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PubMed1983

Aortic dissection.

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Aortic Dissection↗
PubMed2004

Cardiac catheterization-induced type-A aortic dissection detected by intra-operative transesophageal echocardiography--a case report.

Cardiac catheterization is not only a diagnostic tool but also a means of treatment of coronary artery disease. Coronary artery dissection is one of the complications of cardiac catheterization. Emergency coronary artery bypass graft (CABG) surgery is indicated when coronary artery dissection is associated with unstable perfusion or residual severe stenosis. We present a case of progressive type-A aortic dissection as a continuity of catheterization-induced dissection of right coronary artery (RCA) with occlusion, disclosed by transesophageal echocardiography (TEE) during the emergent CABG surgery for the iatrogenic injury. Once the aortic dissection has been diagnosed by TEE, the surgical procedure and cannulation site for cardiopulmonary bypass were altered from those used in regular CABG surgery. Therefore, TEE is able and valuable in such situation to detect this rare but severe complication due to catheterization, especially when retrograde coronary artery dissection has been noted preoperatively.

Aged↗
PubMed1996

[A case report of Stanford type A acute thrombosed aortic dissection complicating cardiac tamponade].

An 85-year-old man was admitted with shock due to cardiac tamponade. Plain computed tomography showed a dilated ascending aorta but did not clearly show an aortic dissection. We performed an emergency operation with median sternotomy without the benefit of findings from enhanced computed tomography and aortography. Soon after the bloody pericardial effusion was decompressed during the operation, bleeding from the ascending aorta occurred. An intimal tear was found in the distal ascending aorta, and the pseudolumen was filled with fresh thrombus. The ascending aorta was replaced. The patient had an uneventful postoperative recovery and was discharged 1 month after the operation. We conclude that patients with Stanford type A acute thrombosed aortic dissection complicating cardiac tamponade should undergo early graft replacement.

Acute Disease↗
PubMed1995

[Successful surgical treatment in a case of type IIIb acute aortic dissection complicated with acute myocardial infarction].

The patient was a 48-year-old man who was brought to our hospital complaining of chest pain, paresthesia of the lower extremities, and pain in the lumbar region. At first, acute myocardial infarction was diagnosed, but transthoracic echocardiogram revealed an intimal flap in the ascending aorta. The presence of an intimal tear below the left subclavian artery was confirmed by intraoperative transesophageal echocardiogram, and a diagnosis of myocardial infarction accompanying type IIIb aortic dissection with retrograde extension to the ascending aorta was made. Coronary artery bypass grafting to segment #2 using a section of saphenous vein and total aortic arch replacement with "elephant trunk" technique, which concurrently served as a means of amputated stump plasty, was performed. The cerebral circulation was preserved by retrograde cerebral circulation. The post operative progress was good, and thrombo-occlusion of the false lumens of the proximal descending aorta was verified. Type IIIb aortic dissection complicated with myocardial infarction is rare, but examination with both transthoracic and transesophageal echocardiograms were useful for the morphological diagnosis and for determining the surgical technique for the dissection.

Acute Disease↗
PubMed1989

[Emergent surgical management of aortic dissecting aneurysm, type A Stanford, complicated with acute cardiac tamponade; report of a case].

A 52-year-old woman, who had been treated medically for 31 days with the diagnosis of type A aortic dissection, suddenly fell in shock because of acute cardiac tamponade. Emergent operation was performed two hours after the onset of shock. Entry and perforation were located in the ascending aorta. Ascending aorta was opened without cross-clamping under profound hypothermic low flow perfusion through femoral artery, and intraluminal grafting with a double ringed graft was completed. Combined technique of open distal anastomosis and ringed graft is useful in such an emergent case as cardiac tamponade of aortic dissection.

Aortic Dissection↗
PubMedDate not supplied

[Clinical case of the month. Turner's syndrome and aortic dissection].

A patient, born in 1961, is hospitalised for pubic abdominal pain with irradiation to the right and left sides. She has a Turner's syndrome. At first evaluation, an abdominal tomography demonstrates a right pyelonephritis. The patient is treated with quinolones and she evolves favourably, except that she continues to present some abdominal pain. She leaves the hospital, but because of permanent abdominal pain, a new abdominal tomography is performed: an aortic dissection type B for (Stanford), or III anterograde for (De Bakey), is diagnosed. Cardiovascular anomalies are frequent in Turner's syndrome. Aortic dissection is a rare complication. Histological analysis shows a cystic medial necrosis. Medical and cardiological follow-up is needed.

Adult↗
PubMed1984

Prognostic factors and indications for surgical treatment of acute aortic dissections: a report based on 191 observations.

