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PubMed1998

[Acute paraplegia. A rare complication of aortic dissection].

A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial temponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.

Acute Disease↗
PubMed2006

Temporal variations at the onset of spontaneous acute aortic dissection.

There have only been a few studies of the chronobiological occurrence of acute aortic dissection (AAD), and most were international and multicentered. The aim of the present study, conducted at only one center, was to determine the most frequent daily, monthly, and seasonal occurrences of AAD. The study population included 204 patients (66.5% male) treated at our institute between January 1, 1998 and January 1, 2004. A significantly higher frequency of AAD occurred from 6:00 AM to 12:00 noon, compared with other time periods (P < 0.001). The results showed a significant circadian variation in AAD (P < 0.001) with a peak between 9:00 AM and 10:00 AM. No significant variation was found for the day of the week; however, AAD occurred most frequently on Wednesday and Monday. The frequency of AAD was found to be significantly higher during winter versus other seasons (P < 0.001). The analysis of monthly variations of the onset of AAD confirmed a peak in February (12.9%) and in January (12.3%). Similar to other cardiovascular diseases, AAD exhibits significant circadian and seasonal/monthly variations. Our findings indicate that the prevention of AAD, especially during the aforementioned vulnerable periods, is possible by adequate tailoring of the treatment of hypertension, which is the main AAD predisposing factor.

Aged↗
PubMed2005

Staged endovascular treatment for complicated type B aortic dissection.

BACKGROUND: A 40-year-old man presented with acute chest and back pain, hypertension and anuria. Two years previously he had been diagnosed with acute uncomplicated type B aortic dissection. Following conservative management, with aggressive antihypertensive therapy and analgesia, he was monitored with 6-monthly surveillance CT scans. These demonstrated a complicated type B dissection with renal and iliac malperfusion. INVESTIGATIONS: Multislice CT, transthoracic and transesophageal echocardiography, digital subtraction aortography. DIAGNOSIS: Acute-on-chronic type B aortic dissection, complicated by aneurysmal dilatation of the thoracic aorta and visceral malperfusion. MANAGEMENT: Antihypertensive therapy; staged thoracoabdominal and branch vessel endoluminal repair (STABLE procedure), with stabilization of the dissection and rescue of renal function; CT imaging surveillance to monitor for any further complications.

Acute Disease↗
PubMed1988

Arrival-time analysis of intravenous digital aortograms in aortic dissection.

Arrival-time analysis was applied to intravenous digital aortograms. A single static image was produced by representing the time to 90% maximum density for each image pixel on a grey scale. Arrival-time analysis confirmed the diagnosis in four of six patients with aortic dissection that had been shown by image subtraction. In a further three patients with no dissection the arrival-time images were normal. In two patients with surgical repair of the ascending aorta, residual false lumens were shown by both subtraction and arrival-time analysis. In one of these cases arrival-time analysis prompted reanalysis of the subtraction image that had previously been interpreted as showing a normal aorta. Arrival-time analysis provides a static image of aortic dissection, which helps to overcome subtraction artefact.

Aortic Dissection↗
PubMed1982

Aortic dissecting aneurysms: causative factors in 204 subjects.

The pathogenesis of dissecting aneurysms of the aorta is controversial. We reviewed the records of the 204 patients with aortic dissecting aneurysms who underwent autopsy at the John Hopkins Hospital, Baltimore, from 1889 to the present and compared them with age-, race-, and sex-matched controls. The results show that hypertension, Marfan's syndrome, and traumatic, atherosclerotic, or inflammatory injuries of the aortic media are factors associated with dissection. The gross and histologic findings and associated circumstances suggest that most spontaneous aortic dissections originate from tears of the inner layers of the aorta followed by intramural cleavage. In other patients, rupture of the intra-aortic course of branch arteries or vasa vasorum may lead to dissection. Thus, no pathogenetic mechanism is common to all aortic dissections.

Adolescent↗
PubMed1986

[Magnetic resonance diagnosis of aortic dissection: with special reference to the communicating orifice between the true and false lumens].

Magnetic resonance imaging (MRI) was performed in thirty-one patients with aortic dissection to evaluate its usefulness in diagnosing the site of communicating orifice between the true and false lumens and the presence of retrograde dissection. MRI revealed the site of the entry as a defect in the intimal flap in the images of 12 of 15 patients (80%). The site of the communicating orifice between the true and false lumens in the abdominal aorta could be determined in six of eight patients (75%). MRI diagnosis of retrograde dissection was successful in three patients. Cross-sectional analysis of the abdominal aorta based on the location of the true lumen revealed that the celiac and superior mesenteric arteries tended to arise from the true lumen when the latter was situated in the anterior part of the abdominal aorta. The right and left renal arteries arose from the true lumen when it was positioned anterolaterally. In conclusion, MRI was a useful diagnostic method for aortic dissection, especially for determining the site of entry in the thoracic aorta. The changes in signal intensity in the false lumen provided useful information for locating the communicating orifice between the true and false lumens and for diagnosis of retrograde dissection. Cross-sectional analysis of dissection in the abdominal aorta was useful for predicting the branching of the main arteries from the true or false lumen.

