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PubMed1998

[Influence of acute aortic dissection on long-term results of aortic root reconstruction in patients with Marfan's syndrome].

Objective of this study is to evaluate influence of acute aortic dissection on long-term results of aortic root reconstruction in patients with Marfan's syndrome. 19 patients who underwent consecutive aortic root reconstruction between 1985 May to 1998 February were retrospectively reviewed. Patients who associated acute aortic dissection at the time of operation (group D, n = 7) were compared long-term results with those who did not (group non-D, n = 12). Mean follow-up period was 5.1 +/- 3.2 years and longest follow-up term was 12.5 years. In each group early postoperative death was found in one patient. In-hospital mortality in each group were respectively; 14.2% and 8.3%. Late deaths were found in four patients who all belonged to group D, respectively caused by; rupture of thoracoabdominal aneurysm, DIC after subsequent thoracoabdominal surgery, sepsis due to prosthetic valve endocarditis, and sudden death. Actuarial overall survival rate including operative death in D and non-D group were respectively; 0.0 +/- 0% at 6.6 years and 91.1 +/- 8.0% at 12 years. Overall cumulative survival rate was 56.6 +/- 14.0%. Freedom from cardiovascular events, in D and non-D group were respectively; 0.0 +/- 0% at 6.6 years and 60.0 +/- 25.3%, and freedom free form dilatation of residual aorta were respectively; 0.0 +/- 0% at 6.6 years and 100.0 +/- 0% at 12 years. Freedom from subsequent cardiovascular surgery in group D, group non-D and over-all patients were respectively; 0.0 +/- 0% at 6.6 years, 60.0 +/- 25.3% at 12 years and 42.6 +/- 20.2%. In this study, acute aortic dissection in Marfan's syndrome significantly increased late cardiovascular events including dilatation of residual aorta, subsequent aortic surgery and late mortality. On the other hand, excellent long-term results after aortic root reconstruction were found in non-dissection Marfan's syndrome. Considering high incidence of late dilatation of residual aorta, simultaneous total arch replacement with aortic root reconstruction is recommended in acute dissecting Marfan's syndrome. Whereas, preventive simultaneous arch replacement is not required in non-dissecting Marfan's syndrome because of less postoperative vascular events.

Acute Disease↗
PubMed1986

Aortic dissection during pregnancy.

Aortic dissection occurred in a nineteen year old woman during the thirty seventh week of pregnancy. Immediate elective delivery of a normal baby by caesarean section was followed by aortic root replacement 48 hours later. It was decided not to proceed immediately to operation on the aortic root because it was believed that the anticoagulation necessary for cardiopulmonary bypass might provoke dangerous haemorrhage from the raw placental site.

Adult↗
PubMed1979

Unsuspected aortic dissection: the chronic "healed" dissection.

Of all aortic dissections, 10% are chronic. Typically they arise distal to the left subclavian artery and have reentry points into the true lumen. Pain may be minimal or absent and patients often present with cardiac failure. Chronic dissections are more likely to appear radiographically as atherosclerotic aneurysms on a chest film than are acute dissections. Four cases of chronic dissections found incidentally during angiography are presented.

Acute Disease↗
PubMed1995

Surgery for acute ascending aortic dissection: closed versus open distal aortic repair.

One hundred twelve consecutive patients with acute ascending aortic dissection and submitted to immediate surgery were retrospectively analyzed with regard to perioperative mortality and morbidity. The patients were divided into two groups according to whether distal aortic repair was carried out by the open procedure (using deep hypothermic circulatory arrest, group A: 68 patients) or by the closed technique (without circulatory arrest, group B: 44 patients). Patients' ages ranged from 24 to 78 years (mean 57.4 years). No significant difference was found between the two groups in terms of age and sex distribution. However, the prevalence in the extent of clinical and anatomical alterations was significantly higher in group A (hemodynamic instability, pericardial tamponade and neurological deficit). The duration of hypothermic circulatory arrest for group A patients averaged 25 min and ranged from 12 to 65 min. The overall perioperative mortality was 17% (19/112 patients); it was 20.6% (14/68) in group A and 11.4% (5/44) in group B; the difference was not statistically significant but consistent with a clear trend. The trend towards a higher mortality in group A mainly reflected the more severe and complex anatomical characteristics and could not be attributed to the circulatory arrest per se. The period of deep hypothermic circulatory arrest in the survivors (25 min) was similar to that of the group with lethal outcome (32 min). Among the non-lethal complications, however, group A patients more frequently showed clinical signs consistent with cerebral injury: apart from the transient symptoms suggestive in reversible diffuse cerebral damage, five patients in group A had a permanent focal neurological deficit (versus one patient in group B).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Sudden death associated with bloodless aortic dissection.

