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PubMedDate not supplied

Transcatheter placement of an intraluminal prosthesis for the thoracic aorta. A new approach to aortic dissections.

A new aortic prosthesis (SAP, shape memory aortic prosthesis) was developed with its transfemoral placement system to treat aortic dissection with minimal invasion. The SAP consists of a Nitinol stent and polyurethane tube, and it is designed in such a configuration that it can be compressed inside a 14 Fr catheter when cold. It regains its original shape when warmed to 30 degrees C. From the results of intra-aortic sutureless placement of SAP in 10 mongrel dogs, we concluded that a SAP of proper diameter could be implanted safely for more than 3 months. The transfemoral placement system is composed of a delivery catheter, pushing rod, catching catheter, and pulling wire. Using these devices, transfemoral placement of SAP was demonstrated successfully in three dogs and one sheep. The original SAP and delivery system can be used as an emergency procedure for aortic dissections, such as Stanford type B. The advantages of the procedure are minimal invasion of acutely ill patients and prompt application in the catheter laboratory.

Alloys↗
PubMed2006

Aortic dissection complicating pregnancy following prophylactic aortic root replacement in a woman with Marfan syndrome.

Prophylactic aortic root replacement is the main factor explaining the increase in median probability of survival in Marfan syndrome (MFS) patients. In women with MFS, earlier root replacement has been suggested as a strategy to facilitate safe pregnancy. However, in this case report a pregnant patient with MFS who sustained a Type B aortic dissection in her second trimester, with fatal outcome, despite having had a prophylactic aortic root replacement five months prior to conception is described.

Adult↗
PubMed2005

Aortic dissection--an update.

Acute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. Rapid advances in noninvasive imaging technology have facilitated the early diagnosis of this condition and should be considered in the differential diagnosis of any patient with chest, back, or abdominal pain. Emergent surgery is the treatment for patients with type A dissection while optimal medical therapy is appropriate in patients with uncomplicated type B dissection. Adequate beta-blockade is the cornerstone of medical therapy. Patients who survive acute aortic dissection need long-term medical therapy with beta-blockers and statins and appropriate serial imaging follow-up. Future advances in this field include biomarkers in the early diagnosis of acute aortic dissection and presymptomatic diagnosis with genetic screening. Overall patients with aortic dissection are at high risk for an adverse outcome and need to be managed aggressively in hospital and long term with frequent follow-up.

Acute Disease↗
PubMed1987

Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results.

Operative treatment of dissections of the ascending aorta differs from that for the descending aorta, not only because of the need for cardiopulmonary bypass, but also because of the frequent occurrence of aortic valve insufficiency. To determine the early and late results of operative repair, we have reviewed the case histories of 121 consecutive patients who underwent repair of ascending aortic dissections between 1962 and 1985. Ages ranged from 16 to 79 years (mean 56 +/- 14 years); 54 patients had operation within 2 weeks of onset of symptoms (acute), and the remainder had later repair (chronic). Seventy patients (58%) had clinical evidence of aortic insufficiency at the time of admission. During repair of acute dissection, 10 patients (19%) had aortic valve resuspension and 15 patients (28%) had aortic valve replacement. During repair of chronic dissection, eight patients (12%) had resuspension and 43 patients (64%) had replacement. Overall operative mortality was 22%, significantly higher for patients with acute than for those with chronic dissections (39% versus 9%, p less than 0.01). Operative risk was similar for patients who underwent repair of ascending aortic dissections without valve resuspension or replacement (31%) versus those who had repair with aortic valve resuspension (17%) or replacement (17%). During a follow-up period ranging from 1 to 208 months, aortic regurgitation developed in only two patients who did not have aortic insufficiency at the time of repair. Late aortic regurgitation necessitating reoperation developed in one of the 15 survivors who had aortic valve resuspension. Eight patients undergoing aortic valve replacement had complications of their prostheses, including one periprosthetic leak and four mechanical failures. We conclude that resuspension or replacement of the aortic valve does not increase the risk of repair of ascending aortic dissections. Selective management of aortic insufficiency (with valve repair whenever possible) yields satisfactory long-term results.

