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PubMed1993

Factors in the initiation and propagation of aortic dissections in human autopsy aortas.

Our goal was to evaluate physical factors in the initiation and propagation of dissections in human aortas. Aortic dissection was simulated in 21 open unpressurized human autopsy aortas by infusing dyed isotonic saline into the media at constant flow. Pressure during growth of the fluid filled cavity was monitored and correlated with volume to give pressure-volume curves, from which distensibility, peak pressure, and work data were calculated. Dissections in specimens occurred at a very high nonphysiological mean pressure of 79 +/- 29 (SD) kPa (596 +/- 214 mmHg). Age and tear depth had no significant effect on medial strength of human aortas but sex, location and atherosclerotic plaque formation did (p < 0.05). The mean pressure value for the female abdominal fibrous/calcified group (92 +/- 30 kPa, 691 +/- 222 mmHg) differed from that of the male abdominal fibrous/calcified group (69 +/- 36 kPa, 508 +/- 269 mmHg). We also observed a significant difference between the male thoracic fibrous calcified (80 +/- 31 kPa, 601 +/- 230 mmHg) and male abdominal fibrous/calcified (68 +/- 36 kPa, 508 +/- 269 mmHg) groups. Significant differences were observed between the female fatty/normal (75 +/- 25 kPa, 562 +/- 187 mmHg) and fibrous/calcified (91 +/- 23 kPa, 685 +/- 176 mmHg) groups of the thoracic aorta and between the male fatty/normal (86 +/- 23 kPa, 650 +/- 169 mmHg) and fibrous/calcified (68 +/- 36 kPa, 508 +/- 269 mmHg) groups of the abdominal aorta. Distensibility data showed no trends. It is probable that dissection does not occur spontaneously in the absence of a connective tissue disorder and/or surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

[Aortic dissection in childhood. Occurrence and diagnostic procedure].

Aortic dissections of the aorta thoracalis are rare in childhood, and mostly cause a life-threatening situation in which an immediate diagnosis is the key for survival. Main causes are an aortic vitium or a traumatic disruption. The conclusive diagnosis can only be obtained by a chest-X-ray, the two-dimensional echocardiography and the dynamic computed tomography scanning of the thorax. It must be taken into account, that patients with a polytrauma could possibly suffer from a traumatic aortic dissection, which sometimes can only be diagnosed at a later date.

Adolescent↗

PubMed2005

[The application of modified classification of the aortic dissection].

OBJECTIVE: To determine the indication, optimal operative procedures, plan and the estimation of the prognosis depending on the subtype of aortic dissection defined by the extension and extent of dissection. METHODS: The outcome of 708 patients with aortic dissection between January 1994 and December 2004 was analyzed. Among them 477 patients suffered from Stanford type A aortic dissection were treated. Type A dissection can be classified into 3 subtypes based on the pathological change of the aortic root. Type A1 (No pathological change type): 212 patients underwent ascending aorta replacements; Type A2 (mild pathological change type): 63 patients underwent ascending aortic replacement with concomitant aortic valve and valsalva sinus plasty and David procedure was performed in 9 patients; Type A3 (severe pathological change type): 193 patients underwent Bentall procedure. The method of aortic arch repair was determined by the pathological type of distal aorta. Total aortic arch replacement was performed in 78 patients with complex type (type C). There hundred and ninety-nine patients with simple type (type S) underwent partial aortic arch replacement. 231 patients suffered from Stanford type B aortic dissection. Type B dissection can be classified into 3 subtypes based on dilated extension of proximal descending aorta. Type B1 (no dilation was confined in the proximal of thoracic descending aorta): endoluminal stent graft repair was performed in 103 patients. Replacement of the partial proximal thoracic descending aorta and replacement combined with stented elephant trunk procedure were performed in 32 and 12 patients respectively; Type B2 (aneurysm in thoracic descending aorta): 32 patients underwent the part proximal thoracic descending aorta replacement combined with aorta plasty. 21 patients underwent the replacement of entire thoracic descending aorta; Type B3 (aneurysm in thoracic descending and abdominal aorta): thoracoabdominal aortic replacement was operated in 31 patients with deep hypothermia circulatory arrest; Type BC (complex type): 44 patients were performed the operation with the use of deep hypothermia circulatory arrest because their left subclavian arteries or distal aortic arch were affected by the dissection; Type BS (simple type): 103 patients were underwent endoluminal stent graft repair. In the 60 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery. Femoro-femoral bypass was performed in 24 patients. RESULTS: Type A: the operative mortality was 4.6% (27/477), and the hospital morbidity was 14.5% (69/477). Type B: the hospital mortality of endoluminal stent graft repair was 1.9% (2/103). 9.7% (10/103) had mild leakage from proximal communications. The morbidity was 2.9% (3/103) in stent group. The mortality was 3.1% (4/128), and the hospital morbidity was 18.8% (24/128) in the operative group. CONCLUSION: The subtype of aortic dissection is much useful in determining the optimal procedure, operative indication and plan, estimating the prognosis.

