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PubMed2005

Aortic dissection presenting as an acute ischemic stroke for thrombolysis.

Thrombolysis for the treatment of acute ischemic stroke requires careful selection of patients. The authors report a case of aortic dissection presenting with acute ischemic stroke for which emergent ultrasonographic evaluation was helpful in the diagnosis and subsequent treatment. The patient presented with acute middle cerebral artery ischemic stroke symptoms and complained of bilateral ear and chest pain. Chest x-ray, cardiac enzymes, and transthoracic echocardiogram were normal, and she was considered for thrombolytic therapy. Carotid ultrasound revealed right common carotid occlusion that led to the diagnosis of aortic dissection, confirmed by chest computed tomography. An experienced sonographer with skills to perform rapid intra- and extracranial examinations may help to change the treatment plan for acute stroke patients.

Acute Disease↗
PubMed1995

[Two case reports of Stanford type A acute aortic dissection complicated with thrombosed false lumen and saccular aneurysm formation].

We report two cases of successful surgical treatment for Stanford type A aortic dissection with thrombosed false lumen and saccular aneurysm formation. They were admitted to our clinic for severe anterior chest and back pain. Diagnosis was made as a Stanford type A dissection with thrombosed false lumen by chest CT, aortography and cardiac ultrasonography. Aortography showed ulcer like projection (ulp) in the ascending aorta, although flow in false lumen was not visualized. They were initially treated with antihypertensive drugs. Six and eight weeks later, although medical therapy was continued, a saccular aneurysm of the ascending aorta was found to be increased in size rapidly in both cases. Operation performed was the ascending aorta replacement with resection of the saccular aneurysm. The location of the ulp was found to be corresponded with the intimal tear at surgery. The postoperative courses were uneventful. Thus, careful medical follow up and surgical treatment were necessary in these cases. We believe that the ulp represents defect in the intima leading to the clotted false lumen and provides a possible sign of rupture in clinical course of aortic dissection.

Acute Disease↗
PubMed1976

Spontaneous dissecting aortic aneurysm in a squirrel monkey (Saimiri sciureus).

Arteriosclerosis and a dissecting aortic aneurysm were diagnosed radiographically and confirmed at necropsy in an aged female squirrel monkey (Saimiri sciureus). The radiographic findings closely resembled the analogous syndrome in man. The dissection began in the aortic arch, extended along the media, and recommunicated with the aortic lumen at the level of the renal arteries. Arterial lesions also included medial necrosis and moderate atherosclerosis.

Aortic Dissection↗
PubMed1992

[Operation of acute dissecting aortic aneurysm in the 25th week of pregnancy using hypothermic extracorporeal circulation].

We report on a 24 + 2 weeks pregnant woman with Marfan's syndrome, who acutely developed a dissecting aortic aneurysm with aortic valve insufficiency. Emergency surgery was performed by using hypothermic extracorporeal circulation, whilst the aortic valve and ascending aorta were replaced by a synthetic graft. Foetal heart rates, continuously monitored by using Doppler ultrasound, were shown to be closely correlated with perfusion pressures. By applying perfusion pressures of 90-100 mmHg, we were able to maintain foetal heart rates of approximately 100/min. During the first postoperative day, the CTG was normal for gestational age and no contractions were noted. During the second postoperative night, the patient prematurely delivered a dead 820 g infant (Apgar score 0/0/0/0). In view of this case report, opportunities and problems associated with an application of extracorporeal circulation during pregnancy are discussed.

Adult↗
PubMed1996

[Intravascular ultrasound for monitoring percutaneous fenestration of a membrane from an aortic dissection].