Aortic Dissection↗
PubMed1983

[Continuous Döppler and aortic dissection. Apropos of 2 cases of protosystolic Döppler velocity wave anomalies in type I aortic dissections].

The diagnosis of dissection of the aorta is based on clinical examination, echocardiography and angiography of the aortic arch. Continuous Döppler ultrasonography may also be useful as a very suggestive abnormality of the wave form can be recorded from the dissected vessels, comprising a deep early mid systolic notch which gives the wave a double hump appearance. This phenomenon, observed in two type I dissections, was recorded from the right subclavian and vertebral arteries in the first case in which the initial components of the systolic wave of the right carotid artery were also amputated. In the second case, the phenomenon was recorded from all vessels arising from the aortic arch. The underlying mechanism could be herniation of the false into the true arterial lumen leading to temporary obstruction of systolic ejection. Another possibility is the successive recording of blood flow first in the true and then in the false lumen. Midsystolic Döppler abnormalities have also been described in aortic regurgitation, hypertrophic obstructive cardiomyopathy, atheromatous plaques causing a valve effect; however, the timing, morphology and extension of these abnormalities are quite different. In practice, the finding of this abnormality is an additional argument in favour of the diagnosis of dissection of the aorta. Continuous Döppler ultrasonography is also a good method of assessing the peripheral consequences of the dissection.

Aged↗
PubMed2006

Neurological symptoms in type A aortic dissections.

BACKGROUND AND PURPOSE: Aortic dissection typically presents with severe chest or back pain. Neurological symptoms may occur because of occlusion of supplying vessels or general hypotension. Especially in pain-free dissections diagnosis can be difficult and delayed. The purpose of this study is to analyze the association between type A aortic dissection and neurological symptoms. METHODS: Clinical records of 102 consecutive patients with aortic dissection (63% male, median age 58 years) over 7.5 years were analyzed for medical history, preoperative clinical characteristics, treatment and outcome with main emphasis on neurological symptoms. RESULTS: Thirty patients showed initial neurological symptoms (29%). Only two-thirds of them reported chest pain, and most patients without initial neurological symptoms experienced pain (94%). Neurological symptoms were attributable to ischemic stroke (16%), spinal cord ischemia (1%), ischemic neuropathy (11%), and hypoxic encephalopathy (2%). Other frequent symptoms were syncopes (6%) and seizures (3%). In half of the patients, neurological symptoms were transient. Postoperatively, neurological symptoms were found in 48% of all patients encompassing ischemic stroke (14%), spinal cord ischemia (4%), ischemic neuropathy (3%), hypoxic encephalopathy (8%), nerve compression (7%), and postoperative delirium (15%). Overall mortality was 23% and did not significantly differ between patients with and without initial neurological symptoms or complications. CONCLUSIONS: Aortic dissections might be missed in patients with neurological symptoms but without pain. Neurological findings in elderly hypertensive patients with asymmetrical pulses or cardiac murmur suggest dissection. Especially in patients considered for thrombolytic therapy in acute stroke further diagnostics is essential. Neurological symptoms are not necessarily associated with increased mortality.

Adolescent↗
PubMed1999

Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.

Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.

Aortic Dissection↗
PubMed2002

Impact of management of abdominal aortic dissection following the successful operation of annulo-aortic ectasia in Marfan's syndrome--a case report.

A 21-year-old female patient with Marfan's syndrome suffering from chronic ascending aortic dissection and aortic insufficiency was treated with total aortic root replacement by Cabrol technique (or procedure). The post-operative course was smooth and the patient recovered satisfactorily with very stable hemodynamic condition and good appetite. Unfortunately she complained of sudden severe abdominal pain followed by complete anuria on the fifth post-operative day. The MRI demonstrated abdominal aortic dissection with malperfusion of all the abdominal organs. Rapid increase of aminotransferases (SGOT and SGPT), severe acidosis and rapid deterioration of vital signs within 10 hours discouraged us from trying surgical intervention. The puzzle of management in those cases will be discussed.