Adult↗

PubMed2006

Stent-graft treatment for isolated infrarenal aortic dissecting aneurysms.

OBJECTIVES: We report three cases of isolated infrarenal aortic dissecting aneurysms managed with stent-graft. MATERIALS AND METHODS: Three patients, two men and one woman, with a mean age at diagnosis of 69 years were identified. In all cases, chest CT-A did not reveal evidence of thoracic aortic dissection. The mean maximal aneurysm diameter was 6.7+/-1.5 cm (range: 5.5-8 cm). All patients underwent stent-graft repair. Follow-up computed tomographic (CT)-angiography examinations were scheduled 1, 4, and 12 months after the procedure. RESULTS: Stent-graft deployment was technically successful in all cases. Intraoperative mortality was not observed. All patients were adequately treated with a bifurcated device. Intensive care unit (ICU) stay was never required. Mean hospitalization was 4.6 days (range: 4-6 days). Mean follow-up was 18 months. No stent-graft-related complications were observed. CONCLUSIONS: Endovascular repair for isolated infrarenal abdominal aortic dissecting aneurysms is feasible and effective.

Aged↗

PubMedDate not supplied

Treatment of acute aortic dissections with expandable metallic stents: experimental study.

PURPOSE: This experimental study was designed to evaluate the effectiveness of metallic stents for the treatment of acute aortic dissection. MATERIALS AND METHODS: Thoracic aortic dissections were created in 14 mongrel dogs. Aortography performed immediately after creation of dissections showed two types of aortic dissections: rapid flow in the false lumen (group 1) and slow flow in the false lumen (group 2). Each group consisted of seven dogs. For each group, expandable metallic Gianturco stents were placed in five dogs and two dogs were used as controls. RESULTS: A week later, false lumina were patent in all dogs in group 1 and thrombosed in all dogs in group 2. In group 1, the mean diameter of the true lumina was considerably enlarged from 5.9 mm +/- 1.6 to 9.9 mm +/- 2.8 and that of the false lumina significantly diminished from 9.1 mm +/- 1.3 to 5.2 mm +/- 2.3 (P < .05) after stent placement. In group 2, the true lumina were significantly dilated (5.2 mm +/- 2.3 vs 12.3 mm +/- 3.1, P < .05) and the false lumina disappeared completely (9.2 mm +/- 3.3 vs 0.0 mm, P < .01). Furthermore, the two control dogs in group 2 died of visceral ischemia due to the compression of the true lumen by the thrombosed false lumina, but the dogs with stents showed no symptoms of the visceral ischemia. CONCLUSION: Expandable metallic stents are not effective in obliterating the false lumen in acute aortic dissection but may be useful in maintaining the blood flow in the true lumen and avoiding visceral ischemia.

Aortic Dissection↗

PubMed2006

Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations.

OBJECTIVE: The femoral artery is the customary site for arterial cannulation for cardiopulmonary bypass in treating type A aortic dissections. However, because of concerns regarding complications caused by retrograde perfusion, the number of surgeons who prefer using the axillary artery as the site for cannulation is increasing. However, axillary artery cannulation also involves some problems. Thus we prefer transapical aortic cannulation for repair of type A aortic dissection. METHODS: Transapical aortic cannulation was performed in 138 patients (83 men and 55 women; mean age, 60.1 years; 129 acute and 9 chronic; 120 hemiarch repair and 15 total arch replacement) with type A aortic dissection. A 1-cm incision is made in the apex of the left ventricle, and a 7-mm soft and flexible cannula is passed through the apex and across the aortic valve until positioned in the ascending aorta transesophageal echocardiographic guidance. RESULTS: There were no cases in which conversion to cannulation of another artery was necessary. In all cases cardiopulmonary bypass flow was sufficient (>2.5 L/m(-2)/min(-1)). There were no malperfusion events. Eight (5.8%) patients had cerebrovascular accidents. Twenty-six (18.8%) patients died in the hospital of complications not related to transapical aortic cannulation. CONCLUSIONS: Our results show that transapical aortic cannulation is safe and useful for repair of type A aortic dissection. There are advantages to transapical aortic cannulation, such as simple and quick cannulation technique, sufficient antegrade aortic flow, and the reliability of true lumen perfusion with decreased risk of stroke and malperfusion.

