PubMed Health⌕ Search

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 523 records · Page 29Linked to original sources
PubMed2005

Acute aortic dissection presenting with primarily abdominal pain: a rare manifestation of a deadly disease.

The objective of this study was to determine the morbidity and mortality of patients with acute thoracic aortic dissections who present primarily with abdominal pain. Nine hundred ninety-two patients (mean age, 62.1 years +/- 14.1; 68% male) encountered from 1996 to 2001 with acute thoracic aortic dissections from the International Registry of acute Aortic Dissection were studied. Patient demographics, presenting symptoms, signs of aortic dissection, aortic pathology, and mortality were compared in patients presenting primarily with abdominal pain (group I, 46 patients, 4.6%) versus all others (group II). Demographics were similar between the two groups. When signs of aortic dissection were examined, 63% of patients in group I presented with hypertension compared to only 47% of patients in group II (p = 0.04). Patients in group I were less likely to present with evidence of end-organ malperfusion. Importantly, mortality in patients with a type B dissection, specifically following surgery for the dissection, was significantly increased in patients who presented primarily with abdominal pain (group I, 28% mortality vs. group II, 10.2% mortality; p = 0.02). This study documented increased mortality in patients with acute thoracic aortic dissections who present primarily with abdominal pain, underscoring the importance of maintaining a high index of suspicion for an aortic dissection in patients who have appropriate risk factors.

Abdominal Pain↗
PubMed2004

Acute aortic dissection--De Bakey Type I and Stanford A.

We report a rare case of aortic dissection which fits into De Bakey Type I and Stanford A, presented with severe tearing chest pain, paraplegia, stupor, hypotension, and syncope. Echocardiography showed dissection involving aortic root. MRI showed aortic dissection involving ascending, arch and descending aorta. Patient was managed conservatively and he died within 12 hours after the admission.

Aged↗
PubMed1995

Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography.

OBJECTIVES: This study was designed to define the frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. BACKGROUND: Aortography and transesophageal echocardiography have been widely utilized to diagnose aortic dissection. Previous reports have not fully addressed the reasons why these studies yield false negative results in a large number of patients with aortic dissection. METHODS: Sixty-five consecutive patients with aortic dissection underwent aortography and transesophageal echocardiography. Diagnosis of aortic dissection was confirmed at operation or by computed tomography in all patients. RESULTS: Biplane transesophageal echocardiograms yielded false negative results in two patients (sensitivity 97% [63 of 65]). Both patients had well localized DeBakey type II aortic dissection. The diagnosis was probably missed because of image interference from the air-filled trachea and mainstem bronchi. In both patients, the dissection was readily identified by aortography. Aortograms yielded false negative results in 15 patients (sensitivity 77% [50 of 65]); the aortic dissection was type I in 7 patients, type II in 1 and type III in 7. The dissection in all 15 patients was readily identified by transesophageal echocardiography. The missed diagnosis was probably due to a completely thrombosed false lumen or intramural hematoma with noncommunicating dissection in 13 patients and to a large ascending aortic aneurysm with nearly equal flow on both sides of the intimal flap in 2. In no patient was the diagnosis missed by both aortography and transesophageal echocardiography. CONCLUSION: Transesophageal echocardiography is an excellent screening tool for aortic dissection. However, it may miss small type II aortic dissections localized to the upper portion of the ascending aorta because of image interference from the air-filled trachea. An intramural hematoma cannot be easily visualized by aortography, and this lesion is the principal reason for false negative aortographic findings.

Adult↗
PubMed2001

Characterization of artifact simulating aortic dissection in computed tomography imaging.

An artifact simulating aortic dissection has been seen in computed tomography (CT) and reported in numerous journals. The purpose of this study is to determine the origin. A phantom was constructed to simulate the motion of the ascending aorta during the cardiac cycle. Technique factors such as scan time, slice thickness, pitch, and reconstruction algorithms were examined for their effect on the simulated dissection appearance. Change in the angle of the simulated aorta with respect to the scanner axis was also studied. CT images displaying the simulated aortic dissection are obtained reproducibly. The amplitude of the artifact is more pronounced for increased scan time. The artifact amplitude is proportional to the displacement of the phantom. The simulated aortic dissection seems to be more pronounced when the scan time is comparable to the cycling time of aortic motion.

Aortic Dissection↗
PubMed1984

Long-term survival of patients with treated aortic dissection.

