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PubMed1994

[Role of transesophageal echocardiography in aortic dissection].

Aortic dissection, especially type A, is a life-threatening condition, that requires a prompt and accurate diagnosis to ensure a rapid and precise therapeutic approach. Transesophageal echocardiography (TEE) is a highly reliable technique because of its sensitivity and specificity (near 100%; almost similar to nuclear magnetic resonance), and because it is a very low risk, rapid and easy diagnostic tool. Two hundred sixty-one patients were admitted at our institution in a 6-year period (1988-1994), because of a suspicion of aortic dissection. Two hundred forty-seven of them were submitted to TEE and the diagnosis was compared with surgical data in 124. There was only one false positive by TEE. Sensitivity of TEE vs surgery was 100%, specificity 93.7%, diagnostic accuracy 99%. Agreement between TEE and surgery in the setting of intimal tear was 69.2%. These data confirm the usefulness of TEE in the diagnostic approach to aortic dissection and the therapeutic decision, without using other methods.

Adolescent↗
PubMed1992

Aortic dissection.

Aortic dissection, once thought to be rare, is the most common catastrophe of the aorta, being twice as common as ruptured abdominal aortic aneurysm. In one Inner London borough, aortic dissection accounted for 4.2% of sudden deaths in men over a three-year period. Early diagnosis and prompt treatment are crucial to achieving a successful outcome, because the events that influence survival occur early in the course of the disease. Surgical repair of aortic dissection is an uncommon operation in the United Kingdom. The Cardiac Surgical Register for 1988 (the most recent year available for analysis) reveals that 208 operations were performed to replace the ascending aorta, 12 operations to replace the aortic arch and 15 operations on the descending aorta during that year.

Aged↗
PubMed2005

Aortic dissection.

Aortic root enlargement is generally asymptomatic, with few clinical clues, but may be observed as an incidental finding on a chest x-ray, echocardiogram, or contrast-enhanced computerized tomogram of the chest. Aortic dissection is one of the most feared complications of hypertension. A history of hypertension is commonly present, but the systolic blood pressure in type A dissection (proximal to the left subclavian artery) has been found to be less than 150 mm Hg in 64% of patients. However, 71% of type B dissections (distal to the left subclavian artery) present with a systolic blood pressure 150 mm Hg or higher (International Registry of Acute Aortic Dissection). Most frequently, onset of symptoms is in the daytime, especially between 6 a.m. and noon. Severe sharp chest pain that is abrupt in onset is the most likely presentation. Migrating pain is uncommon. Although a pulse deficit with decreased or absent carotid, brachial, or femoral pulses occurs in only 30% of patients, three or more deficits predict an in-house mortality of about 60%. A chest x-ray finding of a widened mediastinum is present in 62.6% of type A and 56% of type B dissections. Contrast-enhanced computerized tomography or transesophageal echocardiography is the most commonly performed procedure for diagnosis. In-house mortality has been found to be 32.5% in type A dissections and 13% in type B dissections.

Acute Disease↗
PubMed1988

[The place of radiologic research procedures in the diagnosis of aortic dissection].

Aortic dissection is a rare but life-threatening disease that requires a prompt and exact diagnosis. That is why the radiologist now assumes a central role due to the introduction of new imaging modalities. Each of them can make a contribution while having its own limitations. The choice of the right examination procedure and its correct application determine a successful radiological diagnosis. On the basis of experience with more than 150 operated patients we explain our diagnostic strategy in aortic dissection.

Aortic Dissection↗
PubMed1993

Crack and aortic dissection.

Aortic dissection represents a medical and, potentially, surgical emergency. Hypertension and cystic degeneration of the media are predisposing risk factors in the pathogenesis. Sporadic reports of aortic dissection in association with drug abuse especially crack cocaine are now appearing. We present such a patient whom we recently treated at University of Wisconsin Hospital.

Adult↗
PubMed1991

[Vascular complications associated with aortic dissection].