We report a case of rapidly fatal aortic dissection which was unusual because no intimal tear was present and no blood was present in the dissected aortic wall, although the dissection involved the entire aorta. Death was considered to be due to acute myocardial ischaemia from dissection involving the left coronary artery. Prominent cystic medial necrosis was present. There was no history of hypertension and only histological evidence of left ventricular hypertrophy. No other clinical or pathologic states associated with aortic dissection were present. Although cystic medionecrosis was the probable cause in this case, it is present in only a small proportion of patients in the absence of Marfan's syndrome, and more recently investigated defects in the composition of aortic wall connective tissue components may be more relevant factors in the causation of many cases of aortic dissection.

Aortic Dissection↗
PubMed2005

Role of transesophageal echocardiography in patients with suspected aortic dissection.

Patients with acute aortic dissection of the ascending aorta benefit from rapid surgical intervention. We report a patient with suspected acute aortic dissection based on history and transthoracic echocardiography findings. This patient was taken to the operating room without further workup, where transesophageal echocardiography (TEE) revealed acute myocardial infarction and mitral regurgitation due to papillary muscle rupture. The patient underwent coronary bypass grafting and mitral valve replacement. This case demonstrates that intraoperative TEE can be used as a primary diagnostic modality to rule out aortic dissection, and can provide a definitive etiology for cardiogenic shock before a planned surgical intervention.

Aged↗
PubMed2006

Acute aortic dissection during pregnancy.

Acute aortic dissection is one of the most dreaded clinical conditions during pregnancy. Difficulties in establishing a diagnosis and limitations regarding invasive studies increase mortality rates associated with the disease. The limited experience reported in the literature does not allow the determination of guidelines for clinical and/or surgical management of aortic dissection in pregnancy. The authors present a case of acute aortic dissection in a woman in her 33rd week of gestation and discuss the diagnostic approach considering the peculiarities of the diseases manifestation.

Acute Disease↗
PubMed2004

Paraparesis as the major initial presentation of aortic dissection: report of four cases.

Aortic dissection, which typically manifests as sudden tearing or migratory pain, is a well-known medical emergency. However, in 5% of aortic dissection patients, there is no pain. In these patients, the diagnosis depends on the development of neurologic complications. After analyzing the initial symptoms of a series of patients with aortic dissection, we found 4/211 (1.9%) patients suffered from paraparesis. We suggested that the mid- or low thoracic cord be most vulnerable site during acute aortic dissection. This report highlighted the importance of considering the diagnosis of aortic dissection in a patient with a history of acute onset of transient or permanent neurological symptoms in the lower limbs. Whether paraparesis can be an indicator of the prognosis of aortic dissection requires further researches.

Aged↗
PubMed2003

Acute type A aortic dissection complicated with acute inferior myocardial infarction following aortic valve replacement.

Acute aortic dissection complicated with acute myocardial infarction (AMI) is the most fatal situation. We experienced the successful treatment for acute type A aortic dissection complicated with inferior AMI following aortic valve replacement (AVR). A 60-year-old man had had AVR for aortic regurgitation. Sixteen months after the AVR, he had a sudden onset of severe chest pain with complete atrioventricular block. Immediately, temporary pacing and cardiac catheterization were conducted, showing the occlusion of the right coronary artery due to acute type A aortic dissection. On his way to our hospital, direct current shock was conducted 3 times for ventricular fibrillation. We replaced the ascending aorta combined with coronary artery bypass grafting and the postoperative course was uneventful. The key to treat acute aortic dissection complicated with AMI is early accurate diagnosis, prompt temporary pacing for bradycardia, defibrillation for lethal arrhythmia and insertion of a perfusion catheter if possible. These preoperative hemodynamic stabilization gives us the chance to save these patients.

Aortic Dissection↗
PubMed2004

Aortic dissection in pregnancy.

BACKGROUND: Aortic dissection is a rare but life-threatening disease. The most common predisposing cause is chronic hypertension. CASE: A 38-year-old multipara with chronic hypertension was admitted at 38 weeks of gestation reporting new-onset severe chest pain. Cardiac enzymes, blood gases, electrocardiogram, and chest radiograph were normal. The chest pain and the hypertension worsened despite treatment with narcotics. Bedside transesophageal echocardiography revealed aortic dissection. Uneventful cesarean delivery was followed by surgical repair of the aorta. CONCLUSION: Aortic dissection should be considered when a pregnant woman presents with preeclampsia superimposed on chronic hypertension and intractable chest pain.

Adult↗
PubMed2002

Dissected aortic sinuses repaired with gelatin-resorcin-formaldehyde (GRF) glue are not stable on follow up.