Adult↗
PubMed2006

Münchhausen Syndrome simulating acute aortic dissection.

A young adult man presented to the emergency department reporting a convincing story for acute aortic dissection, a disorder in which diagnostic evaluations should occur in parallel with pharmacologic management. Transesophageal echocardiography demonstrated normal cardiac and aortic structures. Additional history was notable for extensive travel across numerous medical facilities with associated misrepresentation of his diagnosis and treatment. The patient was willing to undergo unpleasant and invasive procedures and succeeded at least once in the past to deceive clinicians to the point of performing a median sternotomy. The intentional presentation of false information leading to unnecessary treatments is consistent with Münchhausen Syndrome.

Acute Disease↗
PubMed1996

Regression of ST segment elevation after thrombolysis in acute aortic dissection.

A 55-year-old man was admitted to the hospital with chest pain and electrocardiogram consistent with the diagnosis of evolving myocardial infarction. Treatment with streptokinase was administered, resulting in clinical and electrocardiographic signs of reperfusion. Hypotension and ST segment elevation occurred 2 hours later and cardiac catheterization was done. At catheterization the diagnosis of aortic dissection was made, but the patient died before surgery. Thus, clinical and electrocardiographic signs of reperfusion after streptokinase may occur in patients with aortic dissection and myocardial infarction.

Acute Disease↗
PubMedDate not supplied

Aortic dissections: a pathologic study of 35 autopsied cases.

A study of 35 autopsied cases of aortic dissection collected over a period of 12 years was carried out. There were 25 males and 10 females, and the majority of the dissections presented in fourth to fifth decade of life. Thirty-six dissections were present in 35 cases. Type III was the commonest (50.0%), followed by Type I (41.7%) and Type II (8.3%) dissections. Rupture following acute dissection was the cause of death in 15 patients. In chronic types, the causes of death were not related to dissection. Hypertension, connective tissue disorders and trauma were identified as some of the risk factors.

Adolescent↗
PubMed1989

[Management of acute intrathoracic aortic dissection].

At the intensive care station of the Internal Medicine Department, University Clinic Graz, all patients admitted were promptly and carefully examined in case of suspected acute intrathoracic aortic dissection and immediately treated. In 1987 a total of 4446 patients were referred to this CCU, 893 suffered from acute thoracic pain. In 21 patients of the latter a clinical suspicion of aortic dissection was observed. In 9 patients of these, diagnosis could be established within 5 hours by echocardiography, CT and angiography. 11 patients had no dissection while one positive finding could only be determined by postmortem exam. Retrospectively, these figures for 1982 were 3908 admitted patients, 790 suffering from acute thoracic pain of which only 5 showed suspected dissection. In 3 cases dissection could be confirmed using the same diagnostic procedures, but 2 were without finding. Further 3 patients out of the total series were affected with dissection which could only be determined postmortem. Out of the 9 patients with positive diagnosis, 6 showed Typ I, 1 Typ II and 2 Typ III dissection according to DeBakey (8m, 1f, range 46-78 years). 2 patients underwent surgery immediately after diagnosis, 1 after 12 hours, while 4 cases were conservatively treated. These 7 patients have survived by controlled hypotension up to now (10 to 22 months). Two patients died 2 and 10 hours, respectively, after admission with positive diagnosis. In spite of the severity of this disease prompt and efficient diagnosis and rapid therapeutic management are the key to survival.

Aged↗
PubMed1987

[Echocardiographic diagnosis of aortic dissection: contribution of pulsed Doppler. Apropos of 29 cases].

Echocardiography is universally recognized as a first-line examination easy to perform at all times in patients with thoracic pain suggestive of aortic dissection. But like all diagnostic methods, it has its limitations and pitfalls. The present study, based on 29 consecutive cases, demonstrates the value of pulsed Doppler echocardiography in the diagnosis and monitoring of aortic dissection. When the echocardiographic images are typical of the disease, the Doppler technique helps evaluate the lesions (aortic insufficiency, number of patent channels), but it is mainly in cases with doubtful echocardiographic findings that the Doppler technique provides elements that clinch the diagnosis, notably by showing the presence ot two patent channels with different blood flows. In addition, we would like to draw attention to a new and useful sign: flapping ot the dissected intima when the Doppler window is over it; we observed this sign in 24 of our 29 patients.

Adult↗
PubMed1992

[Presumed "successful" fibrinolysis in unrecognized acute aortic dissection].

Thrombolysis (1,500,000 IU streptokinase during 60 minutes and 500 mg acetylsalicylic acid was started in a 43-year-old woman with Turner's syndrome who had chest pain lasting for more than 45 min accompanied by ST elevations of 0.2 mV or more in leads II, III, aVF and V1-V5. Pain disappeared within an hour and the ST segments became isoelectric. Severe back and upper abdominal pain occurred 24 hours later. Computed tomography revealed an aortic dissection from the aortic valve to the descending aorta. Intraoperatively the rupture was found to extend to an apparently single left coronary ostium. The aortic valve was bicuspid and incompetent. After aortic valve replacement, resection of the ascending aorta and implantation of a vascular prosthesis the patient's condition gradually improved and she was discharged from hospital.

