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At least 235 records · Page 13Linked to original sources
PubMed2004

Early and long-term results of surgical treatment of type A aortic dissection.

BACKGROUND: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%. AIM: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair. METHODS: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients. RESULTS: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium. CONCLUSIONS: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.

Acute Disease↗
PubMed1999

A bidirectional closing aortic dissection from an atherosclerotic distal aortic arch aneurysm: report of a case.

We experienced one rare case of a 76-year-old male with a Stanford type A bidirectional closing aortic dissection from a coexisting atherosclerotic distal arch aneurysm. He showed a cardiac tamponade, and effective pericardial drainage allowed us to conservatively manage the patient. Both an increase in the size of the aneurysm and a recrudescent dissection in the descending aorta were identified 2 months after the onset. A scheduled surgical repair was successful. The coexistence of an acute aortic dissection and an atherosclerotic aneurysm increases the risk of an aortic rupture, particularly at the confluence of the two lesions. Meanwhile, the management of a closing aortic dissection remains controversial because its characteristics still are not well known. We studied not only the pathogenesis but also the management of these two forms of aortic disease and their complex relationships.

Aged↗
PubMed2002

Self-expandable aortic stent-grafts for treatment of descending aortic dissections.

BACKGROUND: Acute aortic dissection is a life-threatening medical condition that is associated with high morbidity and mortality. METHODS: Of 198 patients treated with a self-expanding polyester-covered stent-graft for various pathologic aortic conditions in our institution, we selected 70 consecutive patients with type B aortic dissection who were undergoing treatment. The stent-graft was introduced through the femoral artery in the angiography suite, under general anesthesia with systemic heparinization and induced hypotension. RESULTS: The procedure was performed in 70 patients; of these, 58 had descending aortic dissection and 12 had atypical dissections. The procedure was successful in 65 patients (92.9%), as documented by exclusion of the false lumen of the thoracic aorta. Eleven patients (18.9%) had persistent blood flow in the false lumen of the abdominal aorta due to distal reentries. Five patients (7.1%) underwent conversion to surgery. Insertion of additional stent-grafts was required in 34 patients (48.6%). At 29 months of follow-up, 91.4% of the patients were alive. CONCLUSIONS: Stent-grafts are an important means of treating aortic dissections, which may replace conventional medical treatment of this condition for the majority of patients.

Acute Disease↗
PubMed1999

Neurologic complications of type I aortic dissection.

BACKGROUND: Aortic dissection (AoD) is characterized by a transverse intimal tear that in most cases occurs in the right lateral wall of the ascending aorta. Neurological deficit is seen as an initial manifestation in about 20% of patients (8%-33%). OBJECTIVES: To analyze the frequency of these complications and the underlying pathogenic mechanisms. METHODS: Retrospective review of the neurologic complications of patients with type I AoD who underwent surgical treatment between January 1988/April 1996. RESULTS: We report 24 patients. Nine (37.7%) developed neurologic symptoms which we have classified as follows: Hypoxic encephalopathy, 5 (55.5%); ischemic stroke, 2 (22.2%); ischemic neuropathy, 2 (22.2%) and spinal cord ischemia, 1 (11.1%). One is included in both first and third group. CONCLUSIONS: Neurologic complications are frequent in type I AoD, mainly focal or global cerebral ischemia. The former could be due to advancement of the false channel towards the aortic arch vessels and the latter to global central nervous system hypoperfusion.

Adult↗
PubMed2003

[Emergent ascending and arch replacement for acute type A aortic dissection with anomalies of the aortic arch].

We experienced 4 cases that had to be performed emergent ascending and arch replacement for acute type A aortic dissection with anomalies of the aortic arch (aberrant right subclavian artery in 2 case and isolated left vertebral artery in 2 cases). As for the aberrant right subclavian artery, preoperative diagnosis is possible by CT scan. We must not overlook aberrant right subclavian artery in order to prevent brain complication in emergency arch replacement for acute type A aortic dissection. For the isolated left vertebral artery, incision of the aortic arch is recommended for its reconstruction.

Acute Disease↗
PubMed1987

Familial aortic dissection in absence of ascending aortic aneurysms: a lethal syndrome associated with precocious systemic hypertension.

The interaction of elevated blood pressure and aortic metabolism in the genesis of aortic dissection is uncharacterized. A kindred with fatal familial aortic dissection in association with precocious systemic hypertension and in absence of a definable connective tissue syndrome has undergone genealogical, clinical, pathological, and biochemical evaluation. Six family members spanning three generations have died of acute dissection. Five men died at a mean age of 28 years (range 22-34), while the proband's paternal grandmother died at 62 years of age. All were hypertensive. A constellation of subtle clinical features points toward deficient integrity of connective tissues; however, major hallmarks of known connective tissue syndromes including aortic root ectasia or aneurysms are absent. Studies of cultured dermal and aortae fibroblasts of two of the proband's brothers mitigate against Ehlers-Danlos IV syndrome. This family's susceptibility to aortic dissection reflects the synergistic liability of coexistent elevated blood pressure and metabolic abnormalities in the genesis of aortic degeneration.