Aortic branch occlusion may constitute the mode of presentation or become an important focus of treatment in patients sustaining acute aortic dissection. The optimal therapeutic approach in patients with acute aortic dissection complicated by cerebral, visceral and peripheral vascular problems, and the implications of such complications, are not well established. We review the outcome in 187 consecutive patients (149 males and 38 females, mean age 58 years) with acute dissection of the thoracic aorta who were admitted and operated on in our department over a 13-year period. We assess the incidence, consequences and specific management of significant stenotic and obstructive lesions of the aorta and its branches. Noncardiac vascular complications occurred in 59 patients (32%); of these complications, 38 were associated with type A dissection (incidence 28%) and 21 with type B dissection (incidence 48%). A trend towards decreasing overall surgical mortality was observed in the second part of the study (1983-1989) compared with the first part (1977-1982) i.e. 28% versus 12%. Although aortic rupture and cardiac tamponade were the strongest correlate of morbidity and mortality, death specifically related to vascular complication was more common when such malperfusion occurred in the carotid, celio-mesenteric and renal circulation. Proximal aortic repair at the site of the intimal tear with obliteration of the false lumen may have restored adequate distal circulation in 27 patients in whom improvement of the visceral or peripheral ischemia was observed after the thoracic aortic repair. Additional procedures (immediately after the thoracic repair or later) were necessary in 15 patients to restore adequate perfusion in the compromised area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Management of familial aortic dissection.

Aortic dissection uncommonly occurs in multiple family members, and this association is most commonly seen in kindreds with Marfan's syndrome. There is increasing evidence that such connective tissue disturbances may not always appear in their complete phenotypic pattern. This report describes two siblings with aortic dissection. It is proposed that this suggests underlying connective tissue disease and warrants investigation of close relatives.

Adult↗
PubMed2000

Aortic dissection.

Aortic dissection is a life-threatening cardiovascular emergency requiring immediate diagnosis and treatment. It is mainly associated with hypertension and the Marfan syndrome. Diagnosis has been revolutionized by the use of transesophageal echocardiography (TEE), which allows for rapid and safe assessment of this condition. Echocardiographic hallmarks of aortic dissection ar the presence of a dissection membrane separating a true from a false lumen, rupture sites in the membrane with to-and-from flow, aortic regurgitation, and pericardial effusion. Dissection of the ascending aorta, which has an extremely high mortality and necessitates emergency surgery, is diagnosed quickly and accurately by TEE.

Aortic Dissection↗
PubMed1994

Late reoperations in patients with aortic dissection.

Aortic dissection is an evolving process that may require one or several reoperations after the initial emergency repair. From January 1977 to September 1993, 148 patients underwent emergency surgery for type A acute aortic dissection. The replacement of the ascending aorta was extended to include the transverse arch in 43 patients (29%). One hundred fifteen patients (78%) survived surgery. During the same period, 37 patients required reoperation once (28), twice (7), or three times (2), for a total of 48 reoperations. Twenty-one patients had undergone initial repair in our institution; 16 patients had been operated on elsewhere. Reoperation was indicated for: aortic valve disease (4); a new dissecting process (7); threatening aneurysmal evolution of a persisting dissection (34); or false aneurysm (3). The re-do procedure involved: the aortic root and/or ascending aorta in 12 cases (group I); the ascending aorta and the transverse arch in 6 cases (group II); the transverse arch alone in 8 cases (group III); the transverse arch and descending aorta, or the descending aorta alone in 11 cases (group IV); and the thoracoabdominal aorta in 11 cases (group V). Risk factors for reoperation were analyzed in the 115 survivors initially operated on at our institution. Seven of 20 Marfan patients (35%) versus 12 of 95 non-Marfan patients (12.6%) required reoperation (p < 0.02). None of the 31 patients surviving arch replacement at initial repair required a reoperation, versus 21 of 84 (25%) patients surviving replacement limited to the ascending aorta (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The diagnosis and management of aortic dissection.