BACKGROUND AND AIM OF THE STUDY: The chemical glue, gelatin, resorcin and formaldehyde (GRF) is widely used to obliterate the false lumen of acute dissected aortic wall tissue. METHODS: A retrospective review of 41 consecutive patients operated upon for ascending aortic dissection between 1993 and 2000 was conducted. This study focused on 19 patients with acute aortic dissection in whom the aortic valve was resuspended and GRF glue used in the proximal aortic sinuses. These patients were compared with ascending aortic dissection patients in whom the aortic valve was not resuspended. In total, nine acute and 13 chronic dissections were performed in which aortic valve replacement, valve-sparing root reconstruction (without GRF glue), or no aortic valve surgery was carried out. RESULTS: The operative mortality for ascending aortic dissections was 24.4%; identified risk factors included the specific surgeon involved. Third-degree heart block occurred only in patients in whom GRF glue was used in the proximal aortic sinus (15% incidence). Operative survivors in whom the aortic valve was resuspended and GRF glue used in the proximal aortic sinus, had a 64% incidence of late recurrent aortic regurgitation requiring reoperation due to recurrent aortic sinus aneurysm formation with or without recurrent proximal aortic dissection. No recurrence of aortic regurgitation or proximal disease occurred in the other two groups (p <0.01). Actuarial survival of patients in whom the aortic valve was resuspended with GRF glue was 52.1+/-11.6% at five years and 27.8+/-14.3% at eight years, compared with 55.6+/-16.6% at five years if the aortic valve was not resuspended using GRF glue. CONCLUSION: The use of GRF glue to repair acute dissected aortic sinuses combined with the resuspension of the aortic valve is associated with an unacceptable incidence of failure of aortic valve repair and recurrence of aortic regurgitation. It may be more appropriate to resect all acute dissected aortic sinus tissue.

Acute Disease↗
PubMed2005

Predictors of in-hospital mortality in patients with acute aortic dissection.

BACKGROUND: If acute aortic dissection is a highly lethal disease. There were few reports addressing predictors of in-hospital mortality of this disease in southern Taiwan. METHODS: If from January 1, 1989, to December 31, 2001, patients with acute aortic dissection were enrolled. Patient demographics, history, clinical characteristics, and laboratory examinations were reviewed. Univariate testing followed by logistic regression analysis was performed to identify the predictors of in-hospital mortality. RESULTS: If in total, 198 (146 male) patients with mean age of 60.7+/-11.6 years were enrolled. The in-hospital mortality rate was 34.8% in overall patients, 58.8% for type A dissection, and 14.8% for type B dissection. There were five independent predictors of in-hospital mortality: presence of hypertension [odds ratio (OR)=0.09, 95% confidence interval (CI)=0.02-0.36, p<0.001], type A dissection (OR=8.26, 95% CI=3.44-19.60, p<0.001), probable extravasation (pericardial effusion in type A dissection or left side pleural effusion in patients with involvement of descending thoracic aorta) (OR=2.70, 95% CI=1.14-6.41, p=0.024), visible intimal flap in ascending aorta in trans-thoracic echocardiography (OR=4.46, 95% CI=1.58-12.60, p=0.005), and acute renal deterioration (OR=3.85, 95% CI=1.36-10.87, p=0.011). CONCLUSIONS: If acute aortic dissection, especially type A, is with high mortality in southern Taiwan. There are five independent predictors of in-hospital mortality found in current analysis. Our result may remind doctors to find out their patients at high risk. Trans-thoracic echocardiography is a useful tool to find out patients at high risk because it is easily performed to check if there is pericardial effusion or visible intimal flap in ascending aorta.

Acute Disease↗
PubMed2004

Endoluminal and surgical treatment for the management of Stanford Type A aortic dissection.

Stanford Type A aortic dissection is a life-threatening disease. A 46-year-old female patient with Stanford Type A aortic dissection was successfully treated by placing a stent-graft into the ascending aorta via femoral artery. No complication was found immediately after the operation. Bentall operation was performed to treat the development of severe aortic insufficiency 21 months after the stent-grafting procedure. Literature review was done to discuss the possibility of using endoluminal stent placement to treat Stanford Type A aortic dissection.

Aortic Dissection↗
PubMed1995

Management of aortic dissection.

Patients with aortic dissection are divided into two main groups: those with hypertension and those with syndromes involving hereditary defects of the aortic wall. The common finding in the setting of both Marfan syndrome and hypertension is dilatation of the aorta. The biological events that may lead to dissection are a decrease in the holding power of the internal layer, an increase in blood pressure, or an increase in aortic diameter combined with a decrease in wall thickness. Treatment of established acute type A dissection is still associated with a hospital mortality of greater than 10% and long-term complications from persistent blood flow in the distal false lumen. The main therapeutic challenge is to prevent aortic dissection by screening of aortic root diameter in patients at risk, together with life-long beta-blockade for Marfan patients. In patients with suspected dissection, the preference is for rapid noninvasive diagnosis and early surgical repair to reduce the risk of malperfusion and irreversible organ damage. Results of surgery have improved, with an increasingly conservative approach to repair of the aortic valve with biological glues. Repair is now routinely carried into the aortic arch using improved methods of cerebral protection such as retrograde cerebral perfusion through the superior vena cava. Nevertheless, there remains scope for further innovation in the prevention and treatment of this difficult problem.

Aortic Dissection↗