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At least 253 records · Page 14Linked to original sources
PubMed1994

Imaging of thoracic aortic dissection.

Acute thoracic aortic dissection has a high mortality if untreated, so the diagnosis must be rapidly made if mortality is to be lowered significantly. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause for death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 of 12 patients studied and correctly classified the type in only five. Aortography was performed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were performed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention.

Acute Disease↗
PubMedDate not supplied

Acute and chronic aortic dissection.

Each year acute aortic dissection is diagnosed in 2,000 individuals in the United States. Acute aortic dissection is no longer a catastrophic event because this problem can be rapidly diagnosed with current medical technology, and therefore promptly treated with medication and surgery. Consequently, patients with aortic dissection can survive for 10 to 20 or more years after the initial event. However, there is considerable current debate regarding the most optimal technique(s) for the diagnosis of aortic dissection. Moreover, little information is available on the best methods for the long-term assessment and treatment of patients who have been successfully treated for acute aortic dissection. This report reviews the current techniques that are available for the diagnosis of aortic dissection and discusses the important issues regarding the acute and long-term treatment of patients with this problem.

Abdominal Pain↗
PubMed1998

[A patient with aortic dissection and abdominal aortic aneurysm with fistula].

Aneurysm of the abdominal aorta is not uncommon in later life. The frequency of aneurysm rupture varies with aneurysm diameter. In rare cases, the aneurysm may rupture intra-abdominally into surrounding structures and give rise to a fistula. When blood vessels are involved, the commonest form is aortocaval fistula, the presenting symptoms being those of severe right-ventricular heart failure. Although thoracic aorta dissection may be made manifest in acute intense chest pain, it is asymptomatic in up to 50 per cent of cases. The article consists in a case report of asymptomatic thoracic aorta dissection occurring concomitantly with a ruptured abdominal aneurysm the symptoms of which were severe right ventricular heart failure due to an aortocaval fistula causing increased pressure, and severe bilateral oedema of the legs. If the rare complication of an aortocaval fistula could be detected earlier, it might be possible to prevent progression to refractory cardiac failure. The possibility of a fistula should be borne in mind if haematuria is present in a case of abdominal aneurysm or a pulsatile abdominal mass is present in conjunction with a murmur.

Aortic Dissection↗
PubMed1986

Surgical treatment of aortic dissection: application of Ivalon sponge to the dissected lumen.

With canine disease models for aortic dissection, we performed comparative evaluations of several surgical procedures for the management of this dissection. From these experimental procedures, we developed a new operative technique, the Ivalon sponge occlusion method, designed to promote thrombus formation and to mesh (organize) effectively with the tissue ingrowth of the peripheral dilated, dissected aortic lumen. The details of the technique are described. It has been used successfully in 12 patients with DeBakey type I and type III aortic dissection. Based on our experimental and clinical evaluations, although the results are preliminary, we believe this operative technique is a simple, effective approach for the management of extended aortic dissection.

Adult↗
PubMed2006

Assessment of aortic dissection and hematoma.

Aortic dissection and aortic intramural hematoma are highly lethal diseases occurring mostly in patients with arterial hypertension or Marfan syndrome. Transesophageal echocardiography (TEE) is the diagnostic imaging procedure of choice in the unstable patient. Hallmarks of dissection are the presence of an intimal membrane, or flap, dividing a true and a false lumen, entry and reentry tears, periaortic hematoma, pericardial effusion or tamponade, and aortic regurgitation in dissection of the ascending aorta. TEE allows detection of involvement of the ascending aorta, which places the patient in an extremely high-risk group and necessitates urgent operation. The accuracy of TEE is similar to computed tomography and magnetic resonance imaging, with the added benefit of being feasible at the bedside or in the operating room. Precautions have to be taken during TEE to avoid an abrupt rise in blood pressure. Aortic intramural hematoma is often a precursor of classic dissection or accompanies it and can also be diagnosed by TEE, although the diagnosis is frequently difficult.

Aortic Dissection↗
PubMed2000

Paraplegia caused by painless acute aortic dissection.