Aortic dissection is a severe disease. Most untreated patients with types I and II (proximal) dissection and over half of those with type III (distal) dissection die within 1 year. Most of the deaths occur within 2 weeks and are caused by rupture, aortic insufficiency, and branch vessel obstruction. Aortic dissection is suspected in patients with anterior chest and back pain that progresses downward. Diagnosis is confirmed by computed tomography, aortography, or echocardiography. Appropriate medical treatment and corrective surgery, including total aortic replacement, performed in the acute and chronic stages, are now successful in over 90% of the cases; long-term results of treatment are steadily improving and are expected to exceed 50% at 10 years. The keys to a successful outcome are being aware of the symptoms of dissection, early diagnosis, and prompt application of appropriate treatment; diligent follow-up includes controlling blood pressure, decreasing the velocity of left ventricular contraction, monitoring the size of the residual aorta, and taking appropriate action if redissection, aneurysmal formation, or rupture occurs.

Acute Disease↗
PubMed1997

Stent angioplasty for renovascular disease associated with acute aortic dissection.

Aortic replacement was performed in a patient with acute type A aortic dissection originating from the descending thoracic aorta. Postoperatively, a persistent false lumen resulted in severe stenosis of the right renal artery. Percutaneous stent angioplasty improved renovascular hypertension and renal function. This procedure is useful for management of patients with branch complications of aortic dissection.

Aortic Dissection↗
PubMed1985

[Aortic dissection presenting aortic regurgitation induced by diastolic prolapse of an intimal flap into the left ventricle: a case report].

A case of aortic dissection associated with aortic regurgitation which was induced by diastolic prolapse of an intimal flap into the left ventricular outflow tract was reported. This 57-year-old man, referred for evaluation of sudden onset of chest oppression and a heart murmur, was hypertensive for several years. His admission blood pressure was 184/44 mmHg, and a systolic ejection murmur and a diastolic decrescendo murmur were audible along the left sternal border. Two-dimensional echocardiography revealed an intimal flap in the markedly enlarged aortic root. The intimal flap moved posteriorly in systole and anteriorly in diastole, and prolapsed into the left ventricular outflow tract during diastole. Associated with the movement of the intimal flap, an aortic cusp was shifted from its original position to the left ventricular outflow tract in diastole. Aortography disclosed type I aortic dissection and severe aortic regurgitation. After medical treatment for four months, the patient underwent a Bentall surgical procedure and recovered. Impaired coaptation of the aortic valve induced by diastolic prolapse of the intimal flap into the left ventricular outflow tract is a newly encountered echocardiographic finding in proximal aortic dissection.

Aortic Dissection↗
PubMed1992

[Aortic dissection after aortic valve replacement: clinical and anatomic features].

BACKGROUND: Cardiac surgery has become a possible cause of ascending aortic dissection, particularly in patients who have undergone aortic valve replacement. METHODS: From January 1979 to December 1989, 134 patients with angiographic evidence of aortic dissection, were studied in the Haemodinamic Laboratory of the University of Turin. Twelve of these patients (7 men and 5 women), mean age 51.6 years, had been previously operated for aortic valve replacement. We evaluated incidence, clinical and anatomic features of ascending aortic dissection in this group. RESULTS: A dilated ascending aorta with a mean diameter of 4.92 cm. was noted in all these patients. The interval between valve replacement and diagnosis of aortic dissection was 57 months (range 1 day to 9 years). Reoperation was performed in 11 patients. Four intraoperative deaths occurred and 2 other patients died in the early post-operative period. Survival rate at 12 months was 50%. Our incidence of ascending aortic dissection after aortic valve replacement was 0.66% (10 patients out of 1499 operated for aortic valve replacement) and it is in agreement with reports from other Authors in literature. CONCLUSIONS: Replacement of the ascending aorta must be considered if an important dilatation of aortic root is found at time of aortic valve surgery. New efforts must be undertaken to identify patients at high risk for this complication because an elevated mortality rate is observed in reoperation for aortic dissection.

Adult↗
PubMed1987

[Late aortic dissection after aortic valve substitution. Considerations on 5 operative cases].