Adult↗
PubMed2002

[Acute aortic regurgitation due to localized aortic dissection adjacent to the commissure of the aortic valve].

A 78-year-old male with a sudden loss of consciousness and chest pain was transferred to our hospital. He presented heart failure due to severe aortic regurgitation. Cardiac ultrasonography and computed tomography (CT) scanning did not lead to an established diagnosis of acute aortic dissection. Aortic valve replacement was performed 24 days after the onset of the disease. The surgical findings showed prolapse of the aortic valve due to localized dissection adjacent to the commissure of the aortic valve.

Acute Disease↗
PubMed1997

Natural history and serial morphology of aortic intramural hematoma: a novel variant of aortic dissection.

BACKGROUND: Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Transesophageal echocardiography is the current standard diagnostic imaging modality in many medical centers. Aortic intramural hematoma is a variant of aortic dissection whose natural history and prognosis have not been well studied. We performed transesophageal echocardiography in patients with aortic intramural hematoma to determine the echocardiographic characteristics and echocardiographic evolution of this lesion, impact on patient management, and patient outcome. METHODS AND RESULTS: Twenty-one consecutive patients with aortic intramural hematoma confirmed anatomically (four patients) or with an additional diagnostic imaging technique (17 patients) underwent a transesophageal echocardiographic examination. Fifteen patients with longstanding hypertension had chest or back pain, and the intramural hematoma was visualized in the ascending aorta (n = 4), along the whole aorta (n = 4), in the descending aorta (n = 6), or in the aortic arch (n = 1). The thickening of the aortic wall was crescentic. Patients with ascending aortic intramural hematoma had the following results: two patients died suddenly, three patients underwent surgery because of increased aortic wall thickening (one patient) or secondary intimal tear (two patients), and the remaining three patients had regression of the hematoma. Patients with hematoma confined to the descending aorta and the patient with aortic arch involvement (n = 7) had a different result: one patient died from aortic rupture and the remaining six patients did well. Six patients had a traumatic aortic injury, and the intramural hematoma was located along the descending thoracic aorta. The thickening of the aortic wall was circular in five patients and crescentic in one. Three of these patients had normalized thickness of the aortic wall on follow-up transesophageal echocardiographic studies. The other three patients died from multiorgan system failure. Aortography showed a reduction of the diameter of the aortic lumen in four patients; diameter in the remaining 17 patients was normal. CONCLUSIONS: Aortic intramural hematoma can be detected and monitored by transesophageal echocardiography but not by aortography. Two types of aortic intramural hematoma can be distinguished: (1) traumatic of good prognosis and (2) nontraumatic, which can be an early stage of the classic aortic dissection, with bad prognosis in cases involving the ascending aorta.

Adult↗
PubMed1999

Transthoracic contrast echocardiographic detection of ascending aortic dissection.

BACKGROUND: Ascending aortic dissection is highly lethal if left untreated. Therefore rapid accurate diagnosis is necessary. Diagnosis can be made with imaging modalities that use contrast agents to delineate anatomy reliably. Transthoracic echocardiography has not routinely been diagnostically useful because of the inability in clearly visualizing the ascending aorta. METHOD AND RESULTS: We describe a case in which transthoracic echocardiography with an echocardiographic contrast agent provided diagnostic information regarding an acute ascending aortic dissection, delineating both the true and false lumens. CONCLUSIONS: Transthoracic echocardiography combined with an echocardiographic contrast agent can be useful in detecting an ascending aortic dissection.

Aged↗
PubMed1997

[Asymptomatic aortic dissection in a patient with aortic valve prosthesis].

The occurrence of iatrogenic aortic dissection after aortic valve replacement is uncommon, usually late, and exceptionally asymptomatic. We present here a case of dissecting aneurysm suspected by excessive mediastinal dilatation observed in the routine annual roentgenogram exam of a patient who has had an aortic valve prosthesis for thirteen years. The confirmation with other diagnostic methods and its successful surgical treatment are also described.

Aortic Dissection↗
PubMed1998

[A case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm].

We report a rare case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm. A 71-year-old female was referred to us with the diagnosis of thrombosed Stanford type A acute aortic dissection, however on the next day transesophageal echocardiography revealed the false lumen has been recanalized. In the operation, there was a distal aortic arch atherosclerotic aneurysm which was unidentified at the preoperation. It is very rare that the dissection originated from atherosclerotic aneurysm and proceeded to proximal and distal portion of the aorta.

Acute Disease↗
PubMed1995

[Acute aortic dissection].

The acute aortic dissection is a relatively rare event carrying a grave prognosis. It is the most common fatal condition involving the aorta. A high index of suspicion is mandatory because of a mortality rate of 1 to 2% per hour in the first 48 hours. A recent series from the Mayo Clinic using modern diagnostic methods showed that in 62% of the patients the initial impression of aortic dissection was correct, but in 28% this diagnosis was only made post mortem. The clinical suspicion arises from a history of sudden severe pain in the chest or the back, sometimes wandering downwards, and from certain clinical findings like aortic regurgitation, pulse deficits or neurologic manifestations such as cerebrovascular accidents or ischemic paraparesis. ST-segment elevation in the ECG is very unusual in aortic dissection and should direct the clinical focus to acute myocardial infarction. Large-bore peripheral venous access should be established, and pain control should start immediately. Hypertensive patients should be treated first with an intravenous beta-blocking agent. Vasodilators increase aortic wall stress, they should only be administered after a beta-blocking agent. Transfer to a hospital with appropriate diagnostic and surgical is mandatory.

