SEARCH · PubMed Health

Results for “Aortic Dissection”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources

PubMed1998

Two cases of unexpected sudden death due to cystic medionecrosis of the aorta associated with bloodless aortic dissection.

The autopsy findings from two rare cases of sudden death concerning a 31- and a 44-year-old woman are reported. Autopsy and morphological examination revealed a dissection of the aorta but no rupture into the pericardial sac. In both cases mucoid deposits in all layers of the media and rarefication of the elastic fibers were found, rendering cystic medionecrosis as the cause of the aortic dissection. In these unusual cases, only a very small intimal tear was present, but no blood in the dissected aortic wall. Evidence of left ventricular hypertrophy and a history of hypertension were reported in both cases. No extension of the aortic dissections into the left or right coronary artery and no other clinical or pathological findings associated with aortic dissection were present. Cystic medionecrosis was the cause of the aortic dissection in these cases. The mechanism of death in both cases is discussed.

Adult↗

PubMed1991

[Two cases of dissecting aortic aneurysm associated with the right-sided aortic arch].

Two cases of dissecting aortic aneurysm with the right-sided aortic arch were reported. Aortography and chest CT demonstrated DeBakey IIIb dissecting aortic aneurysm in association with the right aortic arch and aberrant left subclavian artery arising from the diverticulum of Kommerell in two cases. In the first patient, a 47-year-old male, the intimal tear was repaired with patch grafting under the femoro-femoral bypass using centrifugal pump. Although the dissected lumen was completely closed with thrombus, paraplegia occurred and its recovery was unsatisfactory. In the second patient, a 53-year-old male, maintained on antihypertensive medication for one month, he expired at home 17 days after discharge. Since this type of dissecting aortic aneurysm is extremely rare, nine reported cases, including our two cases, are reviewed. Accurate diagnosis and careful surgical treatments of this disease are mandatory to obtain the satisfactory outcome.

Aortic Dissection↗

PubMed1993

Retrograde ascending aortic dissection: a diagnostic and therapeutic challenge.

Aortic dissection with an entrance tear in the transverse aorta is generally considered to have the highest acute fatality rate of any type of dissection and the direction of its extension is the most difficult to predict. In a prospective study, we evaluated 61 consecutive patients (mean age 56.7 years, ranging from 21 to 75 years), presenting with ascending aortic dissection during a 36-month-period and tried to clarify the incidence of retrograde ascending aortic dissection. In 49 patients (80.3%), the intimal tear was located in the ascending aorta, whereas the dissection originated in the transverse aorta in 12 patients (19.7%); in this latter group, extension was strictly retrograde in 5 patients and in both directions in 7 patients. Three patients died before operation; 58 patients underwent aortic replacement/repair under moderate hypothermia; if the primary tear extended into the transverse aorta or was not found in the ascending aorta, the aortic arch was explored during a brief period of deep hypothermic circulatory arrest. The overall operative mortality was 12.1% (7/58); it was 10.4% (5/48) in ascending aortic dissection and 20% (2/10) in dissection of the transverse aorta. Age (P < 0.005), concomitant coronary artery disease (P < 0.01) and the site of intimal tear (P < 0.01) were significant predictive factors of operative risk. A tear in the transverse aorta is almost always associated with retrograde dissection and may simulate dissection with the entrance tear in the ascending aorta. Localization of the entrance tear remains a diagnostic challenge in aortic dissection but Doppler-echocardiography had a high sensitivity in this series (96.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

Glue aortoplasty repair of aortic dissection after coronary angioplasty.

Aortic dissection complicating percutaneous transluminal coronary angioplasty is rare. We report the case of a 45-year-old man who after right coronary artery angioplasty with stenting, dissected that vessel to involve the aorta to the bifurcation. Surgical repair with Gelatin-Resorcinol-Formaldehyde (GRF) glue as opposed to prosthetic graft replacement of the ascending aorta was successful. The use of GRF glue is effective in the surgical treatment of aortic dissection after coronary angioplasty.

Aortic Dissection↗

PubMed2003

[Role of transesophageal echocardiography in the diagnosis of aortic dissection. Report of 5 cases].

Aortic dissection is medical and surgical emergency. About 5 cases, the authors emphasized the role of transesophageal echocardiography in the diagnosis of aortic dissection. For all patients we realized a clinical examination, electrocardiogram, chest X ray, thoracic and transesophageal echocardiography and laboratory studies. Echocardiography were performed by an apparatus Hewlett Packard sonos 1000 with colour doppler and multiplanar transesophageal. Transesophageal echocardiography made the diagnosis by showing dilatation of aorta, intimal flap, false channel; this exam also allow to classify the aortic dissection.

Adult↗

PubMed2001

Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome.