OBJECTIVES: Painless acute aortic dissection in which paraplegia is the only presenting sign is rare, with limited reported cases. CASE REPORT: The authors report a patient with painless acute aortic dissection who presented with sudden onset paraplegia. Ischemic diseases of the spinal cord were suspected as the cause. MRI revealed extensive acute aortic dissection with an intramural hematoma. The patient was treated conservatively by strictly controlling his blood pressure. The treatment was successful, although the motor function of the lower extremities could not be rescued. Although 3% to 5% of patients with acute aortic dissection present with paraplegia as a result of spinal cord infarction, most of these patients experience severe pain prior to presentation. CONCLUSION: Painless acute aortic dissection in which paraplegia is the only presenting sign is very rare. However, aortic diseases, including acute aortic dissection, should always be considered as a differential diagnosis of patients with sudden onset, painless paraplegia.

Acute Disease↗
PubMed1995

[Pathophysiology and clinical aspects of dissecting aortic aneurysms].

Dissecting aneurysms of the aorta are among the most dangerous acute conditions in medicine. Their incidence is rising in recent years. The pathogenesis of vascular aneurysms is not completely clear. In the submitted paper the authors discuss the most important factors (atherosclerosis, hereditary, metabolic, mechanical, haemodynamic, nutritional) responsible for the development and growth of an aneurysm as well as for the progressing dissection. The authors compare the most important diagnostic methods from the aspect of sensitivity and specificity. In the conclusion they give a brief account of dissecting aneurysms at the IVth Medical Clinic University Hospital Kosice during the period from 1989 to November 1994.

Aortic Dissection↗
PubMed2001

Acute myocardial infarction caused by aortic dissection.

Clinical presentation of aortic dissection is similar to that of acute myocardial infarction (AMI). Clinical differential diagnoses from lethal chest pain in emergency department include AMI, aortic dissection, pulmonary embolism, tension pneumothorax, etc. Thrombolytic therapy for recanalization of thrombotic occluded coronary artery in AMI must be considered, but it is absolutely contraindicated for aortic dissection. However, AMI secondary to aortic dissection is a rare condition, which might be caused by compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. Surgery is the first choice for AMI secondary to aortic dissection caused by extension of dissection into the coronary arterial wall. We present a case of inferior wall AMI caused by type I aortic dissection with presentation of chest pain and hemiparaplegia of right lower limb.

Aortic Diseases↗
PubMed2001

Acute type A aortic dissection associated with an aortic annular abscess.

We describe a 66-year-old woman who underwent open heart surgery because of congestive heart failure. During operation, we found a Stanford type A dissection and an aortic ring abscess, which had burst into the aortic lumen. No other entries were found. Pathological examination showed excessive neutrophil infiltration in the aortic root. We strongly suspect that the abscess produced the intimal tear to cause the aortic dissection.

Abscess↗
PubMed2000

Clinical prediction of acute aortic dissection.

BACKGROUND: Clinical criteria for aortic dissection are poorly defined. Thus, 35% of aortic dissections remain unsuspected in vivo, and 99% of suspected cases can be refuted. OBJECTIVE: To identify independent predictors of acute aortic dissection and create a prediction model for facilitated estimation of the individual risk of dissection. METHODS: Two hundred fifty patients with acute chest pain, back pain, or both; absence of an established differential diagnosis of the pain syndrome; and clinical suspicion of acute aortic dissection were evaluated for the presence of 26 clinical variables in a prospective, observational study. Multivariate analysis was performed to create a prediction model of aortic dissection. RESULTS: Aortic pain with immediate onset, a tearing or ripping character, or both; mediastinal widening, aortic widening, or both on chest radiography; and pulse differentials, blood pressure differentials, or both (P<.001 for all) were identified as independent predictors of acute aortic dissection. Probability of dissection was low with absence of all 3 variables (7%), intermediate with isolated findings of aortic pain or mediastinal widening (31% and 39%, respectively), and high with isolated pulse or blood pressure differentials or any combination of the 3 variables (> or = 83%). Accordingly, 4% of all dissections were assigned to the low-probability group, 19% to the intermediate-probability group, and 77% to the high-probability group of aortic dissection. CONCLUSIONS: Assessment of 3 clinical variables permitted identification of 96% of the acute aortic dissections and stratification into high-, intermediate-, and low-probability groupings of disease. With better selection for prompt diagnostic imaging, this prediction model can be used as an aid to improve patient care in aortic dissection. Arch Intern Med. 2000;160:2977-2982

Aged↗
PubMed2001

A case of Standford type B aortic dissection involving a right-sided aortic arch with mirror-image branching and right-sided descending aorta.