Adult↗

PubMed2005

Aortic dissection with potential origin from a mechanical bypass anastomosis.

Ascending aortic dissection is a known complication of cardiac surgery. Off-pump coronary artery bypass surgery seems to be associated with a higher risk for this event as compared with on-pump bypass surgery. This increased risk may result from aortic side-clamping under pulsatile flow as opposed to continuous flow in conventional bypass surgery. Mechanical devices allowing performance of proximal bypass anastomoses without aortic side-clamping are supposed to reduce the risk for aortic dissection. We report a case in which ascending aortic dissection occurred 8 days after off-pump bypass surgery, most likely arising from a mechanically performed proximal bypass anastomosis.

Aged↗

PubMed1996

Intramural aortic dissection.

We present 10 cases of intramural aortic dissection. The cases are all characterized by the presence of intramural haematoma without the presence of a patent false lumen. The radiological features and possible aetiologies are discussed. The key radiological finding is the presence of a hyperdense rim in the aortic wall on a non-contrast-enhanced computed tomography (CT) scan. In one case, a delayed diagnosis was made using magnetic resonance imaging (MRI). In a further case, the delayed development of a large aortic ulcer was demonstrated. Intramural aortic dissection has only recently been described in the radiological literature. The aetiology of this condition remains controversial. The imaging findings may be subtle and the diagnosis is still frequently being overlooked. We believe CT to be the primary diagnostic test for this condition, and its advantages over MRI and transoesophageal echocardiography (TOE) are discussed.

Aged↗

PubMedDate not supplied

Useful CT findings for predicting the progression of aortic intramural hematoma to overt aortic dissection.

PURPOSE: The purpose of this work was to assess useful CT findings for predicting the progression of aortic intramural hematoma to aortic dissection. METHOD: We analyzed the CT findings of 29 patients with aortic intramural hematoma with regard to the following: involved site, maximum thickness of hematoma, presence or absence of compression of true lumen, and pericardial and pleural effusion. CT findings were compared with those of the patients who progressed to aortic dissection (Group I) and those who did not (Group II). Each CT finding was evaluated with independent t test and Mann-Whitney U test (p < 0.05). RESULTS: Seven of 8 cases of Type A aortic intramural hematoma and 3 of 21 cases of Type B aortic intramural hematoma progressed to aortic dissection. The type of aortic intramural hematoma, maximum thickness of hematoma, compression of true lumen, and pericardial or pleural effusion were significantly different in Groups I and II. CONCLUSION: Type A aortic intramural hematoma, maximum thickness of hematoma, compression of true lumen, and pericardial or pleural effusion are the useful CT findings for predicting the progression of aortic intramural hematoma to aortic dissection.

Aged↗

PubMed1989

[Compression of the right pulmonary artery by chronic aortic dissection].

The authors report the case of a 56-year old woman who had presented with clinical symptoms resembling those of pulmonary embolism and due to chronic dissection of the first aortic segment compressing the right branch of the pulmonary artery. Eighteen months after the acute episode, the diagnosis was suspected at echocardiography, but the other paraclinical examinations performed (scintigraphy of the lung, angiography, computerized tomography) failed to display the aortic dissection, although they enabled the diagnosis to be approached and the physiopathology to be determined. At surgery, a type II dissection was discovered, the compression was relieved and the pulmonary artery was recanalized. The post-operative period was uneventful, with return to normal of the scintigraphic and CT images. This case is exceptional in that it is extremely rare (this is the 6 th case reported) and the lesion was well tolerated, probably due to the presence of a systemic-pulmonary circulation.

Aortic Dissection↗

PubMed2004

Late outcome of patients with aortic dissection: study of a national database.