BACKGROUND: Acute myocardial ischemia and infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. Surgical treatment of these patients relies on the re-establishment of an adequate coronary blood flow and on the rescue of jeopardized myocardium. This article reports the results of a selected group of 24 patients with type A acute aortic dissection and coronary artery dissection. We review our experience and illustrate our approach to this condition, which evolved over a 15-year period. METHODS: Between July 1985 and March 2000, 24 patients from a total of 211 (11.3%) treated for acute type A aortic dissection had dissection of at least one of the coronary ostia. There were 14 men and 10 women. The mean age was 65.5 years (median 61.7; range 41-78 years). The right coronary artery was involved in 11 patients, the left in 4 patients, and both coronary arteries in 9 patients. At admission, 16 patients had Q waves (66%), inferior in 6 (25%) and anterior, lateral, septal, or posterior in 10 (41%). All procedures were done on an emergency basis within 10 hours (median 4 hours) after initial chest pain and within 2 hours after the patient's arrival. RESULTS: Hospital mortality was 20% (5 patients); 3 patients could not be weaned from cardiopulmonary bypass and died intraoperatively, and 2 patients died postoperatively of low cardiac output. CONCLUSIONS: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

Adult↗

PubMed1992

Asymmetric abnormality of renal perfusion with symmetric function in aortic dissection.

Two cases of aortic dissection are presented in which discordance between renal perfusion and function has been demonstrated with Tc-99m DTPA. Renal perfusion on the affected side was decreased on blood flow imaging, whereas renal function, including parenchymal accumulation and excretion assessed by subsequent sequential imaging, were similar for both kidneys. These results suggest that blood flow imaging more readily demonstrates a unilateral renal abnormality in patients with aortic dissection.

Aortic Dissection↗

PubMed1996

Retrograde ascending aortic dissection diagnosed by intraoperative transesophageal echocardiography.

Aortic dissection is a risky but challenging cardiovascular emergency and rapid surgical intervention for life-saving is sometimes inevitable. For detection of aortic dissection, computed tomography, magnetic resonance imaging, aortography all have their advantages but all have their limitations. Transesophageal echocardiography (TEE), which is portable and relatively noninvasive, is a highly sensitive and specific diagnostic tool for evaluation of aortic diseases. We presented a case in which preoperative imaging studies such as MRI and cardiac catheterization were all suggestive of DeBakey's type I aortic dissection. However, it was further proved to be a retrograde ascending aortic dissection during intraoperative TEE imaging study as a retrograde ascending blood flow was demonstrated within the dissected aortic lumen. So the initial operative scheme was changed and sternothoracoabdominal incision was selected for better exposure for one-stage repair of the entire thoracic aorta. Nevertheless, severe intrathoracic adhesion and case to bleed prevented any aggressive intervention to proceed. The operation was called off and the patient was transferred to ICU for further medical treatment.

Aged↗

PubMed1987

[An experimental and clinical study on the dissecting aortic aneurysm--usefulness of magnetic resonance imaging and the ultrasonic pulsed Doppler duplex system].

In the treatment of dissecting aortic aneurysm, it is important to understand the exact conditions of the disease. For this purpose Aortography (AOG) and X-ray computerized tomography (CT) have been used. Magnetic Resonance Imaging (MRI) and the ultrasonic pulsed Doppler duplex system are completely non-invasive and may be used instead of AOG and CT. Experimental aortic dissection was done surgically using modified Blanton's method in 8 mongrel dogs. MRI and the ultrasonic pulsed Doppler duplex system were used on these dogs before and after surgery which consisted of surgical closure of entry and insertion of Ivalon Sponge to false lumen. MRI patterns were classified into three: i.e., low, middle, and high intensity. The ultrasonic pulsed Doppler duplex system patterns were classified into four: i.e., normal flow, to and fro, turbulent flow and wall motion patterns respectively. These patterns of MRI and the ultrasonic pulsed Doppler duplex system were closely correlated to autopsy findings. These results indicated that MRI and the ultrasonic pulsed Doppler duplex system are useful to evaluate the changes of figures and hemodynamics of the false lumen. In the clinical study, MRI was performed on 26 patients of dissecting aortic aneurysm before and after surgery. These results were compared with those of AOG and CT. In the detection of the intimal flap, the main arterial branches, and the location of the entry and reentry, MRI was superior to CT and almost equal to AOG.

Aortic Dissection↗

PubMed1993

[Giant cell arteritis and aortic dissection in 2 siblings].