A total of 191 acute aortic dissections were examined to define prognostic factors for surgical intervention. Overall survival rate reached 40% in the 94 patients operated upon and 8% in the 97 patients not operated upon. Among the 122 patients with involved ascending aorta, survival rate was 2% in the 42 nonoperated patients versus 42% in 80 patients undergoing surgery. Since 1977, overall survival rate has reached 60% in the surgical group (21 of 35 patients) and 20% in the nonsurgical group (5 of 25 patients). Factors that showed a significant correlation with postoperative death include: persistent shock; persistent anuria; persistent neurologic deficit; diffuse intravascular coagulation; and involvement of either the celiac trunk, superior mesenteric artery, or both renal arteries at angiography. With the exception of those patients exhibiting any of these high-risk factors, emergency surgical treatment is recommended for all dissections that involve the ascending aorta.

Adult↗
PubMed2001

Aortic dissection after angioplasty and stenting of an aortic coarctation: detection by intravascular ultrasonography but not transesophageal echocardiography.

In this case report, an iatrogenic dissection of the descending aorta occurred during balloon angioplasty and stenting of a recurrent coarctation. The dissection was not seen by transesophageal echocardiography, but intravascular ultrasonography, performed routinely during such procedures at this institution, identified the dissection and guided further therapeutic stent placement.

Adult↗
PubMed1997

Successful management of acute aortic dissection in a heart transplant recipient.

A case of type III aortic dissection which occurred fourteen months after heart transplantation is presented. Medical therapy was instituted to achieve controlled hypotension. The evolution was favorable and the patient could be discharged after one month. Hypertension and increased ejection fraction after transplantation could have been predisposing factors via an increase of the shear stress in the aorta.

Aged↗
PubMed1995

[A surgical treatment of ruptured aortic dissection with non-opacified false lumen].

A 63-year-old woman was admitted to our intensive care unit suffering from severe chest pain and shock. Emergency CT scan demonstrated an acute type A aortic dissection with non-opacified false lumen and cardiac tamponade. The aortography showed ulcer like projection at the ascending aorta. An emergency operation was performed to replace the ascending aorta with a woven double-velour Dacron graft of 30 mm in diameter. It seems that an acute type A aortic dissection with non-opacified false lumen has good prognosis. The presence of other complications, however, suggests that surgical treatment should be decided upon at an early stage.

Aortic Dissection↗
PubMed1999

Constrictive pericarditis following hemopericardium due to ascending aortic dissection: A case report.

A 79-year-old woman, who had had no history of trauma, tuberculosis, or collagen diseases, was referred for examination of general fatigue and shortness of breath on exertion. Physical examination revealed engorged neck veins, hepatomegaly, and ascites with abdominal distention. On chest x-ray the cardiac shadow was slightly enlarged and bilateral pleural effusion was present. An electrocardiogram showed low voltage of the QRS complex. Computed tomographic scans revealed two lumens in the remarkably dilated ascending aorta and the severely thickened pericardium. Cardiac catheterization showed elevated right atrial pressure and elevated right and left ventricular end-diastolic pressures, in addition to a pressure record of early diastolic dip and end-systolic plateau in the right ventricle. Aortography demonstrated aortic dissection localized to the ascending aorta. On the basis of these findings, the diagnosis of chronic ascending aortic dissection complicated with constrictive pericarditis was made. After subtotal pericardiectomy, graft replacement of the ascending aorta and proximal aortic arch was performed with successful results. Her postoperative recovery was uneventful. Histological studies of the pericardium showed fibrosis and marked infiltration of the inflammatory cells. No findings of specific pericarditis such as tuberculosis or collagen diseases were detected.

Aged↗
PubMed1992

Polyarteritis nodosa with aortic dissection: necrotizing vasculitis of the vasa vasorum.

A 59-year-old woman was admitted to our hospital with acute onset of chest pain. She had experienced high fever, weight loss, polyarthralgia, myalgia, polyneuropathy and hallucinations for 3 years before admission. The diagnosis of polyarteritis nodosa with hepatitis B surface antigenemia was made by muscle biopsy and serological examinations, and administration of prednisolone induced remission of all the manifestations. After developing the acute attack of severe chest pain, she died suddenly. At autopsy, a DeBakey type 1 aortic dissection was found and the immediate cause of death was found to be cardiac tamponade secondary to rupture of the aortic dissection. Microscopically, necrotizing inflammatory lesions were present in the medium sized vascular arteries throughout her body. Furthermore, necrotizing vasculitis was also found in the vasa vasorum of the adventitia and media of the thoracic aorta. The dissecting lesion was seen in the outer layer of the media. Our results suggest that spontaneous dissection of the aorta may be attributed to necrotizing vasculitis of the vasa vasorum.

Aortic Dissection↗