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PubMed2006

Pregnancy in a Marfan patient with pre-existing aortic dissection.

In women with Marfan syndrome pregnancy increases the risk of aortic dissection. There are a number of articles reporting the outcome of acute aortic dissection during pregnancy in this patient group. In contrast, only scarce information is available concerning pregnancy in patients with pre-existing chronic aortic dissection. We report the case of a pregnant Marfan syndrome patient with pre-existing chronic aortic dissection that showed a favourable maternal and fetal outcome.

Adult↗

PubMed2000

A surgically treated case of Takayasu's arteritis complicated by aortic dissections localized in the ascending and abdominal aortae.

Because complication by aortic dissection is markedly rare in patients with Takayasu's arteritis, a limited number of reports have been published regarding surgically treated cases of Takayasu's arteritis that is complicated by aortic dissection. When graft replacement of the ascending aorta and aortic arch and extra-anatomic bypass grafting were performed in a 72-year-old japanese woman with Takayasu's arteritis, which was complicated by aortic dissections localized in the ascending and abdominal aortae, the postoperative course of this patient was satisfactory. It was considered that the media became friable in this patient because of the presence of Takayasu's arteritis and that hypertension that persisted for a long time caused the independent development of aortic dissections in the ascending and abdominal aortae.

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PubMed1996

[Echocardiography and aortic dissection].

Echocardiography is the technique most used in the diagnosis of aortic dissection. In this article the echocardiographic signs of aortic dissection are described. The following issues regarding the usefulness of echocardiography in aortic dissection are reviewed as well: detection of entry site, distinction between false and true lumen, assessment of aortic regurgitation, ventricular function, aortic branches involvement, pericardial effusion and follow-up.

Aortic Dissection↗

PubMed2002

Painless acute aortic dissection and rupture presenting as syncope.

Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. This article reports on a case of a completely painless acute dissection and rupture in a middle-aged man who presented with syncope. The diagnosis was made by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. This patient underwent immediate surgery, and ultimately had a successful outcome.

Aortic Dissection↗

PubMed2004

Branch vessel complications are increased in aortic dissection patients with renal insufficiency.

Morbidity and mortality from aortic dissection remain high despite advances in diagnosis and treatment. Simple markers to identify patients at high risk for non-aortic complications of dissection are lacking. We investigated the effect of renal insufficiency on the presentation, complications, and outcome of patients with acute aortic dissection. We evaluated 638 patients with type A and 365 patients with type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1996 and December 2000. Chi-squared and Student's ttesting were performed to identify the effect of renal insufficiency on patient presentation, management, and outcome. Patients with renal insufficiency more often required nitroprusside for blood pressure control (type A: 40.7% vs 31.1%, p = 0.049; type B: 66.7% vs 37.3, p = 0.0001) and had a greater risk of mesenteric ischemia (type A: 10.7% vs 1.4%, p < 0.0001; type B: 17.7% vs 3.0%, p < 0.0001). In conclusion, aortic dissection patients with renal insufficiency are at increased risk for drug-resistant hypertension and aortic branch vessel compromise. Routine measurement of serum creatinine provides a readily accessible clinical marker for important complications. Upon recognition, renal impairment indicates a need for close monitoring, aggressive blood pressure control, and evaluation of aortic branch vessel circulations.

Acute Disease↗

PubMed1998

Successful operative treatment for acute triple-barreled aortic dissection in a patient with Marfan's syndrome: report of a case.

Triple-barreled aortic dissection is a rare form of aortic dissection associated with high mortality. We report herein the case of a 41-year-old woman with Marfan's syndrome who developed acute triple-barreled aortic dissection from a Stanford type B dissecting aneurysm. Successful graft replacement of the proximal third of the descending thoracic aorta was subsequently performed. To the best of our knowledge, this is the first case of successful operative treatment for an acute triple-barreled aortic dissection ever to be reported.

Adult↗

PubMed1997

Thoracoabdominal fenestration for aortic dissection with ischemic colonic perforation.

Previous attempts at repair of aortic dissection complicated by intestinal infarction requiring concomitant bowel resection have been fatal. Presented is a case of distal aortic dissection resulting in colonic infarction and perforation. Thoracoabdominal aortic fenestration with concomitant right hemicolectomy was successful. In patients with aortic dissection complicated by mesenteric ischemia, we recommend urgent graft replacement of the thoracoabdominal aorta when feasible. When peritoneal contamination precludes the use of prosthetic grafts, thoracoabdominal fenestration is an effective option.

Adult↗

PubMed2003

Coronary malperfusion due to type A aortic dissection: mechanism and surgical management.

