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At least 19 recordsLinked to original sources
PubMedDate not supplied

Proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich.

The gross and histopathologic lesions observed in a case of spontaneous proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich are reported. At necropsy, a dissecting intramural hematoma was seen in the proximal aorta, extended about 12 cm distally from the aortic valves. Histopathologic changes in aortic dissection included fragmentation and disruption of elastic laminae, presence of cystic extracellular spaces, and pooling of ground substance in the tunica media. Hepatic copper levels were measured, and the low concentration found suggested that a copper deficiency together with other risk factors such as the elevation of blood pressure may have been implicated in the development of the aortic dissection seen in this ostrich.

Aortic Dissection↗
PubMed1995

Acute aortic dissection, aortic insufficiency, and a single coronary artery in a patient with Turner's syndrome.

A rare case of acute aortic dissection and aortic regurgitation in a patient with Turner's syndrome is reported. A 25-year-old woman with a history of Turner's syndrome presented to our hospital with complaints of chest pain and dyspnea. Emergent surgery was performed after chest roentgenography and two-dimensional echocardiography. Intraoperatively, the patient was found to have a single coronary artery and a bicuspid aortic valve. The patient was treated successfully with a composite graft consisting of a 24 mm woven dacron graft, a 21 mm St. Jude Medical aortic prosthetic valve, and an equine pericardial skirt. The composite graft was inverted into the ascending aorta and connected to a small coronary artery graft. The patient's postoperative course was uneventful. A cardiac catheterization was performed postoperatively and revealed a competent anastomotic site and no evidence of aortic regurgitation. We provide a brief review of coronary anomalies and aortic diseases associated with patients with Turner's syndrome. The most commonly associated complications include coarctation of the aorta and bicuspid aortic valve disease. The incidence of coronary anomalies in patients with Turner's syndrome is maybe rare.

Acute Disease↗
PubMed1988

Aortic dissection and dissecting aortic aneurysms.

Operation was employed in the treatment of 546 patients for complications of aortic dissection during the 32-year period of 1956-1988. Current concepts and operative techniques evolved during this period. Fortunately, about half the patients were treated during the latter 4 years, as modern therapy became standardized. The cumulative survival rate was 86% for all patients and 94% for those treated during recent years. Pathologic processes and requirements of operation became clearer by treating 174 patients who had had 198 previous operations by the time of referral. Reoperation was required for complications of operations now considered outdated, heart operations in patients with ascending aortic dilatation, and progressive dilatation of residual segments of the aorta. The 546 patients were followed, and a total of 838 operations were finally employed, resulting in total aortic replacement in 18, near total replacement in 41, entire thoracic aorta in 22, near total thoracic aorta in 33, and the entire thoracoabdominal aorta in 148 patients. Long-term survival in 439 patients after final operation was 66% and 44% at 5 and 10 years, respectively, despite the fact that the median age at first admission was 59. Operative treatment appears to be well-established for this disease.

Adolescent↗
PubMed1998

Clinical and echocardiographic outcomes of aortic intramural hemorrhage compared with acute aortic dissection.

Aortic intramural hemorrhage (IMH), which presents clinical manifestations identical to those of acute aortic dissection, is different from aortic dissection in terms of the absence of intimal tear and communication of blood flow between the true and false lumen. This study was conducted for the purpose of diagnosing IMH by transesophageal echocardiography (TEE) prospectively and comparing the clinical and echocardiographic outcome of IMH with aortic dissection. Between August 1991 and November 1996, 27 IMHs and 73 acute aortic dissections were diagnosed using TEE in 202 consecutive patients with suspected aortic dissections. The TEE diagnoses of IMH and aortic dissection were initially compared with computed tomography and magnetic resonance imaging and later confirmed by operative findings (n = 37) or follow-up changes (n = 12). In the 49 patients whose diagnosis was confirmed by operation or follow-up changes, the sensitivity and specificity of TEE for the diagnosis of IMH were 27 of 27 (100%) and 20 of 22 (91%), respectively. There were 11 deaths in 73 patients (15%) from acute aortic dissection and 1 death in 27 patients (4%) from IMH during a follow-up of 1.7+/-1.5 years (p = NS). Stanford classification and types of treatment were not related to death in both groups. Complications developed less often in patients with IMH (3 of 27) than in those with acute aortic dissection (24 of 73), and no death occurred in patients with uncomplicated IMH who were medically treated. A follow-up imaging study of 12 IMH patients showed complete resolution in 8, regression in 3, and progression in 1 patient. TEE is accurate in the diagnosis of IMH and IMH has a lower incidence of complications than aortic dissection because of the absence of intimal tear and communication of blood flow in the false lumen.

