multiplanar reformation, and three-dimensional (3D) rendering in assessing the presence of dissection and the extent of intimal flap. MATERIALS AND METHODS: Patients were referred for helical CT scanning because of chest pain or an abnormal chest radiograph. Scans were performed during bolus injection of nonionic contrast material at 2.0-2.5 ml/sec using a mean scan delay of 47 sec. Axial scans with 5-mm collimation were obtained in all patients. They extended from the great vessels to the distal thoracic aorta just above the hiatus. Delayed nonhelical sections were obtained through the upper abdomen. Multiplanar reformations and 3D models were reconstructed from the helical data in 13 patients and were compared to axial sections in 7 patients who proved to have documented dissection. The efficacy of CT was determined using surgery, angiography, or clinical outcome to establish the diagnosis. RESULTS: Of the 23 patients studied, axial sections resulted in 15 true-negative, 7 true-positive, and 1 false-positive interpretation. In three of seven patients with dissection, it was difficult to determine the extent of the intimal flap on axial sections; multiplanar reformation or 3D views clarified the relevant anatomy in all 3 cases. Among the 3D display methods, ray-sum projection views were superior to surface model or maximum-intensity-projection views. CONCLUSION: If studies of larger numbers of patients confirm our preliminary findings, multiplanar reformation and 3D rendering of helical CT scans will be a valuable addition to axial display of CT studies used to detect aortic dissection and to determine the extent of the intimal flap.

Adult↗
PubMed1997

[A case report: successful treatment of acute type B aortic dissection with renal and leg ischemia].

A 56-year-old patient of acute type B aortic dissection with renal and leg ischemia successfully underwent emergency replacement of the descending thoracic aorta. Prior to this operation, we reperfused the ischemic legs in a controlled manner using a cardiopulmonary bypass circuit. This controlled limb reperfusion method could reduce reperfusion injury. Postoperatively, the patient also suffered from renovascular hypertension due to stenosis of the right renal artery. Renal stent angioplasty, performed 10 days after the operation, stabilized his blood pressure. Controlled limb reperfusion and renal stent angioplasty may be useful for managing branch complications associated with aortic dissection.

Aortic Dissection↗
PubMed1996

Lymphoplasmacytic aortitis and acute aortic dissection. An uncommon association.

A 43-year-old white man with a history of cigarette smoking, hypertension, nephrolithiasis, and cervical degenerative arthritis was hospitalized for sudden-onset severe, substernal, and pleuritic chest pain with epigastric radiation. Despite evaluation, the cause remained unclear and the patient expired on hospital day 5. Autopsy revealed acute Stanford type A aortic dissection, hemopericardium, and hemothorax. Grossly, the aorta and its branches, including uninvolved medium-sized arteries, displayed extreme mural fragility. Microscopic examination showed a primary lymphoplasmacytic aortitis-periaortitis without giant cells. Rents within the tunica media, medial-adventitial inflammation, and elastic fiber disruption were limited to sites of gross aortic dissection. Muscular arteries showed patchy, chronic arteritis-periarteritis without giant cell infiltrate or aneurysm formation. This case documents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.

Adult↗
PubMed1987

Diagnosis of aortic dissection. Comparison of investigatory methods--case report.

A case is presented of a patient with an acute aortic dissection, rapidly followed by thrombosis of the false channel. The classical aortoangiography failed to give adequate information, whereas newer, less invasive investigation methods gave images that finally led to the correct diagnosis. The value of these methods in the diagnosis of aortic dissection is discussed.

Aortic Dissection↗
PubMedDate not supplied

Surgical treatment of dissecting aortic aneurysm. Twenty years' experience.

Early and late results of 40 cases of dissecting aortic aneurysm were reported. 1. Result of 6 cases with acute dissection was as follows: two of three surgical patients survived, whereas all three with drug therapy died. Surgical treatment is preferred for the dissection of the ascending aorta or the arch. Some problems of the postoperative morbidity were discussed: 2. Whether medically treated or surgically, chronic dissection of the descending aorta or the abdominal aorta had better prognosis than that of the other site. Chronic dissection with no saccular enlargement had good prognosis. More than 10 years survival is to be expected. The operative result for the chronic aortic dissection was poor, especially in case of the involved ascending aorta and arch. For the saccular enlargement of the pseudolumen wrapping method with or without the resection might be the preferable procedure to avoid early rupture.

Acute Disease↗
PubMed1998

[The surgical treatment for acute aortic dissection--a retrospective study from the statistics of affiliated hospitals of a medical school].

A retrospective study was conducted for the surgical treatment on acute aortic dissection among the cardiovascular services of 5 affiliated hospital of medical school. The total of 74 cases were operated for the last 5 years period from Jan., 1991 to Dec., 1995, in which 64 cases were classified as Type A and 10 for Type B. The average age for Type A was 58.4 years old and 10% of patients were consisted of Marfan syndrome. The most frequent complications associated with dissection was aortic regurgitation (37.5%), followed by cardiac tamponade (23.4%). The surgeries were undertaken in less than 24 hours from the onset of symptom in 45.3% of patients. The localization of initial tear as was proved by intraoperative finding was at ascending aorta in 64.0%, whereas it was found at aortic arch in 21.8% of patients. The most frequent application of operative procedure was simultaneous graft replacement of ascending aorta and aortic arch (68.7%) with the use of profound hypothermia and antegrade selective cerebral perfusion (85.4%). The overall mortality rate was 25.0%, however when compared as ascending only vs ascending + arch replacement, the later group demonstrated higher mortality rate (16.6% vs 28.9%). The majority of surgical indication for Type B was hemorrhage from the dissection and 20.0% of mortality was recorded in this group of patients.

