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PubMed1992

Foregut ischemia and odynophagia in a patient with a type III aortic dissection.

We report a case of ischemia of the distal esophagus with secondary odynophagia that occurred as a result of a type III aortic dissection. A 56-yr-old hypertensive male presented with acute chest pain radiating to his back. A dissection of the descending aorta was found to begin just distal to the left subclavian artery and end in the region of the iliac arteries. The patient was treated medically and remained stable, but then developed odynophagia to solids. Upper endoscopy showed erythematous friable esophageal mucosa, and biopsies were consistent with ischemia. Aortography and barium fluoroscopy provided further evidence of foregut ischemia. The patient recovered on oral omeprazole with no residual symptoms. Ischemic compromise of the esophagus secondary to aortic dissection has not been previously described, nor have the associated endoscopic findings. Knowledge of this rare condition may help in the recognition and management of esophageal mucosal ischemia.

Aortic Dissection↗
PubMed2001

Collapse, hoarseness of the voice and swelling and bruising of the neck: an unusual presentation of thoracic aortic dissection.

A 66 year old woman presented to the accident and emergency department with history of collapse, hoarseness of the voice, and swelling and bruising of the neck. The diagnosis was not initially obvious because of the absence of chest pain. The findings on the radiograph of the soft tissue of the neck and chest radiograph suggested the need for computed tomography of the neck and chest. This confirmed the cervical haematoma and typical signs of aortic dissection. This unusual presentation of thoracic aortic dissection is discussed below.

Aged↗
PubMed1997

[Surgical treatment of aortic dissection (Stanford type A) using hypothermic retrograde cerebral perfusion in patients older than 70 years of age].

Since 1991, 27 consecutive patients with aortic dissection (Stanford A) have been operated on using deep hypothermic retrograde cerebral perfusion (RCP). There were no differences in ECC time (247 +/- 15 vs 307 +/- 22 min), and RCP time (47 +/- 2 vs 47 +/- 3 min) between the aged (> or = 70 y.o., n = 11) and non-aged (< 70 y.o., n = 16) group. Although the aged group showed the higher incidences of postoperative neurological complications of prolonged emergence (2 cases) and delirium (3 cases), respiratory disorder (3 cases), and renal dysfunction (3 cases), there was no significant difference in hospital mortality (18% in the aged vs 13% in the non-aged). We concluded that RCP is well acceptable procedure for surgical treatment of the aged patients with aortic dissection.

Age Factors↗
PubMed2006

Quality of life in patients with chronic type B aortic dissection.

OBJECTIVE: To study functioning and well-being among patients with conservatively treated acute type B aortic dissection. DESIGN: Cross-sectional survey. METHODS: Patients referred with acute type B dissection between January 1990 and November 2000 were prospectively followed after conservative initial management. In October 2002, we sent the SWED-QUAL questionnaire to all patients who were alive and had not undergone surgery of the dissected aorta. Fifty-three of 55 patients responded, 39 males and 14 females. Patient scores for the 12 aspects of health-related quality of life included in the SWED-QUAL were compared to a normative Swedish population, controlled for age and gender differences. RESULTS: There were only minor differences in functioning and well-being between patients and the normative population. Patients reported similar emotional well-being, cognitive functioning, quality of sleep, overall general health and quality of social relations as their normative counterparts. However, patients' perception of their current health, prior health, perceived resistance to illness and health concern was worse than in the normative population. Female patients also reported worse physical functioning and a lower satisfaction with their physical functioning than male patients or female counterparts in the normative population. We did not find any significant association between length of follow-up and quality of life scores. CONCLUSIONS: In terms of functioning and well-being, patients with uncomplicated acute type B aortic dissection, who are initially managed conservatively, differ little from a normative Swedish population. Our study supports conservative management of this group of patients.

Adult↗
PubMed1989

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas color-coded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20% from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal two-dimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up.

Adult↗
PubMed2006

Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus.

We report a case of Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus. A 57-year-old man was involved in an explosion accident. It was indicated that he had suffered Stanford type A acute aortic dissection, cardiac tamponade, and situs inversus by contrast enhanced computed tomography and echocardiography. With the introduction of anesthesia, he went into shock. An extracorporeal circuit was immediately introduced with heart massage. The ascending aorta was replaced with a prosthesis using cardiopulmonary bypass. The branches of the aortic arch were mirror-image reversed. The patient's general condition improved, and he was discharged from our department 3 weeks after the operation.

Aortic Dissection↗
PubMed1993

Aortic dissection due to discontinuation of beta-blocker therapy.

beta-Blockers are known to protect a vulnerable aorta from acute dissection, as well as reducing the risk of recurrent dissection. This case presentation reports the history of a 60-year-old male suffering from acute aortic dissection following discontinuation of beta-blocker therapy. The patient has shown arterial hypertension for about 20 years treated solely by beta-blockers. Two days after stopping the use of metoprolol, a nonselective beta 1-blocker without ISA, the patient developed severe chest pain during exercise. Diagnosis of type I-aortic dissection according to DeBakey was achieved by transthoracal echocardiography and computed tomography. Successful surgery by replacement of the ascending aorta was performed about 1 h following admission to the intensive care unit. During the procedure, tamponade of the left ventricle occurred followed by cardiogenic shock. Postoperative management was complicated by prolonged respiratory therapy and acute gastrointestinal bleeding; 1-year follow-up showed no evidence of disease. Thus, in this case acute dissection may be the consequence of discontinuing the use of metoprolol, possibly due to uncontrolled hypertension or specific response to the beta-blocker.