We present the case of two female siblings with temporal arteritis, polymyalgia and type B aortic dissection. Aortic aneurysms in families are well known in Marfan's and Ehlers-Danlos syndrome; they can, however, occur without signs of a collagen disorder. In patients with arteritis temporalis the incidence of aortic aneurysms is higher than normal. In a retrospective survey of 20,591 autopsies there were 443 aortic aneurysms (2%), 30 (7%) being a consequence of arteritis. Arteritic processes caused 15% of the thoracic and 5% of the abdominal aneurysms. This is the first description of temporal arteritis, polymyalgia and aortic dissection in siblings. The observation illustrates the danger of aneurysmatic aortic dilatation and/or dissection at a later or chronic stage of arteritis.

Aged↗

PubMed1997

Open distal anastomosis in retrograde cerebral perfusion for repair of ascending aortic dissection.

BACKGROUND: In patients with aortic dissection, a patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of performing an open distal anastomosis using retrograde cerebral perfusion. METHODS: Over a 10-year period, 41 patients with acute type A aortic dissection underwent 43 surgical repairs. In 1991, an open distal anastomosis using retrograde cerebral perfusion (group 2) was introduced to replace the standard aortic cross-clamp method (group 1). The mean retrograde cerebral perfusion time was 47.3 minutes (range, 22 to 67 minutes), and there were no neurologic sequelae in surviving patients. RESULTS: The operative mortality rate was 18.5% in group 1 and 18.7% in group 2. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 9 of 18 patients (50%) in group 1, and 2 patients died of aortic rupture. There were no deaths in group 2, and dilatation of the distal false lumen occurred in only 15.4% of patients (p < 0.05). CONCLUSIONS: The use of retrograde cerebral perfusion in patients with acute aortic dissection provides adequate time to perform a safe, open, distal anastomosis, and could decrease significantly the rate of enlarged, patent, false lumina.

Acute Disease↗

PubMed1992

Aortic dissection as complication of percutaneous transluminal coronary angioplasty.

We report two cases of aortic dissection during coronary angioplasty with a disparate evolution that was due to the different location of the entry port of the dissection. Aortic dissection occurring during coronary angioplasty may be self-limiting, but it may also be life-threatening and may call for urgent surgical repair.

Aortic Dissection↗

PubMed2005

[Current treatment of acute type A aortic dissection. Surgical treatment and treatment of malperfusion syndrome].

Acute type A aortic dissection is a surgical emergency. Treatment is based on dissected ascending aortic replacement and correction of an associated aortic insufficiency. Catheterization of the axillary artery, open distal anastomosis and systematic resection of the intimal tear are the main surgical evolutions of the last years. They allowed to significantly reduce intraoperative mortality rate particularly due to bleeding. Thirty days mortality rate of operated aortic dissection is about 20 to 30%. Visceral malperfusion syndromes induced by aortic dissection represent an important cause of postoperative death. An early diagnosis and treatment appears necessary. Thoracoabdominal CT scan allows understanding mechanisms inducing malperfusion. Aortography and an emergency endovascular procedure allow restoring arterial blood flow before renal or mesenteric irreversible ischemia. Collaboration between radiologist, anesthesiologist and surgeon is necessary to optimize survival of acute type A aortic dissection.

Acute Disease↗

PubMed2000

[Minimally invasive therapy options in aortic dissections].

Current day therapy for aortic dissection is aimed at the relief of branch vessel ischemia and the prevention of aortic rupture or aneurysm formation. Malperfusion complicating aortic dissection has historically been treated by surgery. Operations in patients with branch-vessel involvement may be technically difficult and the operative mortality is reported to be between 25% and 51%. This may rise to above 70% in patients with critical mesenteric or renal ischemia. Over the past decade, successful relief of such ischemia using the interventional radiological techniques of balloon fenestration, stent implantation and/or thrombolysis has been reported. In addition to being less invasive, this approach is associated with a lower mortality, ranging between 0% and 25%. Patency of the false lumen increases the probability of aortic rupture or aneurysm formation. Recent studies have reported successful closure of the proximal entry site with the help of stent grafts. The aim of the intervention is to initiate a thrombosis of the false lumen and thus stabilize the dissection. Based on a review of the literature and our own experience, we discuss the percutaneous management of branch vessel ischemia complicating aortic dissection as well as the role of stent graft implantation in patients with aortic dissection.

Aortic Dissection↗

PubMedDate not supplied

Transesophageal echocardiographic diagnosis of thoracic aortic dissection with the completely thrombosed false lumen: differentiation from true aortic aneurysm with mural thrombus.