Acute Disease↗
PubMed1999

Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection.

OBJECTIVES: Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60%. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting. METHODS: Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia. RESULTS: Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93% +/- 4% (+/-70% confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25% +/- 7% (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months. CONCLUSION: Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection.

Acute Disease↗
PubMed2005

Celiac artery compression syndrome due to acute type B aortic dissection.

Acute distal aortic dissection sometimes causes one or more visceral vessels to be stenosed by the thrombosed false lumen. Although stenosis of the only celiac artery (CA) usually does not cause ischemic symptoms because of the extensive collateral pathways of the mesenteric circulation, we experienced a rare case of CA compression syndrome which was caused by acute type B aortic dissection. The principal symptom was severe epigastric pain that was refractory to medicinal treatment. The angiogram showed absence of the anatomically well-developed collateral pathways between the CA and the superior mesenteric artery. We treated the patient with percutaneous transluminal angioplasty in the CA. This report indicates that attention should be given to the possibility of CA compression syndrome in the case of acute distal aortic dissection and that endovascular management can be successfully applied to control symptoms caused by the syndrome, which is otherwise extremely difficult to repair directly by surgery.

Aortic Dissection↗
PubMed2002

Clinical, diagnostic, and management perspectives of aortic dissection.

The incidence of aortic dissection ranges from 5 to 30 cases per million people per year, depending on the prevalence of risk factors in the study population. Although the disease is uncommon, its outcome is frequently fatal, and many patients with aortic dissection die before presentation to the hospital or prior to diagnosis. While pain is the most common symptom of aortic dissection, more than one-third of patients may develop a myriad of symptoms secondary to the involvement of the organ systems. Physical findings may be absent or, if present, could be suggestive of a diverse range of other conditions. Keeping a high clinical index of suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. CT scanning, MRI, and transesophageal echocardiography are all fairly accurate modalities that are used to diagnose aortic dissection, but each is fraught with certain limitations. The choice of the diagnostic modality depends, to a great extent, on the availability and expertise at the given institution. The management of aortic dissection has consisted of aggressive antihypertensive treatment, when associated with systemic hypertension, and surgery. Recently, endovascular stent placement has been used for the treatment of aortic dissection in select patient populations, but the experience is limited. The technique could be an option for patients who are poor surgical candidates, or in whom the risk of complications is gravely high, especially so in the patients with distal dissections. The clinical, diagnostic, and management perspectives on aortic dissection and its variants, aortic intramural hematoma and atherosclerotic aortic ulcer, are reviewed.

Adult↗
PubMed1989

[Aortic dissection associated with percutaneous intra-aortic balloon pumping].

This is a case report of aortic dissection associated with percutaneous intraaortic balloon insertion, which was attempted for systolic unloading after repair of left ventricular rupture. But the hemodynamic condition gradually deteriorated in spite of IABP support and aortic dissection was suspected from the difference between monitoring pressures of bilateral radial arteries and balloon tip. The balloon was removed on the 3rd postoperative day, but the patient died from renal failure, liver dysfunction and D.I.C. on the 7th postoperative day. At postmortem examination, aortic dissection was found, which extended from left common iliac artery, all the way past right renal artery and ended just below origin of left subclavian artery. Therefore, acute renal failure was supposed to be followed by aortic dissection.

Aortic Dissection↗
PubMed1984

Risk factors for aortic dissection: a necropsy study of 161 cases.

Among 161 necropsy cases of aortic dissection, 87 (54%) were type I, 34 (21%) type II, and 40 (25%) type III, and an intimal tear was identified in each. Systemic hypertension had been present in 63 of 121 cases (52%) with type I or II dissection and in 30 of 40 (75%) with type III dissection. Aortic dissection involved 7 of 16 cases (44%) with the Marfan syndrome. In the 154 cases without the Marfan syndrome, grade 3 or 4 medial degeneration (cystic medial necrosis) was observed in the ascending aorta in only 27 (18%). The risk of aortic dissection in persons with congenitally bicuspid and unicommissural aortic valves, respectively, was 9 and 18 times that in subjects with tricuspid aortic valves. The mean age of those with aortic dissection and tricuspid, bicuspid and unicommissural aortic valves was 63, 55 and 40 years, respectively, and aortic dissection was more common in men than in women. Grade 3 or 4 atherosclerosis involved the intimal tear in only 11 of 121 type I or II dissections (9%) but 32 of 40 type III dissections (80%). Accordingly, the major risk factors for aortic dissection were systemic hypertension, the Marfan syndrome, and, for type I and II dissections, congenitally bicuspid or unicommissural aortic valves. Aortic medial degeneration was a less important risk factor. Rupture of ulcerocalcific aortic atheromas may have initiated the intimal tear in some type III dissections.

Adult↗