Acute Disease↗
PubMed1996

[Recent progress in adjunctive methods during surgery of aortic dissection].

Aortic dissection is severe disease, but recently surgery of aortic dissection is reported in good results. In order to improve results, three adjunctive methods have been progressed recently; intraoperative color Doppler retrograde cerebral perfusion and deep hypothermia. Intraoperative color Doppler reveals dynamic hemodynamics and structural information in aortic dissection in real time which leads to proper surgical treatment to obtain maximum effects with minimum invasiveness. To carry out thrombus obliteration in false lumen by informations of intraoperative color Doppler leads to a healing in aortic dissection. Retrograde cerebral perfusion during surgery of aortic dissection permitted simple procedure and good surgical results with reduced neurological complications. Deep hypothermia for protection of spinal cord and other organs also yielded good operative results and reduced rate of paraplegia.

Aortic Dissection↗
PubMed2003

Endoluminal treatment of aortic dissection.

Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature.

Aortic Dissection↗
PubMed2004

Hoarseness as an unusual initial presentation of aortic dissection.

Aortic dissection is a life-threatening medical emergency. While an abrupt, tearing pain in the chest or back is present in more than 90% of the patients, diagnosis of aortic dissection has been shown to be particularly difficult when such symptoms are not present. In this report we describe a 36-year-old man presenting with a 10-day history of new onset of hoarseness associated with several transient headache episodes. The possibility of aortic dissection was overlooked at the initial presentation, and unilateral vocal cord palsy due to a cerebrovascular accident was the initial diagnosis. The patient's abnormal chest radiograph led to a re-diagnosis, and a Standford type-B aortic dissection was confirmed using thoracic computed tomography. The unusual presentation of aortic dissection is emphasized, and its management is discussed.

Adult↗
PubMed2005

Chronic descending aortic dissections.

Aortic dissection involving the descending aorta has a predictable and often debilitating course of progressive dilatation that occurs once patients survive the acute phase of the disease. Important factors that impact the rate and degree of dilatation include the persistence of a false lumen channel (and the amount of thrombus), the control of hypertension, and the presence of an underlying connective tissue disorder. The mainstay of management of chronic descending aortic dissections is antihypertensive therapy including beta-blockade until the dissected aorta becomes significantly aneurysmal. Surgical management is recommended at that point. Multiple advances have been made that have improved the results of operative repair of aneurysmal descending aortic dissections including circulation management methodologies, CSF drainage, neurocerebral monitoring, and more recently, endovascular therapies. The presentation, diagnosis and management of chronic descending aortic dissections are discussed.

Aortic Dissection↗
PubMed1993

[Role of radiology in the diagnosis of aortic dissection].

Aortic dissection requires a prompt diagnosis and must be treated without delay in order to reduce the mortality rate. Whereas aortic dissection involving the ascending aorta (type A) requires immediate surgery, aortic dissection involving the descending aorta (type B) will usually be treated conservatively. This review article reevaluates the respective efficiency of conventional and modern radiological means offered in a well equipped university hospital.

Aortic Dissection↗
PubMed1996

[Pathology of aortic dissection].