The conventional criteria of aortic dissection with a completely thrombosed false lumen by transesophageal echocardiography is separation of the intima from the layer of thrombus; however, it is not always easy to distinguish from true aortic aneurysm with mural thrombus. Thus we proposed a new transesophageal echocardiographic diagnostic criteria. Seventeen operative patients with suspected subacute or chronic thoracic aortic dissection in whom it was difficult to exclude true aortic aneurysm with mural thrombus underwent transesophageal echocardiography. In thoracic aortic dissection with in completely thrombosed false lumen, the inner lesion surface composed of intima may be smooth and crescent-shaped thrombus may appear inside the wall surface. Therefore our criteria were on the basis of any two of the following: (1) high-echogenic lesion surface, suggesting intima, over the thrombus, (2) smooth lesion surface, and (3) crescent-shaped thrombus. Imaging data were referenced to intraoperative findings. According to the present criteria only two out of 17 patients were misdiagnosed, whereas according to the conventional criteria six patients were misdiagnosed. The sensitivity was significantly higher than when the conventional criteria were used (90% versus 40%; p < 0.05), whereas the specificity was similar. We conclude that the present transesophageal echocardiographic criteria for detection of thoracic aortic dissection with a completely thrombosed false lumen is clinically useful.

Aortic Dissection↗

PubMed1994

[A case report of type A acute aortic dissection, which arose from true aneurysm in aortic arch].

A 69-year-old woman was admitted to our hospital because of back pain. Examinations showed type A acute aortic dissection, which arose from true aneurysm in aortic arch, and emergency operation was considered. Deep hypothermic selective cerebral perfusion was carried out for brain protection. Ascending to aortic arch was replaced with 24 mm woven Dacron graft. There was no postoperative neurological complication.

Acute Disease↗

PubMed1976

Ascending vs descending aortic dissections.

One hundred eight patients with spontaneously developing thoracic aortic dissection were seen between 1966-1973, 78 of whom had acute dissection and 30 chronic. The age (49 vs 60 yrs) and incidence of hypertension (32% vs 71%) were significantly lower in the 56 patients in whom dissection originated in ascending aorta than in the 52 patients in whom the dissection originated in the upper descending aorta. The mortality rate in medically treated patients with acute ascending aortic dissection was 88%. Cardiac tamponade was the major cause of death. The mortality rate was significantly lower in those who were treated surgically (24%). Fifteen (54%) of the patients with ascending aortic dissection and significant aortic incompetence did not have aortic valve replacement and only two subsequently (53 and 92 months later) required valve replacement. Although the initial mortality in patients with acute descending aortic dissection treated medically and surgically was similar, the long term survival rate was higher in the surgically treated group. We conclude that ascending aortic dissection and descending aortic dissection have different clinical profiles and prognoses. Immediate surgical intervention is indicated in patients with acute ascending aortic dissection. Patients with acute descending aortic dissection can be treated medically initially followed by early elective operation.

Acute Disease↗

PubMed2002

The presenting chest roentgenogram in acute type A aortic dissection: a multidisciplinary study.

Acute type A aortic dissection requires early diagnosis and prompt surgical intervention. It is not entirely clear whether patients with this form of dissection have clear-cut chest roentgenogram (CXR) patterns or whether the CXR can guide the physician in directing further workup for acute aortic dissection. The purpose of this study is to evaluate the impact of the initial CXR in arousing suspicion for acute type A aortic dissection. Twelve physicians from four specialties (emergency medicine, radiology, cardiology, and cardiothoracic surgery) evaluated the presenting CXR of ten patients with acute type A aortic dissection and the CXRs of ten normal individuals in a blinded manner. They were asked whether the CXRs were normal or abnormal (part A) and what the findings were and then were asked whether the CXRs were suspicious for acute aortic dissection (part B) and what the findings were. In part A, of the normal CXRs 81 of 120 (68%) readings were recorded as normal. Of the dissection CXRs 112 of 120 (93%) readings were recorded as abnormal (P < 0.001). In part B, the physicians were asked specifically about suspicion for aortic dissection. Of the normal CXRs 101 of 120 (84%) readings were listed as not suspicious for dissection (i.e., 16% of the normal CXRs were listed as supsicious for dissection). Of the dissection CXRs 88 of 120 (73%) readings were recorded as suspicious for dissection (p < 0.001). The most frequent findings on a dissection CXR when physicians were specifically asked about dissection included widened mediastinum in 46 of 120 (38%) followed by not suspicious for dissection in 32 of 120 (27%). Among the physician specialties the only statistically significant finding was that the cardiology group was the most likely group to find an abnormality in a "normal" CXR. This data indicates that the presenting CXR is neither sensitive nor specific for acute type A dissection. In a patient with a suspicious history or physical examination, however, a CXR showing mediastinal widening or other aortic abnormalities should increase the suspicion for dissection and warrant further workup. Furthermore in a patient with a clinical suspicion a normal CXR reading should not delay echocardiography to rule out type A dissection.

Acute Disease↗