Acute Disease↗
PubMed1993

[Role of transesophageal echography in the diagnosis of aortic dissection and in therapy programming].

The diagnostic accuracy of transesophageal echocardiography and its relevance on the decision making process were evaluated in 80 patients with suspected aortic dissection during a 37-month period. The diagnosis was proven by aortography and/or magnetic resonance and/or computerized tomography and/or surgery and/or autopsy in each case. Transesophageal echocardiography had no serious complication. A correct diagnosis of aortic dissection was made in 39 of 40 patients (sensitivity, 97.5%; specificity, 100%) and the type of dissection was correctly demonstrated in each case. Thrombi in the false lumen were detected in 16 patients. The primary entry site was correctly identified in 33 patients (85%). Aortic regurgitation was detected in 25 cases (severe in 9) and pericardial effusion in 14 (with tamponade in 2). Transesophageal echocardiography was more accurate than aortography in the diagnosis of noncommunicating intramural dissection (2 cases) and identified more precisely the retrograde extension of the dissection in DeBakey type III patients (4 cases). In 9 cases surgical indication was based on clinical data and transesophageal echocardiography alone. We conclude that transesophageal echocardiography allows a bedside, safe and accurate diagnosis of aortic dissection. In the majority of the patients it provides the minimal diagnostic information necessary to the therapeutical decision making.

Acute Disease↗
PubMed1996

[Rupture of type A aortic dissection into right cardiac cavities].

We present three cases of communication between the false channel of an ascending aortic dissection and a right cardiac chamber in three patients that had previously been operated on for aortic valve replacement. In two cases there already was a degree of aortic dissection at the moment of surgery. Diagnosis was confirmed by transesophageal echocardiography and/or aortography. Two patients developed severe cardiac failure and underwent surgery, while the other one is surviving with medical treatment.

Aged↗
PubMed2004

Aortic dissection: diagnosis, state-of-the-art of imaging and new management acquisitions.

A prompt diagnosis is the cornerstone of effective treatment of aortic dissection and it is the single most important determinant of survival in this patient population. New imaging modalities such as transesophageal echocardiography, magnetic resonance imaging, helical computed tomography and electron-beam computed tomography have been introduced during the last decade. These new imaging techniques allow for a better and earlier diagnosis of aortic diseases even in emergency situations. Bearing in mind the high overall mortality of aortic dissection, the role of prevention cannot be overstressed. The main risk factor for aortic dissection/rupture is the aortic diameter; therefore we would like to stress the role of aortic replacement as an effective preventive method for aortic dissection/rupture. Determining the right time for elective surgery, when the operative risk is lower than the risk of dilation-related complications, could contribute to a decrease in urgent surgical procedures on the ascending aorta.

Aortic Dissection↗
PubMed1987

Surgical decision making in acute aortic dissection type A.

In principle there are 3 different approaches to the treatment of acute aortic dissection type A (AADA): replacement of the aortic valve and ascending aorta, reconstruction of these structures, and a combination of both techniques. This study summarizes our experiences with these methods and delineates indication for the different surgical procedures. Since 1979, a total of 51 patients (39 male, 12 female, mean age 45.5 years) underwent surgery for AADA with an overall mortality of 25%. Differences in mortality of the operative variants (reconstruction 12%, composite replacement 18%, combined reconstruction and replacement 47%) predominantly mirror growing experience than applicability of the methods. The follow-up of patients with reconstruction of the aortic valve revealed a reoperation rate of only 9% after 0.3 to 6.3 years. Four patients with constant and minor annuloectasia and/or subclinical aortic insufficiency are observed in short intervals. We conclude, that the operative procedure in AADA must be adapted to the intraoperative pathoanatomical findings. Patients with primary annuloectasia should undergo graft replacement. Reconstruction of the ascending aorta and aortic valve is considered to be the preferable method in patients with primarily normal caliber of the ascending aorta and aortic anulus.

Adult↗
PubMed2006

A non-operative survival case of an 84-year-old patient with type A acute aortic dissection complicated by pulseless tamponade.

An 84-year-old woman was hospitalized in hemodynamic shock due to type A acute aortic dissection (AAD) complicated by pulseless tamponade. She was treated conservatively as her family refused emergency surgery. In spite of warning her family that lack of intervention may possibly lead to an early death, she gradually improved and went home without any further problems. Emergency surgery for octogenarians remains controversial, however. We report the first surviving, non-operative case of an octogenarian with pulseless shock due to aortic dissection.

Aged, 80 and over↗
PubMed2002

Embolisation of a renal artery pseudoaneurysm in a patient with renal malrotation and chronic aortic dissection.

INTRODUCTION: Renal artery pseudoaneurysms may arise as a complication of percutaneous nephrolithotomy (PCNL). Prompt recognition and treatment is essential to arrest haemorrhage which may be life threatening. CLINICAL PICTURE: A patient with chronic aortic dissection and malrotated right kidney underwent PCNL for right renal calculus. He developed delayed gross haematuria. TREATMENT: Angiography showed a pseudoaneurysm arising from one of two right renal arteries, which in turn arose from the false lumen of the aortic dissection. The supplying artery was successfully embolised. CONCLUSION: Renal artery pseudoaneurysms can be successfully treated with prompt angiography and embolisation, even in the presence of renal malrotation and aortic dissection.

Adult↗
PubMed1991

Invasive thymoma presenting as aortic dissection.

We report the case of an invasive thymoma presenting as an aortic dissection in a 49-year-old woman with hypertension and a marfanoid appearance. The patient presented to the emergency department with "tearing" substernal chest pain. A chest radiograph revealed a right para-aortic bulge consistent with a dissecting aorta, but an aortogram was normal. Other disease states, including various types of mediastinal masses, have been reported to mimic aortic dissection.

Aortic Dissection↗