This study analyses the clinical course of five patients who developed acute ascending aortic dissection 45.8 months (17-87 months) after aortic valve replacement (AVR) and underwent reoperation in our Department. All except one had aortic insufficiency with mild dilatation of the ascending aorta. No evidence of aortic wall degeneration was present at the time of AVR. Prostheses implanted were: Hancock 2, St. Jude 2, Bjork-Shiley 1. Associated procedures (coartectomy, coronary artery by-pass) were carried out in two patients. The dilated aorta was managed at the first operation by longitudinal resection in 3 of them. Emergent aortic dissection repair was performed: in 3 cases with composite graft according to the Bentall procedure, in one case with non valved dacron conduit and in the last case with teflon patch. Histological examination of the dissected aortic wall showed elastic fiber degeneration like cystic medial necrosis. Three patients survived surgical repair and are doing well at 22.4 months of mean post-operative follow-up. Surgical strategy of this complication is discussed; particular emphasis is given to the method of treatment of ascending aorta dilatation during AVR.

Adult↗
PubMed2000

Transition from classic aortic dissection to aortic intramural hemorrhage--a case report.

A 64-year-old man was hospitalized with chief complaints of chest and back pain. A diagnosis of Stanford type A aortic dissection with a false lumen extending from the ascending to the descending aorta was made based on the results of computed tomography (CT). A CT obtained the following day showed resolution of the false lumen and increased brightness of the aortic wall, typical of aortic dissection with intramural hemorrhage. Although previous studies have described a gradual transition from aortic intramural hemorrhage to aortic dissection with a false lumen, there are no reports of the transition from an aortic dissection with a false lumen to the intramural hemorrhage type of aortic dissection. This patient is of interest when considering the pathogenesis of aortic dissection with intramural hemorrhage and the relationship between the intramural hemorrhage and false-lumen types of aortic dissection.

Aortic Dissection↗
PubMed1987

[Color Doppler echocardiography in the diagnosis of aortic dissection and aortic wall abscesses].

In eleven patients with aortic dissection or perforated endocarditic aortic wall abscess cavity, the diagnostic usefulness of Color Doppler Echocardiography (CDE) for the identification of true and false lumen as well as the perforation jet was assessed by comparison with the findings of angiography, digital subtraction angiography, computed tomography and surgery. The information gained in addition to that of these procedures, as well as to that of the four conventional echocardiographic techniques was evaluated. Six patients had aortic dissections of DeBakey type I or III; in all of them the diagnosis had been established with conventional ultrasonic techniques. Similarly, in all patients with aortic dissection of DeBakey type I, a clear differentiation between true and false lumen in the aortic root and ascending aorta could already be made by grey-scaled echocardiography. In these patients, however, CDE made the additional demonstration of the perforation jet into the false lumen possible. In those three patients with aortic dissection of DeBakey type III as well as in the abdominal aortic region of DeBakey type I, color Doppler echocardiography was the only method to define true and false lumen and to clearly localize the perforation sites. Two further patients were found to have a small, local dissection, which could only be assumed by conventional echocardiography; the color Doppler M-mode image led to a clear diagnosis. In three patients an endocarditic abscess cavity of the aortic wall could be detected by conventional echocardiography. Two-dimensional color Doppler echocardiography additionally enabled us to visualize the presence and the course of perforation flows. In two patients color-coded Doppler echocardiography made it possible to detect perforations in regions which could not be localized either with conventional echocardiographic techniques or the above-mentioned control procedures.

Abscess↗
PubMed1998

Distribution of hyaluronan and dermatan/chondroitin sulfate proteoglycans in human aortic dissection.

Aortic dissections (AD) are characterized by the separation of the artery into two sheets, possibly due to fragility of the vessel wall. A mucoid histological pattern, imparted to the tissues mainly by hyaluronan and proteoglycans, can be seen in "cysts" and, in chronic cases, in a band of repair tissue. We studied the localization of hyaluronan, versican, decorin and biglycan in situ in aortas of 21 patients with recent AD, 8 with chronic AD and in 15 control cases. None of these substances was increased in the areas of mucoid "cysts" that possibly contain anomalous material. Similar distributions were seen in normal and dissected aortas: versican and hyaluronan were more prominent in the external half of the medial layer where the dissection usually occurs. Since these molecules play a role in resistance to compression, disorders not detected by our method may be involved in aortic dissection. Hyaluronan was seen adjacent to fibrin at the dissection tear, probably as an early wound repair phenomenon. Biglycan, hyaluronan and mostly versican are seen during advanced repairing. The mucoid deposits may represent various compounds which reflect different disorders in vascular biology.

Acute Disease↗