Acute Disease↗
PubMed1986

Aortic dissection in a gorilla.

Autopsy findings in a 39-year-old male gorilla included aortic dissection, internal rupture of the aortic arch with axial direction of the tear, external rupture of the ascending aorta, cardiac tamponade, myocardial hypertrophy, cystic and basophilic degeneration of the aortic media, marked obesity, severe degenerative joint disease, focal glomerulonephritis, and widespread hemosiderosis.

Aortic Dissection↗
PubMedDate not supplied

[Acute aortic dissection: diagnostic possiblities of mono- and two-dimensional echocardiography].

A case of an acute aortic dissection (AAD) has been reported in a 61-year-old woman, in whom, by the mono and two-dimensional echocardiography (M and 2D E) the authors have detected: 1) The disconnection between the intima and adventitia. 2) A flap of the intima in the aortic cavity. The authors emphasize the usefulness of the M and 2D E because it permits: 1) An early diagnosis of the AAD. 2) A reduction of the lapse between the angiographic examination and the surgical therapy. 3) A better prognosis.

Aortic Dissection↗
PubMed1979

Aortic dissection: surgical and nonsurgical treatments compared. An analysis of seventy-four cases at the University of Virginia.

During the eleven year period from 1965 to 1976, aortic dissection was diagnosed in seventy-eight patients treated at the University of Virginia Medical Center. The seventy-four cases that comprise the present report were confirmed by aortography, surgery, or autopsy. Forty patients (54 per cent) were surgically treated by interruption of the origin of dissection and insertion of a Dacron prosthesis. The remaining thirty-four (46 per cent) were treated according to the Wheat regimen or by nonspecific supportive measures. The overall survival at one year was 28 per cent. One year survival for patients with type I dissections treated surgically was 19 per cent compared with 8 per cent one year survival for nonsurgically treated patients. Sixty per cent of patients with type II dissections treated surgically were alive at the end of one year, whereas no patients with type II dissection treated nonsurgically survived beyond one year. Half the patients with type III dissections treated surgically were alive at one year compared with 35 per cent of those nonsurgically treated. These data suggest that surgery is the treatment of choice for all types of aortic dissections, but particularly for type II. Patients with type I dissections have a very poor prognosis regardless of therapy.

Aged↗
PubMed2000

Successful conservative surgery of acute ascending aortic dissection occurring during coronary angiography.

We reported the case of an acute aortic dissection complicating right guiding catheter manipulation during engagement in the right coronary ostium. Despite absence of hemodynamic deterioration, dissection progressed rapidly from the sinus of Valsalva to the ascending aorta along its entire length. At surgery, performed in emergency, the aorta was not dilated and the aortic wall did not appear pathologic. Therefore conservative surgery was performed, consisting of suture of the aortic tear and incollage of the false lumen, with good immediate and mid-term results.

Aged↗
PubMed2003

Ascending aorta replacement and local repair of tear site in type A aortic dissection with arch tear.

BACKGROUND: Transaortic repair of the tear was previously proposed as a compromise alternative to total arch replacement for acute type A aortic dissection with an arch tear. However, there are no data about long-term prognosis and radiologic findings after this procedure. METHODS: We reviewed the postoperative course and computed tomographic findings of 13 patients who underwent replacement of the ascending aorta and transaortic repair of an arch tear for acute type A aortic dissection. RESULTS: There were no early or late deaths during a mean follow-up period of 36.8 months. Computed tomographic follow-up showed complete thrombosis with or without later regression of the false lumen in the descending thoracic aorta in 9 patients (69.2%). Thrombosis of the false lumen usually occurred within 3 months postoperatively. Repair techniques incorporating the full thickness of the aortic wall in closure of the tear resulted in higher rate of success than approximation of the intima only (7 of 8 versus 2 of 5 patients, p < 0.05). CONCLUSIONS: Transaortic repair of the arch tear with replacement of the ascending aorta can be an option in selected patients who have a small intimal tear in the aortic arch. This option would be more viable for less experienced surgeons who would hesitate to replace the total arch.

Acute Disease↗
PubMed2004

Spontaneous echocardiographic contrast in the ascending aorta mimicking the appearance of aortic dissection in a patient with a left ventricular assist device.

We describe a patient with a previously implanted Jarvik 2000 left ventricular assist device (LVAD), who presented with bacteraemia and with features suspected for aortic dissection at the CT scan. However, transesophageal echocardiography showed competition in the ascending aorta between the retrograde pump flow and the anterograde transaortic output, which mimicked true aortic dissection and could be resolved by lowering the pump speed. As patients with LVAD are increasing in number, clinicians should be aware of this possible effect.

Aged↗