BACKGROUND: Coronary malperfusion associated with aortic dissection is relatively rare, but when it occurs, it is fatal to the patient. To salvage such moribund patients, aggressive coronary revascularization concomitant with aortic repair is essential. We review the surgical results and mechanism of malperfusion in a group of 12 patients with coronary malperfusion caused by type A aortic dissection, and we discuss our surgical approach. METHODS: Between March 1990 and March 2003, 12 patients (6.1%) from a total of 196 consecutive patients with acute type A aortic dissection undergoing surgery suffered coronary malperfusion associated with the dissection. There were 4 men and 8 women (mean age, 60.8 +/- 8.3 years). Nine patients had acute myocardial infarction due to dissection before surgery, and 3 patients suffered coronary malperfusion after aortic declamping. RESULTS: Hospital mortality rate was 33.3% (4 patients). The mortality rate was higher than that in patients without coronary malperfusion (33.3% vs. 8.2%, p = 0.019). Three patients could not be weaned from cardiopulmonary bypass, and 1 patient died of heart failure in the intensive care unit. Involved coronary arteries included the right coronary artery (8 patients), left coronary (2 patients), and both (2 patients). Mechanisms of coronary obstruction were compression (2 patients), coronary dissection (7 patients), and coronary disruption (3 patients). Coronary artery bypass grafting was performed concomitant with aortic repair. CONCLUSIONS: Acute type A aortic dissection with coronary involvement is associated with high mortality rate, aggressive coronary revascularization and early aortic repair with simple techniques are necessary to salvage these critically ill patients.

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PubMed1978

Renal autotransplantation in dissecting aortic aneurysm with renal artery involvement.

A dissecting aortic aneurysm in a 60-year-old woman resulted in renal artery insufficiency and medically uncontrollable hypertension. Following a nephrectomy and renal autotransplantation, the patient's renal insufficiency improved dramatically and her hypertension became easily manageable with antihypertensives. Nephrectomy with renal autotransplantation is discussed as an alternative to conventional renal artery reconstruction in cases where reconstruction is either too hazardous or impossible to perform.

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PubMed1997

[Stent graft treatment for two cases of DeBakey IIIb dissecting aortic aneurysm].

Two patients with DeBakey IIIb dissecting aortic aneurysms were treated with transluminally placed endovascular stent grafts. Surgery was required for both patients because the false lumens were not thrombosed for several months. Stent graft devices composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron were inserted through 18 Fr sheathes via femoral arteries. The stent grafts were deployed successfully and blood flow into the false lumens was reduced immediately and finally thrombosed without blood leakage from the entries. The endoluminal stent graft treatment is minimally invasive operation in comparison with former surgical operations, and is useful for aortic aneurysms especially in high risk patients. However, improvement of the stent graft devices, including the delivery systems such as the dilator, sheath and pushing rod, which are incomplete, and developing better devices, is required to reduce delivery failure and to make the stent graft treatment more reliable.

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PubMed1999

Aortic dissection in young patients with chronic hypertension.

We describe four patients aged 14 to 21 years who developed acute aortic dissection. In three of the four patients, the course was fatal, despite aggressive medical and surgical intervention. All four patients had sustained systemic hypertension related to chronic renal insufficiency. The patients had no other identifiable risk factors for aortic dissection, including congenital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma, pregnancy, or family history of aortic dissection. Although aortic dissection is rare in individuals younger than 40 years of age, young patients with sustained systemic hypertension are at increased risk for this serious and often fatal condition. Physicians must be aware of this rare complication of hypertension and consider aortic dissection in the differential diagnosis of unusual chest, abdominal, and back pain in hypertensive children, adolescents, and young adults.

Adolescent↗

PubMed1994

[Calcified false channel wall in aortic dissection].

Chest radiographs and computed tomographic images of 110 patients with chronic aortic dissection were retrospectively reviewed. Among these, calcification of false channel wall was observed in 12 cases (about 10%). Stanford type A dissection was noted in 5 cases and type B in 7 cases. Calcified false channel wall may closely simulate intimal calcification of atherosclerotic aneurysm on chest radiographs and sometimes even on CT. Careful observation of CT images with and without contrast enhancement is helpful to correctly identify the site of calcifications in the false channel wall, true channel wall, and intimal flap in the individual cases. In 3 cases calcification was present mainly in the false channel wall with no or only minimal calcification in the true channel wall. These cases may suggest that the endothelialized false channel lumen may develop atheromatous changes much more rapidly than the true lumen. According to advances in surgical and medical treatment of acute aortic dissection, radiologists may encounter cases of chronic aortic dissection with increasing frequency. Full recognition of this potential pitfall in the diagnosis of aortic dissection is important to avoid confusion.

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PubMed2003

Potential pitfalls in the diagnosis of aortic dissection.