Isolated right aortic arch with mirror-image branching is a rare congenital anomaly. To date, no case has been reported for aortic dissection involving a right aortic arch with mirror-image branching. We report here on a case involving a 58-year-old man in whom expanding type B aortic dissection was demonstrated in the right aortic arch with mirror-image branching and a right descending aorta. The patient was successfully treated by interposition of a prosthetic graft via a right posterolateral thoracotomy approach. We also reviewed the literature.

Aortic Dissection↗
PubMed2006

[Bilateral cervical arterial dissection as a sign of proximal aortic dissection: a rare cause of recidivating TIA].

Proximal aortic dissection is a life-threatening disease. In addition to other complications, involvement of the brain-supplying arteries can lead to acute cerebral ischemia. In the presented case, only the patient's clinical course and duplex sonography, which showed bilateral cervical arterial dissections, led to the diagnosis of aortic dissection. This case emphasizes that early ultrasound examination is crucial in patients with suspected cerebral ischemia.

Aortic Dissection↗
PubMed1989

[Experimental study on the dissecting aortic aneurysm].

Type I dissecting aortic aneurysm is not only the most common type of all but an extremely lethal event. It is important to create the experimental model of type I dissection for clarifying behavior of this disease and successful treatment. The purpose of this study is: (1) production of experimental model of type I aortic dissection; (2) examination of progression manner of dissection; (3) and investigation of influence of dissection upon aortic valve and coronary artery. The experimental model of type I aortic dissection was produced in adult mongrel dogs. Bilateral thoracotomy was made and intimal tear was created in the ascending aorta by modified Blanton's procedure. Hypertension and creation of large pocket of the aortic media were necessary to produce type I aortic dissection. Extension of dissection had a tendency toward the inner layer of the aortic wall at distal site. However, at proximal site the dissection progressed in the same layer of the aortic wall. In this series, retrograde extension of dissection remained blind above annulus of aortic valve, and no incidence of aortic regurgitation or coronary ischemia was occurred. But on histologic examination, degeneration of the aortic wall by the dissection was observed. Such weakness of aortic wall showed potentiality to developed into subsequent aortic regurgitation or coronary ischemia.

Aged↗
PubMed1989

[Study on the change in serum enzyme activity during acute aortic dissection].

Cases of acute aortic dissection presenting to the First Department of Surgery at Toyama Medical and Pharmaceutical University Hospital were divided into 2 groups according to the presence or absence of complications such as electrocardiographic abnormalities, hepatic or renal dysfunction, intestinal necrosis, and leg ischemia. After hospitalization such complications were completely absent in the "complication-free group", but were present in the "complication group". Fluctuations in serum enzyme activity (CK, LDH, GOT, GPT) were measured, and the 2 groups compared. In the complication-free group, serum CK activity was significantly elevated at 273.3 +/- 154.5 IU/l, reaching a peak on the first day, after which it decreased to normal by the fourth day. In the complication group, fluctuations in the serum enzyme activity levels corresponded to the type of complication, with the fluctuations paralleling changes in the clinical course. Also, CK activity was measured in aortic wall specimens obtained at autopsy, and the CK activity of 585.0 +/- 35.3 IU/g protein demonstrated. From the above it was thought the transient elevation of serum CK activity found in uncomplicated aortic dissection is due to the CK released from the dissected aortic wall into blood.

Acute Disease↗
PubMedDate not supplied

Unusual presentation of dissecting aortic aneurysm.

Dissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.

Abdominal Pain↗
PubMed2006

Treatment methods for spinal cord injury caused by acute type B aortic dissection.

Acute distal aortic dissection rarely causes spinal cord ischemia presenting with paraplegia or paraparesis. Spinal cord involvement has poor outcomes, and there is no established effective treatment for this disorder. In this report we describe the acute conservative treatment of two cases of paraplegia/paraparesis due to acute type B aortic dissection. Early reversal of lower-limb dysmobility was achieved.

Aged↗
PubMed2003

DeBakey IIIb aortic dissection originating in a distal aortic arch aneurysm.

This report presents a case of DeBakey IIIb aortic dissection originating in a distal aortic arch fusiform aneurysm. The atherosclerotic change of the aneurysm was mild and the letter "C"-shaped intimal flap was turned over to obstruct the true lumen blood flow. A four-branched woven Dacron vascular prosthesis was implanted in a double barrel fashion. Although this case was successfully managed, an emergent operation should have been conducted.

Aortic Dissection↗