OBJECTIVES: The incidence of late mortality and morbidity of aortic dissection remained unchanged during the past 20 years. The present study was to analyze the risk factors of late events for patients with aortic dissection. METHODS: A total of 5654 cases of aortic dissection (3871 males) were collected from the National Health Insurance Databases from 1996 to 2001. Age, gender, Marfan syndrome, and initial treatment modality were the main factors to be investigated. Corrective group was defined by surgical operation with cardiopulmonary bypass and palliative group for the remaining. Late aortic events were defined by late aneurysmal evolution of diseased aorta needing surgical intervention or death of aortic causes from 6 months to 6 years. RESULTS: The incidence of aortic dissection was 43 per 1000000 population in our country. Corrective group accounted for 19.3% of them and palliative group for 80.7%. Marfan syndrome accounted for 1.5% of all cases (4.3% of corrective surgery group). The rate of freedom from mortality at 1, 6 months, and 6 years was 80.4+/-1.3, 69.0+/-1.5, and 56.5+/-2.9% for corrective group and 89.5+/-0.5, 78.4+/-0.6, and 46.1+/-1.35% for palliative group. Nearly half of the late mortalities were attributed to atherosclerosis-related conditions (cardiac, stroke, or aortic causes). The incidence of late aortic events was 2.48% per year on an average, comparable between corrective and palliative groups. This incidence increased since the fourth year after their initial episode. For corrective group, young age was a risk factor of late aortic events (relative risk of 0.60-0.82 per decade, P = 0.037). For palliative group, Marfan syndrome and male gender were risk factors of late aortic events (relative risk of 4.08-10.7, P < 0.001 in the former; relative risk of 1.46-2.1, P = 0.002 in the latter). CONCLUSIONS: Late aortic events were not uncommon for both corrective and palliative groups, and its incidence increased since the fourth year after their initial episodes. Young age for corrective group, Marfan syndrome and male gender for palliative group were risk factors of late aortic events.

Adult↗

PubMedDate not supplied

Giant cell arteritis presenting with aortic dissection: two cases and review of the literature.

Aortitis is the most serious location of the disease giant cell (temporal) arteritis (GCA). Aortic dissection or the rupture of an aortic aneurysm can be responsible for sudden death among patients with GCA. This report discusses two cases of GCA presenting with aortic dissection. One case had histologically proven giant cell aortitis. The second case was a fatal aortic dissection preceded by a stroke. We describe the main features of aortic dissection and aortitis during GCA, reviewing the existing literature on this subject, and focusing on the requirement of prospective aortic imaging studies to screen patients with this kind of location.

Aged↗

PubMed1989

Familial aortic dissection: a report of rare family cluster.

Acute aortic dissection occurred in three of four siblings without Marfan syndrome. All of them were successfully treated by operation and remain well 6-42 months after operation. Their mother died suddenly in another hospital of acute aortic dissection. All her siblings were dead and cardiovascular disease was suspected in all of them.

Acute Disease↗

PubMed1998

[Clinical results of acute closing aortic dissection].

The therapeutic outcomes of 43 patients with acute closing aortic dissection treated during the past 10 years were evaluated. The patients consisted of 30 men and 13 women with a mean age of 65 +/- 9 years. Ten were classified as Stanford type A, and the remaining 33 as type B. During follow-up (6 to 120 months; average 55 months), recanalization and an enlarged ulcer-like projection (ULP) were observed in 5 and 2 type a patients. Although recanalization was not observed in type B patients, enlarged ULP was observed in 10 of them, in 6 of whom developed aneurysm. During the follow-up period, ULP was observed at 30 sites in 26 patients. Monitoring the change in ULP over time showed that the ascending and the proximal descending aorta frequently tended to be enlarged and progressed to aorta frequently tended to be enlarged and progressed to aneurysm. Surgery was performed in 3 patients with recanalization, 5 with enlarged ULP, and 3 with atheroscloerotic aortic aneurysm. Although one patient died of cerebral complications, the other 10 patients showed favorable postsurgical courses. Among 8 patients who died, the actuarial survival rate was favorable, being 96, 91 and 83% at 1, 3 and 5 years. However, the survival rate free from complications related to aortic dissection, defined as rupture, ercanalization, enlarged ULP and aneurysmal change, was 78, 58 and 54% at 1, 3 and 5 years, indicating that aortic dissection-related complications are likely to develop within 3 years. This being the case, conservative therapy may be selected for closing aortic dissection when there are no serious complications in the acute phase. However, closely following patients with diagnostic imaging techniques is essential as there may be complications such as recanalization or enlarged ULP. Such complications should be surgically treated because they may affect long-term prognosis.

Aged↗

PubMed1990

Early diagnosis and surgical intervention of acute aortic dissection by transesophageal color flow mapping.