STUDY OBJECTIVES: The primary objective of our study was to identify clinical issues contributing to delay in the diagnosis of nontraumatic aortic dissection. DESIGN: Retrospective observational study. SETTING: A 425-bed community based, university-affiliated teaching hospital. PATIENTS: Medical records were analyzed for physiologic, clinical, and outcome variables in 32 consecutive patients who presented to our hospital with non-traumatic aortic dissection over a three-year period (1995-1997). MEASUREMENTS AND RESULTS: The mean time to diagnosis was 10.7 hours (range 0.5-72 hours). The time to diagnosis and clinical variables did not differ between type A and type B aortic dissections (8.7 vs 11.4 hours; P = 0.54). The diagnosis of aortic dissection was not entertained initially in 44% (14/32) of patients, leading to a significant delay in diagnosis compared to patients with suspected aortic dissection on admission (15.0 vs 4.5 hours; P = 0.008). Lack of a widened mediastinum on chest roentgenography (18.7 vs 6.6 hours; P = 0.026) and lack of hypertension (< 140/90 mmHg) at presentation (14.9 vs 7.1 hours; P = 0.03) were associated with a delayed diagnosis of aortic dissection as compared to presence of either finding. The presence or absence of chest or back pain, resting ECG changes, and a past medical history of hypertension did not correlate with time to diagnosis. There was a trend toward earlier diagnosis when the initial diagnostic modality was transesophageal echocardiography as compared to computed axial tomography (CAT) scan (7.7 vs 10.1 hours; P = 0.20). CONCLUSIONS: Patients with aortic dissection are frequently normotensive and may lack typical chest roentgenographic findings at presentation. A high index of clinical suspicion for aortic dissection is essential to avoid potentially fatal delays in its diagnosis.

Aortic Dissection↗

PubMed2000

Surgical treatment for acute type A aortic dissection in pregnancy: a case of aortic root replacement just after Cesarean section.

A 25-year-old woman with Marfan syndrome in the 37th week of pregnancy was referred for acute chest pain and dyspnea. An emergency Cesarean section was performed because of fetal distress. Intraoperative echocardiography at the end of the Cesarean section showed dilatation of the aortic root and dissection of the ascending aorta. The patient underwent replacement of the aortic root and the ascending aorta on the following day because of uterine bleeding. The postoperative course was uneventful for the mother and her baby.

Adult↗

PubMed1989

[Improvement of operative result of Stanford type A aortic dissection].

21 cases of Stanford type A aortic dissection (15 acute and 6 chronic) were treated with or without surgery in the last 38 months. Out of seven cases who were admitted before October, 1986, three cases were treated medically and all died suddenly within 30 days. The remaining four cases were operated upon as emergency with only one survival. Extensive hemorrhage was the cause of operative deaths. After November 1986, substantial reduction in hospital mortality (one death in eight acute cases) was accomplished by the following strategy for acute aortic dissection, i.e., (1) urgent operative intervention for cases with cardiac involvement, and initial medical treatment followed by elective operation at chronic stage for those without cardiac involvement, (2) routine use of open distal anastomosis, (3) preferential adoption of simple surgical intervention limited to the ascending aorta. There was no operative death in six chronic cases in spite of more extensive approach. These results suggest that the strategy mentioned above is reasonable in treatment for Stanford type A dissecting aneurysm.

Adult↗

PubMed2002

[Three-channeled aortic dissection; report of a case].

The formation of 2 adjacent lumens is rarely observed in aortic dissection. We report herein a case of ruptured 3-channeled aortic dissection in a short time of hospitalization. A 58-year-old man who had been followed up for aortic dissection (Stanford type B) was admitted to Kumamoto National Hospital with an abdominal pain and a lumbago. A computed tomography (CT) revealed that a 3-channeled aortic dissection from the aortic arch to the right common iliac artery. An intramural hematoma was generated in the abdominal aorta and the left kidney was not enhanced. We initially adopted conservative therapies. But on the next day, he suddenly complained a severe back pain and died. At autopsy, the thoracic aorta was found to have ruptured into the mediastinum, and massive hematoma was formed.

Aortic Dissection↗

PubMed1996

[Surgery for acute type A aortic dissection associated with Marfan syndrome].

Recently, extended operation has been recommended for aortic dissection associated with Marfan syndrome. However, the operation for acute type A aortic dissection associated with Marfan syndrome is controversial. Between May 1985 and July 1994, 5 patients associated with acute type A aortic dissection and Marfan syndrome underwent surgical repair. CT examination on all patients, the survivors of the initial operation, revealed a gradually enlarged residual pseudolumen. 2 patients who underwent aortic root reconstruction and ascending aortic replacement for the initial operation eventually had to undergo aortic arch repair. From the results of this study and the improvements of intraoperative cerebral protection, we recommend aortic arch repair with aortic root reconstruction and ascending aortic replacement on initial emergency operation for acute type A aortic dissection associated with Marfan syndrome.

Acute Disease↗

PubMed1993

[Emergency surgical salvage for a closing aortic dissection: 2 case reports].

We report here the emergency surgical salvage for closing an aortic dissection in 2 female patients (case 1; 52 years old, case 2; 72 year old). They were admitted to our clinic for severe back pain (case 1) and a loss of consciousness (case 2). Acute aortic dissection (Stanford A type) with cardiac tamponade was confirmed by chest CT, aortography, and cardiac ultrasonography. Diagnosis was determined as a closing aortic dissection from a thrombosed pseudolumen on enhanced chest CT. An emergency operation was performed on the ascending aorta replacement and included resection of the entry port. The postoperative courses were uneventful, except for temporary hemodialysis in case 1. A closing aortic dissection is a new subcategory for an acute aortic dissection. Diagnosis is difficult, but it is regarded as having a good prognosis following timely emergency treatment. However, provided there is no complication, we recommend that surgical treatment should be performed aggressively to avoid rupture and/or cardiac tamponade.

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