HISTORY AND CLINICAL FINDINGS: A 51-year-old man, having experienced sudden retrosternal pain was admitted to another hospital with suspected myocardial infarction. He also had dysaesthesia and later paresis of the left leg. There was no sign of acute infarction in the ECG. However, computed tomography revealed aortic dissection, type III (DeBakey). The left pedal pulses were diminished. The patient was transferred to our hospital for further diagnosis and treatment. At a blood pressure of 110/60 mm Hg the occlusion pressure of the leg artery was 55 mm Hg on the left and 95 mm Hg on the right. INVESTIGATIONS: Transoesophageal echocardiography detected no abnormality of the aortic valve and ascending aorta. But distal to the origin of the left subclavian artery it demonstrated a free floating membrane of an aortic dissection and computed tomography showed its extension to the aortic bifurcation. TREATMENT AND COURSE: At first, because of the incomplete ischaemia syndrome affecting the left leg, a percutaneous fenestration of the dissection membrane was performed. After conventional angiography intravascular ultrasound imaging was also undertaken; it revealed that the membrane was almost completely occluding the left iliac artery. Under ultrasound monitoring a puncture needle and two balloon catheters were introduced across the membrane and thus a window created in it. The clinical findings quickly disappeared and the patient was discharged without further operation. CONCLUSION: Monitoring with intravascular ultrasound imaging makes it possible to perform safely a percutaneous fenestration of the membrane of an aortic dissection and to obtain immediate evidence of its success.

Aortic Dissection↗
PubMed1997

[Clinical experience with the gelatin-resorcine-formol biological glue in acute type A aortic dissection].

From May 1995 through June 1996, the gelatin-resorcine-formol (GRF) biological glue was used for tissue reinforcement in 20 patients operated on for acute type A aortic dissections at our institution. The results in these patients (Group I) were compared to those in 37 patients operated on between 1992 and 1994 with conventional techniques (Group II). There were no significant differences between the two groups concerning demographic data. Operative procedures in Group I consist of replacement of the ascending aorta with or without proximal arch (n = 10), total arch replacement (n = 7), and aortic root reconstruction (n = 2), whereas those in Group II were 22, 12, and 3, respectively. Cardiopulmonary bypass time was significantly shorter in Group I than Group II (164 +/- 39 vs 265 +/- 122, p < 0.05). Average blood loss in first 24 hours after operation was 688 +/- 601 ml in Group I and 1481 +/- 1505 ml in Group II (p < 0.05). Consequently operative mortality was significantly (p < 0.05) reduced from 40.5% (Group II) to 15.0% (Group I). In conclusion, the use of GRF glue reduces perioperative bleeding and improves results of operation for acute aortic dissections.

Acute Disease↗
PubMed1995

[A successful repair of the aortic dissection (DeBakey type I) with ischemic complications of the kidney and lower extremities].

A 65-year-old male was referred to our institution under diagnosis of aortic dissection which passed 1 month after the onset. An aortography revealed DeBakey type I aortic dissection with the left renal artery involvement and the very narrow true lumen of the abdominal aorta compressed by the pseudolumen, especially at the orifice of the right renal artery. On the 3rd day of admission, the patient manifested SVC syndrome, oliglia and pulselessness of the femoral artery bilaterally, that indicated ischemia of the kidney and the lower extremities. An emergency operation was performed, and the ascending aorta was replaced using open distal anastomotic technique for the distal site of the aorta under deep hypothermia and retrograde cerebral perfusion method. The ischemic symptoms and SVC syndrome were disappeared promptly after operation. Postoperative CTscan showed the narrow true lumen of the abdominal aorta expanded remarkably. The postoperative course was uneventful and the patient discharged on the 54th postoperative day.

Acute Kidney Injury↗
PubMed2003

[Successful total arch replacement for a 92-year-old woman with acute Stanford A aortic dissection: report of a case].

We reported a successful case of emergent total arch replacement for a nonagenarian with acute Stanford A aortic dissection. A 92-year-old woman complained of general fatigue, with hypotension. Echocardiography showed moderate pericardial effusion and aortic regurgitation. Computed tomography (CT) scan showed widely extended aortic dissection from the ascending aorta to descending thoracic aorta, and cardiac tamponade. An emergent total arch replacement was performed under hypothermic selective cerebral perfusion with bladder temperature of 22.5 degrees C. Although she suffered from pneumothorax, renal insufficiency and gastrointestinal (GI) bleeding postoperatively, she tolerated the operation and complications, well. She is now leading a good life with the same level of activities of daily living (ADL) as preoperative one.

Activities of Daily Living↗
PubMed2005

Endograft repair of acute aortic dissection. Promises and challenges.