Adult↗
PubMed1997

[Two cases of annulo-aortic ectasia with type A aortic dissection reconstructed by reimplantation of the aortic valve].

We performed aortic valve sparing operation in two cases of annulo-aortic ectasia combined with Type A aortic dissection. Marfan syndrome was found in one case and the dissection was acutely evolving in another case. The aortic valves were observed as normal configuration in both cases and then reimplanted within the synthetic grafts along with the David's procedure. No aortic regurgitation was found in the acute case but slight regurgitation was checked out in the Marfan case at the discharge. The aortic valve preserving operation for annulo-aortic ectasia was considered much effective in cases with aortic dissection in order to expect the thrombolization in the pseudo lumen.

Adult↗
PubMed1982

[Aortic dissection and Horton arteritis].

Aortic dissection in a 61-year-old woman treated symptomatically and with a fatal outcome within three months by extension to the arch of the aorta and its major vessels, and as a direct result of haemopericardium. The association with temporal arteritis, presenting before the aortic complication by prolonged headache with raised sedimentation rate and painful inflammation of both temporal arteries, was confirmed by histopathological examination of the aorta. This revealed giant cell arteritis independent of atheromatous lesions. The association of aortic dissection and temporal arteritis is very rare. Clinical and pathological examination of the smaller arteries and in particular the craniocephalic arteries is therefore justified in all cases of aortic dissection. When it affects the aorta, temporal arteritis may favor aortic dissection as a result of changes in the media.

Aortic Dissection↗
PubMed1994

[A case report of successful management of intraoperative aortic dissection during aorta-coronary bypass and aortic valve replacement].

A 70-year-old woman underwent aortic valve replacement and coronary artery bypass surgery with a saphenous vein graft for aortic regurgitation and 99% stenosis in the right coronary artery. During the period of weaning from the cardiopulmonary bypass enlargement of the ascending aorta and bleeding from the suture line were observed. The intraoperative diagnosis of ascending aortic dissection (DeBakey type I) was made with transesophageal and transthoracic echocardiography. Cardiopulmonary bypass was reinstituted and the patients was cooled to 20 degrees C. Under circulatory arrest and continuous retrograde cerebral perfusion through the superior vena cava the intimal tear at the point of infusion cannula was removed and the ascending aorta was reconstructed by direct suture bolstered with Teflon felt strips. Following completion of the repair no further dissection was seen, and the patient was successfully weaned from cardiopulmonary bypass. There were no signs of neurologic complications. Although intraoperative aortic dissection is uncommon, it can be a fatal iatrogenic complication of cardiac operations. Prompt recognition and surgical repair of the injuries are essential to achieve a successful outcome. The combination of transesophageal echocardiography and transthoracic echocardiography permits the immediate diagnosis of aortic dissection. And it is suggested that continuous retrograde cerebral perfusion through the superior vena cava protects the brain for 52 minutes of cerebral circulatory arrest at the lowest nasopharyngeal temperature of 18.7 degrees C. This technique is simple, and required neither special preoperative preparation or special equipment, so that it is suitable especially for intraoperative aortic dissection such as this case.

Aged↗
PubMed1997

[Successful surgical treatment for type B aortic dissection with Marfan's syndrome after aortic root and mitral valve replacement: report of a case].

A 30-year-old female with Marfan's syndrome underwent aortic root replacement for annuloaortic ectasia and mitral valve replacement for mitral regurgitation. She remained well until 16 months postoperatively when she had sudden onset of pain. Preoperative angiogram showed Stanford B aortic dissection. Thoracoabdominal aortic replacement was performed successfully under deep hypothermic bypass.

Adult↗