To determine whether transesophageal color Doppler echocardiography (TEE) is useful for the early diagnosis and surgical intervention in acute aortic dissection, 57 serial patients with acute aortic dissection were examined. These patients were evaluated by TEE with either the single-plane probe (39 patients) or the biplanar probe (18 patients) just after admission. The intimal flap was detected in all patients, and there were 18 patients with type A dissection and 39 patients with type B dissection. The entry was visualized in 83% of type A dissection cases and in 90% of type B dissection cases. In two of 18 patients examined with the biplanar probe technique, the entry was detected in the longitudinal view only. Emergency operations were performed in 18 patients with type A dissection and in 10 patients with ruptured type B dissection. Twenty-nine of 39 patients with type B dissection were treated conservatively. The operative mortality rate of patients with type A dissection was 22%, and that of patients with ruptured type B dissection was 60%. The major advantage of TEE is its ease of application at the bedside or in the operating room, which allows immediate and accurate diagnosis of acute aortic dissection for emergency surgical intervention. Biplanar TEE provides additional acoustic windows, ease of spatial orientation, and more accurate visualization of entry. TEE is a useful and powerful diagnostic tool for acute aortic dissection, and by using this method, one may achieve a more rapid and aggressive surgical approach for patients with acute aortic dissection.

Acute Disease↗

PubMed2000

Acute thoracoabdominal aortic dissection presenting as painless, transient paralysis of the lower extremities: a case report.

Acute dissection of the aorta can be one of the most dramatic of cardiovascular emergencies. Its symptoms can occur abruptly and progress rapidly. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. A 63-year-old woman presented with transient loss of lower extremity motor and sensory function as the only symptom of an acute thoracoabdominal aortic dissection. Aortic dissection presenting as a transient neurologic syndrome is quite unusual. The sudden onset of weakness and parasthesia can result from the interruption of blood flow to the spinal cord. These symptoms of acute spinal cord ischemia, suggestive of a serious cardiovascular event, must be recognized and thoroughly investigated.

Acute Disease↗

PubMed1999

Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques.

BACKGROUND: The modern imaging techniques of transesophageal echocardiography, CT, and MRI are reported to have up to 100% sensitivity in detecting the classic class of aortic dissection; however, anecdotal reports of patient deaths from a missed diagnosis of subtle classes of variants are increasingly being noted. METHODS AND RESULTS: In a series of 181 consecutive patients who had ascending or aortic arch repairs, 9 patients (5%) had subtle aortic dissection not diagnosed preoperatively. All preoperative studies in patients with missed aortic dissection were reviewed in detail. All 9 patients (2 with Marfan syndrome, 1 with Takayasu's disease) with undiagnosed aortic dissection had undergone >/=3 imaging techniques, with the finding of ascending aortic dilatation (4.7 to 9 cm) in all 9 and significant aortic valve regurgitation in 7. In 6 patients, an eccentric ascending aortic bulge was present but not diagnostic of aortic dissection on aortography. At operation, aortic dissection tears were limited in extent and involved the intima without extensive undermining of the intima or an intimal "flap." Eight had composite valve grafts inserted, and all survived. Of the larger series of 181 patients, 98% (179 of 181) were 30-day survivors. CONCLUSIONS: In patients with suspected aortic dissection not proven by modern noninvasive imaging techniques, further study should be performed, including multiple views of the ascending aorta by aortography. If patients have an ascending aneurysm, particularly if eccentric on aortography and associated with aortic valve regurgitation, an urgent surgical repair should be considered, with excellent results expected.

Adult↗

PubMed1983

Recognition and management of ascending aortic dissection complicating cardiac surgical operations.

This study retrospectively reviews the hospital records of 24 patients who developed ascending aortic dissection during or following 6,943 cardiac surgical procedures performed from January, 1971, through December, 1981. Group I consists of 15 patients with ascending aortic dissection presenting intraoperatively during myocardial revascularization. Group II consists of nine patients, seven who underwent myocardial revascularization and two who underwent aortic valve replacement, who developed ascending aortic dissection 30 minutes to 21 days after cardiac operation. Four of these patients had poorly controlled hypertension postoperatively. Surgical repair was attempted in all patients in Group I, with an operative mortality of 33%. The major cause of death was myocardial dysfunction secondary to ischemia. There were no operative deaths among six patients managed with closed plication techniques alone. Four of nine patients in Group II underwent ascending aortic dissection repair with an operative mortality of 50%. The overall mortality in Group II was 78%. The major factor in this high mortality was a delay in diagnosis and surgical therapy. Early diagnosis of the intraoperative or postoperative ascending aortic dissection process is essential to minimize the extent of dissection and prevent delay of definitive surgical therapy. Closed aortic plication of the intimal injury rather than more extensive aortic repair may reduce morbidity and mortality in selected patients.

Adult↗