Acute dissection is a uniquely complex, relatively common, and frequently lethal aortic catastrophe. Historically, surgical treatment has been reserved for cases with complications including rupture; the results have been less than optimal because of excessive morbidity and mortality. This is the main reason why conservative management emerged as the standard of care for management of acute type B aortic dissection (TBAD). While more patients would appear to survive with a conservative treatment strategy, the outcome in terms of 30-day mortality (20%) and occurrence of late complications - such as enlarging aneurysms of the thoracic false lumen (30-40%) - leaves (again) much to be desired. Stent-graft endovascular repair has emerged as a very promising, less invasive treatment option. These devices, when used appropriately, can achieve the important therapeutic goals of entry-site coverage, depressurization of the false lumen, and expansion of the compressed true lumen - overcoming ischemic (malperfusion) manifestations. The early results of stent-graft repair of TBAD are encouraging, and even exciting, but much more work needs to be done in various critical areas surrounding this condition. Thoracic endograft technology has lagged behind its abdominal counterpart. The design of acute dissection-specific devices is imperative, reflecting the significant differences between TBAD and degenerative thoracic aortic aneurysm disease. Needs for this and other important developments notwithstanding, it is generally acknowledged that stent-graft intervention does represent an important advance in the treatment of patients with TBAD. Well-designed, controlled clinical trials will be necessary to elucidate the relative value of several endovascular thoracic strategies.

Acute Disease↗
PubMed2001

Acute aortic dissection during pregnancy.

We review the cases of two women with acute aortic dissection during their last trimester of pregnancy who underwent aortic root replacement. One patient with type A dissection had to undergo surgical intervention immediately, and required extracorporal membrane oxygenation for four days. The other patient with a pre-diagnosed Marfan's disease had suffered a type B dissection and had to undergo emergency operation after developing a type A dissection nine days later.

Adult↗
PubMed1997

[A case of successful surgical treatment of recurrent Stanford type A thrombosed aortic dissection].

A 70-year-old female was hospitalized with a complaint of anterior chest pain. Enhanced CT scan demonstrated acute type A aortic dissection with the clotted false lumen. Aortography showed ulcer-like projection in the ascending aorta. The patient received the conservative medical treatment and had been followed up medically at outpatient clinic. One year later, she was admitted with the general malaise, chest discomfort and the enlargement of the mediastinum on the chest X-ray. Aortography revealed recrudescent enlarged false lumen. Graft replacement of the ascending aorta was successfully performed. Careful medical follow up should be necessary for the thrombosed Stanford type A aortic dissections.

Aged↗
PubMed1991

Cine phase-contrast magnetic resonance imaging for analysis of flow phenomena in experimental aortic dissection.

Using a 1.5 T magnetic resonance imaging (MRI) system, cine phase-contrast and magnitude images were obtained in three phantoms that simulated different anatomic configurations of aortic dissection. The dissection phantoms were made of compliant materials, and pulsatile flow was used in all experiments. Phantoms differed only in the location of the fenestration between the true and false lumens (I: an upstream "entry" only, II: both upstream "entry" and downstream "re-entry," and III: a downstream "entry" only). Flow jets, flap motion, and wave propagation were clearly visualized in cine MR images of each phantom, and quantitatively analyzed with reference to the stimulated cardiac cycle of the pump. Flow in the false lumen was always bidirectional. Upstream and downstream flow waves collided and dispersed within the false lumen. Flow through the false lumen was the same in phantoms I and II, and least in phantom III. The average area of the true lumen was largest in phantom III and smallest in I. Phantom I had the highest overall flow rate in the false lumen and greatest change in false lumen size during the cardiac cycle, while the downstream "entry" phantom had the lowest of both parameters. Flow phenomena in aortic dissections can be studied by cine phase-contrast MRI.

Aortic Dissection↗
PubMed1993

Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome.