Aortic Dissection↗
PubMed2003

How to exclude the dilated false lumen in patients after a type B aortic dissection? The cork in the bottleneck.

PURPOSE: To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen. CASE REPORTS: Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like "a cork in the bottleneck" to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the "cork." In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable. CONCLUSIONS: An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.

Aged↗
PubMed1987

Two-dimensional and Doppler echocardiographic diagnosis of an aortic to right atrial fistula complicating aortic dissection.

A 60 year old woman presented with massive aortic root dilation and sudden cardiovascular collapse 10 years after aortic valve replacement. An aortic to right atrial fistula was diagnosed by echocardiographic imaging and Doppler ultrasound. At operation, the patient was found to have chronic aortic dissection with aneurysm formation. Rupture of the aneurysm into the right atrium was confirmed.

Aortic Dissection↗
PubMed1981

Cerebral disseminated coagulation. An encephalitis-like syndrome in a boy with dissecting aortic aneurysm.

A boy was suspected of having meningoencephalitis probably of viral origin, although all microbiological, including virological, tests were negative. Postmortem examination revealed a dissecting aortic aneurysm and disseminated intravascular coagulation involving the central nervous system exclusively. The clinical evolution, the age of the patient, and the association of DAA with this cerebral disseminated coagulation is very unusual.

Adolescent↗
PubMed1996

[A case report of closing aortic dissection with cardiac tamponade].

A 64-year-old man was hospitalized with severe chest and back pain. A computed tomography (CT) demonstrated an acute type A aortic dissection with cardiac tamponade. Emergency pericardial drainage was performed. Then he was referred to our hospital. An enhanced CT showed an acute type A aortic dissection with thrombosed false lumen. A digital subtraction angiography (DSA) showed no intimal tear and false lumen. He received the medical treatment. Marked elevation of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha(2) plasmin inhibitor complex (PIC), fibrin degradation products (FDP), and D-Dimer indicated the activation of both coagulation and fibrinolysis in the false lumen. These thrombotic and fibrinolytic parameters were completely normalized 6 weeks after admission. He was discharged in good health 7 weeks after admission.

Aortic Dissection↗
PubMed1996

[Surgical treatment of aortic dissection with ringed intraluminal graft--late results and fate of the false lumen].

Between April 1981 and March 1992, sixty-nine patients underwent surgery for aortic dissection in our hospital and affiliated hospitals. Of them, 48 patients who survived the operation were followed up 2 months to 11.8 years (mean: 4.6 years). We compared the fate of the false lumen and late results in the 31 patients who underwent ringed intraluminal graft (RIG group) and the 17 patients who underwent conventional graft replacement (GR group). To clarify the status and severity of the dissected aorta, we devised a scoring system (dissection score: DS) to evaluate the long-term changes in the diseased aorta after operation. Of 12 patients (25%) who died of late dissection-related complications, 10 were in the RIG group and 2 in the GR group. The actuarial survival at 5 years was 66 +/- 9% in the RIG group and 88 +/- 8% in the GR group. Late dissection-related events (dissection-related death, redissection, reoperation) were observed in 17 patients, 14 of whom belonged to the RIG group and 3 to the GR group. The dissection-related event-free survival at 5 years was 51 +/- 10% in the RIG group and 88 +/- 8% in the GR group. In 36 (75%) of the 48 patients, including 20 (65%) of the 31 patients in the RIG group and 16 (94%) of the 17 in the GR group (p < 0.05), it was possible to resect the primary intimal tear. The actuarial survival at 5 years was 76 +/- 8% for those 36 cases in which resection of the primary intimal tear was possible and 64 +/- 15% for those in which resection was not possible. The dissection-related event-free survival at 5 years was 72 +/- 8% in the former group and 33 +/- 15% in the latter. The dissection score (DS) decreased from a pre-operative value of 21.5 +/- 8.4 to 12.0 +/- 9.3 postoperatively (p < 0.001). A significant decrease in DS was observed both in the RIG group and the GR group, in the former from 22.1 +/- 7.2 to 13.1 +/- 9.3, and in the latter from 19.9 +/- 11.5 to 9.1 +/- 9.2 (p < 0.01). The DS for those whose primary intimal tear could be resected was significantly decreased postoperatively (pre-operative 20.6 +/- 8.9, post-operative 9.3 +/- 8.4; p < 0.001); but for those whose primary intimal tear could not be resected, there was no difference between the pre- and post-operative DS (pre-operative 23.4 +/- 7.3, post-operative 18.2 +/- 8.7). The percent reduction in DS (%R) was significantly greater in the former group than in the latter one (61% vs. 29%; p < 0.02). DS significantly decreased for those with no late dissection-related events (from 22.4 +/- 9.2 to 10.9 +/- 8.8; p < 0.001) while for those who presented with such events there was no difference between before and after the operation (pre-operative 19.0 +/- 5.7, post-operative 14.9 +/- 10.6). The %R in those with dissection-related events tended to be lower than that in those without such events (33% vs. 58%). Resection of primary intimal tear seemed to be important not only to improve operative results in patients with aortic dissection but also to improve late results. Depending on the site and size of the intimal tear, the ringed intraluminal graft insertion technique often makes intimal tear resection impossible. Indications for this surgical technique are thus quite limited.