Retrospective data on the treatment of aortic dissection at the Massachusetts General Hospital from 1963 to 1978 are reported. During this period, 160 patients with spontaneous aortic dissection were treated by definitive medical or definitive surgical therapy. Patients were classified according to type (proximal versus distal) and duration (acute versus chronic) of dissection. Long-term follow-up (mean 48 months, range 1 to 147) was available in 156 cases. Hospital and late survival in each of the categories of dissection were evaluated in relation to those features of the dissection itself and of the subsequent therapy that correlated with ultimate survival. Results show that: 1) chronic presentation was the most significant determinant of both hospital and late survival; 2) in acute dissection, prognosis was determined largely by the presence or absence of major complications, regardless of ultimate therapy; the only complication without adverse effect on survival was aortic insufficiency; 3) late survival after discharge from the hospital was similar for patients with all types of dissection and modes of therapy; and 4) the incidence of late complications from aortic dissection was lower than previously reported. Thus, the success of early definitive medical and surgical treatment was sustained on long-term follow-up.

Acute Disease↗
PubMed1996

Circulatory management with retrograde cerebral perfusion for acute type A aortic dissection.

BACKGROUND: Cerebral circulation during urgent repair of acute type A aortic dissection has traditionally been managed with cardiopulmonary bypass and aortic cross clamping proximal to the innominate artery or by the use of hypothermic circulatory arrest (HCA). The more recently introduced retrograde cerebral perfusion (RCP) may confer additional cerebral protection during elective aortic arch reconstruction. The purpose of this study was to demonstrate the efficacy of RCP in the urgent repair of acute type A aortic dissection. METHODS AND RESULTS: We evaluated 60 consecutive patients who underwent repair of acute type A aortic dissection over a 6-year period. Patients were grouped according to intraoperative circulatory management strategies. Group 1 consisted of 41 patients operated on early in the series who were managed by cardiopulmonary bypass and standard aortic cross clamping (n = 21) with conversion to HCA (n = 20) if the intimal tear extended into the aortic arch. Since 1993, 19 patients, who make up group 2, were managed with routine open distal anastomosis and HCA with RCP. Data were analyzed for clinically evident, radiographically confirmed cerebrovascular accidents and 60-day mortality and evaluated by chi 2 analysis. Stroke and mortality rates of patients managed with either cardiopulmonary bypass or HCA were 26.3% and 29.3%, respectively. Patients undergoing RCP experienced statistically significant reductions in rates of confirmed cerebrovascular accidents (0%, P = .015) and mortality (5.3%, P = .04). CONCLUSIONS: We conclude that the introduction of circulatory management using RCP with HCA during urgent operative repair of acute type A aortic dissection has significantly improved both stroke and mortality rates.

Acute Disease↗
PubMed2001

Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta.

PURPOSE: The current therapy for type A aortic dissection is ascending aortic replacement. Operative mortality and morbidity rates have been markedly improved because of recent advances in surgical techniques and anesthesiology. However, type A aortic dissection with an entry tear in the descending thoracic aorta is still a surgical challenge because of the need for extensive aortic replacement. METHODS: Ten patients with type A aortic dissection were treated with endovascular stent-grafts. The false lumen of the ascending aorta was patent in five patients, and it was thrombosed in the other five patients. The entry tears were located in the descending thoracic aorta in all cases. Seven patients had acute dissection, and three patients had subacute dissection. Four patients had pericardial effusion. Stent-grafts were fabricated from expanded polytetrafluoroethylene and Z-stents. RESULTS: Entry closure was achieved in all patients. Complete thrombosis of the false lumen of the ascending aorta was observed after stent-grafting in all patients. A second stent-graft was required in two patients to obtain complete thrombosis of the false lumen of the descending thoracic aorta. No procedure-related complications were observed, with the exception of a minor stroke in one patient. During a mean follow-up period of 20 months, no aortic rupture or aneurysm formation was noted in either the ascending or descending thoracic aorta, and all patients were alive and doing well. The abdominal aortic aneurysm enlarged after stent-grafting in one patient, and this was treated by closing the fenestrations of the abdominal aorta with stent-grafts. CONCLUSION: Stent-graft repair of aortic dissection with an entry tear in the descending thoracic aorta is a safe and effective method and may be an alternative to surgical graft replacement in highly selected patients.

Adult↗
PubMed1988

Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases.

The accuracy of combined M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six-year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n = 15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n = 64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two-dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.

Aortic Dissection↗
PubMedDate not supplied

[Aortic dissection: role of the general surgeon in diagnostic-therapeutic procedure].