The aim of the present study was to determine the long-term status of the native aortic valve after surgical treatment of acute aortic dissection involving the ascending aorta. From 1972 to 1991, 93 patients underwent operation for type I or II aortic dissection. There were 76 men and 17 women. Mean age was 54 +/- 13 years. Eighty patients (86%) had a conservative procedure regarding the aortic root and aortic cusps: 74 had prosthetic replacement of the ascending aorta and 6, complete replacement of the aortic arch. Thirteen patients (14%) had simultaneous replacement of the aortic valve and the ascending aorta. The overall hospital mortality rate was 29% (27/93). The overall actuarial survival rate was 60.2% +/- 5.2%, 49.7% +/- 6.1%, and 35.9% +/- 8.1% at 5, 10, and 15 years, respectively. The survival rates for patients who had an ascending aortic procedure only were 63% +/- 5.5%, 54% +/- 6.5%, and 39% +/- 8.5% at 5, 10, and 15 years, respectively, and for patients who required aortic valve replacement, 45% +/- 14% and 22% +/- 17.5% at 5 and 10 years, respectively. Fifty long-term survivors (94% follow-up) with preservation of the aortic valve and aortic root were studied. Among them, 9 (18%) died within a mean interval of 97 +/- 46 months after operation. Causes of death were ischemic cardiac failure (2), aortic rupture or extension of dissection (4), renal disease (1), stroke (1), and sudden death (1). Forty-one patients had long-term clinical and echocardiographic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Dissection↗
PubMed2000

[Right pleural effusion in aortic dissecting aneurysm].

Right hemorrhagic pleural effusion may be a presenting sign of thoracic aortic dissecting aneurysm. We describe 2 cases of massive right hemorrhagic pleural effusion and dissection of the descending aorta (type B) detected at tomographic scan. Transesophageal echocardiography ruled out a retrograde dissection of the ascending aorta. Right hemorrhagic pleural effusion is an unusual clinical presentation in thoracic aorta dissection and, up to now, the underling pathophysiology of this sign has not been defined yet.

Aortic Dissection↗
PubMed1995

Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging.

PURPOSE: To compare transesophageal echocardiography (TEE) and magnetic resonance (MR) imaging in the diagnosis of dissection of the thoracic aorta. MATERIALS AND METHODS: Thirty-one consecutive patients with clinically suspected aortic dissection and 10 postoperative patients underwent transesophageal color Doppler echocardiography and MR imaging. Imaging results were compared at independent double-blind readings. Final diagnosis was obtained from consensual review of all corroborative studies. RESULTS: MR imaging depicted the intimal flap in 95% of aortic dissections; TEE, in 86% (P < .05). In surgical patients, the sensitivity of MR in detection of residual dissection was 100% versus 86% with TEE (P < .05). The inferior extent of the dissected lumen was seen only with MR imaging. False-positive results occurred in two cases with TEE and in one with MR imaging. CONCLUSION: MR imaging is superior to TEE in the evaluation and follow-up of dissection of the thoracic aorta. Because the availability of MR is limited, however, TEE should remain the standard modality for diagnosis.

Adult↗
PubMed1987

Chronic proximal aortic dissection presenting as tamponade after 16 years.

A patient presented with tamponade and haemopericardium 16 years after experiencing sudden severe chest pain associated with enlargement of the proximal aorta. Investigations revealed a proximal aortic dissection (DeBakey type II) with extensive laminar and partially calcified thrombus within its false lumen and a large pericardial effusion, which together resulted in a cardiothoracic ratio of 100%. Long term survival after medical treatment of proximal aortic dissection, with such late progression to tamponade, has not been reported before.

Aortic Dissection↗
PubMed2002

[Esophageal rupture just after the graft replacement of thoracoabdominal aorta for chronic aortic dissection].

A 51-year-old man with thoracoabdominal aortic aneurysm (DeBakey IIIb type chronic aortic dissection) first underwent the graft replacement of thoracic aorta with elephant trunk technique. Postoperatively, the residual false lumen just distal to the inserted graft as an elephant trunk enlarged in a short period, and it compressed the esophagus. He underwent the second graft replacement of thoracoabdominal aorta 2 months after the first surgery. Just after the second surgery, he had the esophageal rupture probably because of direct damage due to the enlarged aneurysm and loss of the arterial blood supply due to the graft replacement. He died of bleeding from the distal anastomosis because of the uncontrolled graft infection. It may have to be kept in mind that the esophageal rupture after the graft replacement could be one of the reason of the graft infection when the aortic aneurysm severely compressed the esophagus preoperatively.

Aortic Dissection↗