Aged↗
PubMed2003

Iatrogenic aortic dissection during coronary intervention.

Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. Localized aortic dissections have been treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We describe a coronary dissection with retrograde extension to the ascending aorta that occurred during angioplasty of the right coronary artery. The extensive dissection, which was limited to the ascending aorta, was successfully treated by stenting of the right coronary artery and monitoring the aortic dissection by means of transesophageal echocardiography.

Aortic Dissection↗
PubMed1992

[Surgical treatment of acute aortic dissection in the aged: a case report].

A 77-year-old woman with Stanford type A acute aortic dissecting aneurysm was successfully treated by the sutureless technique using arringed intraluminal graft. A month after the operation, re-dissection to the distal abdominal aorta occurred. Because of the poor condition of the patient and her great age, we chose an antihypertensive therapy instead of a reoperation. Two years after the operation this patient leads a sound life without any symptoms. In a case of acute aortic dissection of the aged, special consideration may be allowed to a surgical method and a decision-making for a reoperation.

Acute Disease↗
PubMed2005

Importance of early repair of isolated abdominal aortic dissecting aneurysm.

BACKGROUND: Since the available information on isolated abdominal aortic dissecting aneurysm (AADA) is mainly related to case reports or reports of small groups of patients, its natural history remains undetermined and there is no agreement on its optimal management. The purpose of this study is to define the features and pattern of development of this unusual entity as well as to propose criteria for treatment based on our own experience and previously published data. PATIENTS AND METHODS: We retrospectively evaluated the history of 6 patients diagnosed with AADA. The patients were 5 males and 1 female. The mean age was 71 +/- 8 years (range: 61-80 years), and the mean aneurysm diameter was 54 +/- 14 mm (range: 35-70 mm). All of these patients were hypertensive (100%). History of cerebrovascular accident, ischemic heart disease, peripheral arterial disease, or diabetes mellitus was present in 1 patient, respectively. Two patients developed mycotic AADA. RESULTS: Emergency operations had been performed in 3 cases, and scheduled surgical reconstruction in the remaining 3 cases. Operation consisted of aneurysmectomy and graft replacement of the diseased aortic segment in all cases. One patient treated in an emergency setting died subsequently of multisystem organ failure, but the others did well. CONCLUSION: Symptomatic patients or patients at good risk should undergo surgical repair earlier than in the case of abdominal aortic aneurysm without dissection (AAA). Dissection in addition to an AAA will further increase the weakness of the aortic wall and the possibility of aortic rupture will become higher.

Aged↗
PubMed2006

Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome.

Cardiovocal syndrome (Ortner's syndrome) is characterized by left recurrent laryngeal nerve palsy due to cardiovascular disease, but in rare cases it can also be caused by aortic dissection. An 81-year-old man with hypertension was admitted to the hospital with aspiration pneumonia. He had been developing progressive dysphagia and hoarseness for several months before admission. A videofluoroscopic swallowing study showed supraglottic penetration with barium paste and liquid. Laryngoscopy and electromyography revealed left vocal cord palsy caused by left recurrent laryngeal neuropathy, and a contrast-enhanced chest CT revealed dissection of the aortic arch.

Aged, 80 and over↗
PubMed1988

[A rare case of successful surgical treatment of dissecting aortic aneurysm (DeBakey IIIb) associated with total obstruction of the abdominal aorta and acute complicated renal failure].

A rare case of successful surgical management of dissecting aortic aneurysm (DeBakey IIIb) is presented. A fifty-year-old male was admitted to our hospital with a complaint of severe backache and both leg pain. A diagnosis of acute renal failure and assessed total obstruction of the abdominal aorta was made angiographically. Immediate hemodialysis was carried out. After 50 days, a right subclaviafemoral bypass was performed. However, on the 60th postoperative day, plasma creatinine and BUN levels were significantly elevated. A left renal revascularization was performed using saphenous vein graft from the right common iliac artery. The postoperative course was excellent and the creatinine and BUN levels were immediately reduced. And there was no need of hemodialysis postoperatively. Because of difficult management of this kind of complication, extra-anatomic bypass is preferable, instead of total replacement of the dissecting aortic aneurysm. And weaning from such a long term hemodialysis by revascularization of one-kidney is very rare.

Acute Kidney Injury↗