Aortic dissection is not a popular disease but it should be listed in the disease to be excluded especially in acute emergent cases, because of its serious and protean clinical manifestations. While DeBakey classification was used over 30 years. Stanford classification is now widely accepted for its clinical availabilities. The features of the aortic dissection are 1) presence of the intimal tear at the proximal end in almost all cases, 2) its frequent location in the ascending aorta and aortic segment just distal to the left subclavian artery, and 3) the dissected plane at the outer media or medial-adventitial border. Systemic hypertension is frequently noticed in cases with aortic dissection. These features suggest hemodynamic effect as a pathogenic factor in addition to mural fragility of the aorta. Aortic dissection is frequently encountered in Marfan syndrome and other heritable diseases of connective tissue. Concerning Marfan syndrome, mutation of fibrillin gene was confirmed. Fibrillin is a microfibril consisting of glycoprotein closely bound to elastin. Therefore, traditional "cystic medial necrosis" which was referred as a principal morphological change corresponding to aortic dissection is now thought to be a secondary change to the aortic injuries occurred in the aortic wall.

Aortic Dissection↗
PubMed1990

Transesophageal echocardiography in aortic dissection.

Aortic dissection is an emergent and potentially fatal condition requiring prompt and accurate diagnosis. In some patients, aortic dissection is abruptly painful at onset; in others, however, it has a chronic progression-with no apparent symptoms or with symptoms mimicking those of congestive heart failure. Transesophageal echocardiography, a promising new method for diagnosis of aortic dissection, has the advantages of being performed at the patient's bedside and providing results within 15 minutes. This method utilizes endoscopy and traditional noninvasive imaging techniques to provide a definitive picture of most segments of the aorta without the limitations associated with aortography and other invasive procedures. The technique of transesophageal echocardiography and its application in the diagnosis of aortic dissection are described in this report.

Journal Article↗
PubMed2001

Aortic dissection.

Aortic dissection is the most common catastrophic condition affecting the aorta. Its clinical presentation is variable and can mimic any number of medical and surgical conditions. The most prevalent symptom is excruciating chest pain. Essential treatment includes rapid initiation of pharmacologic agents to control hypertension. Aortic dissection involving the ascending aorta also necessitates immediate surgical repair. Surgical treatment of aortic dissection involving only the descending aorta generally is reserved for patients with persistent pain, intractable hypertension, or evidence of propagation of the dissection. Nursing management includes blood pressure monitoring, serial physical assessment, and postoperative care, as appropriate.

Aortic Dissection↗
PubMed2003

[Primary aldosteronism. A risk factor for aortic dissection?].

Aortic dissection is a rare but severe disease. Numerous risk factors have been reported, all leading to an alteration of arterial structures, particularly extracellular matrix. Aortic dissection is a complication of arterial hypertension, whatever its origin. Primary aldosteronism, frequent cause of secondary arterial hypertension, is associated with arterial structural alterations, indirectly by a pressure factor, and directly by aldosterone, which modifies collagen contents and elastin/collagen ratios. In addition to the three previously reported cases, the three cases reported in the present paper lead to the hypothesis of a causal relationship between aldosteronism and aortic dissection. The need for hypertension screening and diagnosis of its potential causes, namely primary aldosteronism, is highlighted.

Adrenal Cortex Neoplasms↗
PubMed1988

The management of localized abdominal aortic dissections.

Aortic dissections limited to the abdominal aorta occur infrequently. We have identified four cases of abdominal aortic dissection and have reviewed these in combination with 43 previously reported cases to identify factors that influence the prognosis and management of this disease. Abdominal aortic dissections are similar to thoracic dissections in their presentation, with acute shearing pain and systolic hypertension occurring commonly. Although the diagnosis may be made by ultrasonography or CT scanning, angiography is the definitive diagnostic study. Factors found to be associated with high mortality include presentation with acute pain (p less than 0.0003), involvement of visceral vessels (p less than 0.02), and rupture (p less than 0.000002). Chronicity appears to be protective (p less than 0.04), although chronic dissections may present acutely. Although prosthetic replacement of the involved aorta is the treatment of choice in most cases, nonoperative management with regular follow-up can be considered in asymptomatic chronic dissections.

Aged↗