Aortic dissection occurs when there is a tear or separation of the aortic intima from the media; flow of blood into the intima-media space allows the tear to develop into a dissecting hematoma. Aortic dissection is a rare condition which represents an acute cardiovascular emergency for which the appropriate therapy is immediate surgical correction. Patients with aortic dissection show a heterogeneous constellation of symptoms; hence, clinical suspicion is often difficult. Only a minority of patients has "classic" symptomatology, the electrocardiogram is often misleading and the chest radiogram is almost always non-specific. In Italy, the usual "hospital routine practice" assigns the key-role in the emergency diagnostic procedure for these patients to the general surgeon. In view of the necessity of immediate cardiac surgery and the overwhelming likelihood of adverse events when surgery is delayed, techniques for diagnosis must be accurate, widely available and easily and quickly used. The present study consists of four case-reports of aortic dissection thoroughly examined and confronted with the literature. Management strategy based on emergency echocardiography is a reliable, feasible and successful technique for evaluating patients with aortic dissection. It allows a rapid accurate diagnosis with a single examination that can also be performed in the emergency room and provides information of sufficient diagnostic value to allow immediate cardiovascular surgery. CT scan and/or MRI are also valid tools for the emergency diagnosis of aortic dissection. However, a major problem still exists: the range of symptoms is sufficiently broad that a high index of "personal suspicion" of aortic dissection is required on the part of the general surgeon when he performs the role of "emergency-team leader".

Adult↗
PubMed1996

Imaging Modalities in the Diagnosis of Acute Aortic Dissection.

The management of patients with acute aortic dissection requires a rapid diagnosis and precise information about the localization and extent of the dissection. Four imaging techniques are currently available to diagnose aortic dissection: aortography; contrast-enhanced computerized tomography (CECT); magnetic resonance imaging (MRI); and transesophageal echocardiography (TEE). All of these techniques have their specific advantages and inherent limitations. Recent studies have demonstrated that MRI may best provide a comprehensive and detailed evaluation of the thoracic aorta, therefore proposing this technique as a "new gold standard" in the diagnosis of acute aortic dissection. TEE, however, may be the best alternative technique, as it combines high sensitivity and specificity with high practicality. The practicality is particularly important in hemodynamically unstable patients in whom a rapid bedside imaging modality is required. CECT might be necessary in selected cases in whom TEE fails to provide a definite diagnosis. Aortography may be necessary in patients in whom clinical signs are suggestive of organ ischemia and in whom coronary anatomy needs to be delineated before operation. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Journal Article↗
PubMed1997

[Concomitant composite graft replacement of the aortic root and the aortic arch for type A aortic dissection].

Successful surgical treatment of type A aortic dissection with annuloaortic ectasia (AAE) and severely destroyed aortic root was reported. Between April 1991 and April 1996, 26 patients with type A aortic dissection underwent the surgical treatment in our institute. Among those cases, 4 cases (15%) needed the total aortic root replacement with composite graft. Two cases had Marfan syndrome and AAE and aortic regurgitation. Other two cases had severely destroyed aortic root because of the extension and advancement of the dissection to the aortic root. One was the case of disrupted right coronary ostia. And another was the case of frank rupture and massive bleeding from the aortic root during the operation. Cases of AAE were treated successfully by the routine composite graft that was made before the operation. However, the reconstruction of the aortic root for the cases who had destroyed aortic root with normal relation and size of the aortic root was cumbersome because of non displaced coronary artery ostia and the relatively narrow aortic root. For these cases, composite graft was fixed just below the aortic valve annulus by the sutures enforced with Teflon felt strip from the outside of the aorta and it made the reimplantation of the coronary ostia easier. As for the technique of the reimplantation of the coronary ostia, Carrel patch technique was used because good coaptation and fixation of the suture line around the coronary ostia could be obtained with this technique which prevent the complication such as the pseudoaneurysm or the periostial aneurysm formation around the coronary artery in the long term period. Concomitant procedures were aortic arch replacement in all cases, total arch replacement with four vessels graft in 3 cases and hemiarch replacement in 1 case. Each operations were performed with the aid of selective cerebral perfusion and open distal anastomosis.

Aged↗
PubMed1987

Primary repair of acute ascending aortic dissection.

Primary repair of acute ascending aortic dissection was performed in 14 patients. Repair included resection of the intimal tear where applicable, a circumferential suture line in the ascending aorta at the site of the tear, and wrapping of the intrapericardial ascending aorta with Teflon felt to contain the distal residual false channel. The aortic valve was resuspended in 6 patients. The single operative death was unrelated to the method of repair. Two late deaths at 4 and 6 years were due to preexisting multisystem disease. In 1 patient, new aortic insufficiency with an isolated aneurysm of the noncoronary sinus of Valsalva developed at 26 months, and was repaired successfully at another institution. These results compare favorably with those reported by others employing more extensive surgical procedures for repair of acute ascending aortic dissection.

Acute Disease↗
PubMed2004

[Acute type B aortic dissection].

Although most patients with acute type B aortic dissection are treated medically, emergency surgery is needed for patients with complications, such as rupture, uncontrollable pain, refractory hypertension, a huge pseudo-lumen or organ ischemia. Optimal surgery should be selected according to each condition. An emergent descending aortic replacement is applied mainly for ruptures or impending ruptures, while a surgical bypass, fenestration or thrombectomy is used for visceral organ or leg ischemia. In our data, 9 (23%) out of 40 patients with acute type B aortic dissection underwent emergent surgical treatment. In-hospital mortality was 11.1%. Because it is difficult to diagnose visceral ischemia, patients who might be affected with one must be treated promptly. Although catheter intervention is expected to improve the results of these high-risk patients, more investigation is needed to discover a new therapeutic strategy for acute type B aortic dissection.

Acute Disease↗
PubMed2000

Aortic dissection after superior mesenteric artery percutaneous stenting. Case report.

We report an unusual case of aortic dissection after superior mesenteric artery percutaneous stenting. A 44-year-old patient, who suffered from back pain and fever, was diagnosed as having an aortic dissection. Aortic dissection, extending from the aortic arch (just after left subclavian artery origin) to the aortic carrefour, was successfully diagnosed by means of Duplex scan and CT scan examination. Two pathogenetic hypotheses, malformative and iatrogenic, were discussed.

Adult↗
PubMed1997

Abdominal aortic tailoring for renal, visceral, and lower extremity malperfusion resulting from acute aortic dissection.

PURPOSE: The treatment of ischemic complications that result from aortic dissection is a challenging and controversial problem. The purpose of this study was to evaluate aortic tailoring in the management of acute aortic dissection associated with visceral, renal, or lower extremity ischemia. METHODS: We retrospectively reviewed the clinical courses of seven consecutive patients (five men, two women) with a median age of 68 years (range, 48 to 74 years) from January 1994 to January 1997. All patients underwent an abdominal aortic tailoring procedure for relief of ischemic complications associated with acute aortic dissection (type IIIB, n = 6; type I, n = 1) and a normal-sized aorta. RESULTS: All seven patients survived and recovered full mesenteric, renal, and lower extremity function. Two patients required temporary hemodialysis in the immediate postoperative period. There has been no significant dilatation of the tailored aortic segments, with an average follow-up of 19 months (range, 1 to 30 months). CONCLUSIONS: Abdominal aortic tailoring represents a safe and effective method for treating ischemic complications associated with acute aortic dissection and a normal aortic luminal diameter.

Acute Disease↗
PubMed1997

Aorto-right atrial fistula: a rare complication of aortic dissection type A. A report of two cases.

BACKGROUND: Aortic dissection with rupture into the right atrium is an extremely rare condition and rapidly lethal. The authors report their experience in the treatment of two complicated aortic dissections observed at 85 and 93 months after previous cardiac operations. These were redo mitral valve replacement and saphenous vein coronary artery bypass grafts. METHODS: Both cases underwent hospital admission on an emergency basis because of severe chest pain and cardiac failure. One case had a history of hypertension. The aortography revealed aortic dissection and a fistulous communication into the right atrium. At surgery dissection repair and closure of the fistula was performed. Furthermore in one case vein grafts were reimplanted into the vascular graft. RESULTS: Both patients survived the operation without complications, were rapidly extubated and were asymptomatic and fully active at late follow-up. CONCLUSIONS: In the light of these results we conclude by affirming that aortic dissection with rupture into the right atrium is an extremely rare condition, rapidly lethal. Patient survival is strictly dependent on the time interval between fistulization of the dissection and the operation.

Aged↗
PubMed1992

Impact of transesophageal echocardiography on the treatment of patients with aortic dissection.

To determine the impact of transesophageal echocardiography (TE) on the treatment of patients with aortic dissection, the clinical course and outcome of 18 patients with TE diagnosis of dissection were analyzed. Ascending aortic dissection was present in nine patients, of whom six had surgery with confirmation of TE findings. Angiography was performed in only two of these patients and was falsely negative in one patient. Angiography was not performed in the three patients who were not surgical candidates. In the nine patients who had descending aortic dissection, angiography was performed in seven patients, of whom two underwent surgery. Information provided by angiography did not change the treatment of these patients. Thus, TE provides a prompt and accurate diagnosis in aortic dissection obviating the need for angiography in most patients.

Adult↗