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At least 91 records · Page 5Linked to original sources
PubMed1989

[Emergency operation in impending rupture of aortic arch dissecting aneurysm--a case report of dissecting aortic aneurysm with adhesion to the lung after lobectomy].

Successful surgical treatment of impending rupture of a aortic arch dissecting aneurysm in a 59-year-old man was reported. The aneurysm was tightly adhered to the lung, because he had a previous history of lobectomy. In this case, the permanent aortic bypass with permanent aortic clamp as a means of exclusion procedure of the aortic aneurysm was effective. The postoperative course was uneventful. In the emergency operation for aortic arch aneurysm, operative procedure should be selected by operative findings and risk.

Aortic Dissection↗
PubMed1991

[Clinical features of aortic dissection with early thrombosis of the false lumen].

There are cases of dissecting aortic aneurysm in which thrombotic formation occurs in the false lumen at an early stage, preventing dissection of the vessel wall and enlargement of the aneurysm. We studied such early thrombotic obliteration of false lumina in 12 (28.6%) of 42 patients with dissecting aortic aneurysm who underwent transesophageal two-dimensional echocardiography in the acute phase from June 1986 to October 1989. It was the first employment of a transesophageal approach at our hospital. In this study, we examined the clinical profiles of these patients as well as the usefulness of transesophageal two-dimensional echocardiography in establishing the diagnosis of dissecting aortic aneurysm and characterizing the disease. The patients were classified as Type I (2 patients) and Type III (10 patients; 6 Type IIIa and 4 Type IIIb) according to DeBakey's classification. The minimum and mean intervals from the onset of symptoms to transesophageal two-dimensional echocardiography were 1.5 hours and a mean of 38.2 hours, respectively. These results indicated that thrombotic obliteration of the false lumen had already occurred at a very early stage in some patients. The maximum diameter of the descending aorta was mean 37.6 mm with only 2 patients having that of 40 mm or more. Since left intrapleural hemorrhage was observed in these 2 patients (1 received emergent replacement of the descending aorta), enlargement of the aortic diameter may be indicative of unpredictable outcome, even in patients with early thrombotic obliteration of the false lumen. The long-term clinical course was favorable in all patients, including those who were treated surgically, over a mean follow-up period of 14.5 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Treating aortic dissection and penetrating aortic ulcer with stent graft: thirty cases.

BACKGROUND: The purpose of this study is to evaluate the feasibility and safety of stent graft in the treatment of aortic dissection and penetrating aortic ulcer. METHODS: From June 2001 to April 2004, 25 patients with aortic dissection and 5 patients with penetrating aortic ulcer received stent-graft implantation. Within this group were 24 male and 6 female patients, with an average age of 52.3 +/- 11.9 years. One patient was diagnosed as type A dissection, 23 patients as chronic type B dissection, 1 patient as acute type B dissection, and the remaining 5 patients with penetrating aortic ulcer. Among the 25 patients with aortic dissection, 3 had contained rupture. All patients were followed up in 1 to 32 months. RESULTS: All patients received stent-graft implantation. There were 5 type I endoleaks. Retrograde ascending aortic dissection occurred during the operation in 1 patient. Two other retrograde ascending aortic dissections occurred in 2 patients 1 day and 7 days, respectively, after stent-graft implantation. Two patients died 1 day and 18 days, respectively, after operation because of rupture of ascending aortic dissection. One-month mortality rate was 6.7%. No death occurred during follow-up time. One patient received a second stent-graft implantation 20 months after the first procedure. CONCLUSIONS: Serious complications may develop after stent-graft implantation, but the early results of treatment of aortic dissection and penetrating aortic ulcer with stent graft were satisfactory. Long-term follow-up was needed.

Adult↗
PubMed1986

CT of aortic dissections.

Dissecting aortic aneurysms are one of the few medical emergencies where prompt recognition is crucial. Contrast-enhanced computed tomography combined with dynamic scanning offers an excellent noninvasive means to evaluate patients with suspected aortic dissection. At the Medical College of Wisconsin, we retrospectively reviewed all patients who were referred to the Section of Computed Body Tomography with the diagnosis of suspected aortic dissection. Over 100 patients were studied. The sensitivity, specificity, and overall accuracy of computed tomography was greater than 95%.

Adult↗
PubMed1999

[Atherosclerotic and dissecting aortic aneurysms].

Atherosclerotic aortic aneurysm frequently contains organized thrombus on its luminal surface. Macroemboli or microemboli derived from fragile thrombus may cause occlusion of peripheral arteries. Although this ischemic symptom is seen preoperatively, it occurs more frequently as a complication caused by intraoperative manipulation. Of late, aortic dissection with clotted false lumen has been recognized as having unique characters with good prognosis. There is, however, no definite diagnostic criteria or treatment strategy for this entity. Disseminated intravascular coagulation is a rare consequence of massive thrombus formation in giant atherosclerotic or dissecting aortic aneurysm. In this chapter, we will describe clinical signs relevant to the thrombus formation in these aortic aneurysms, and refer to key points of surgical treatment.

Aortic Dissection↗
PubMed1991

[General anesthesia for cesarean section in a patient with Marfan's syndrome associated with dissecting aortic aneurysm].

A 23-year-old woman with Marfan's syndrome was scheduled for Cesarean section at 31 week gestation because of progressive aortic dissection. Since she had undergone two surgical corrections for scoliosis (Harrington rod instrumentation) 5 and 12 years ago, we selected general anesthesia. She had been taking diltiazem and propranolol for hypertension and tachycardia. Anesthesia was induced with thiopental 75 mg iv followed by O2-N2O-enflurane (4%) by face mask. Following iv administration of vecuronium 4 mg and tracheal injection of 4% lidocaine 120 mg, the trachea was intubated without a significant hemodynamic change. Anesthesia was maintained with O2-N2O-enflurane (0.5-1.5%) before delivery. Following delivery, enflurane was discontinued and small doses of fentanyl iv (total 0.2 mg) were given with iv infusion of nitroglycerin (0.2-0.5 micrograms.kg-1.min-1) during surgery. Bleeding after delivery was controllable by iv infusion of oxytocin. The Apgar score was good (9 at 1 min and 10 at 5 min respectively). Post-operative course was uneventful. Therapeutic abortion or Cesarean section should be performed as soon as possible in a patient with dissecting aortic aneurysm because of increasing risk of aneurysm rupture during pregnancy. During the surgery, minimal hemodynamic changes are required to prevent the rupture.

Adult↗
PubMed2006

Aortic dissection late after aortic valve replacement.

We experienced 3 cases of an aortic dissection occurring late after an aortic valve replacement, and successfully treated by an aortic root replacement. An aortic dissection involving the ascending aorta can develop late after an aortic valve replacement, and such an occurrence is associated with a high mortality and morbidity. The development of effective surgical strategies at the initial aortic valve surgery, strict control of blood pressure after aortic valve replacement, serial evaluations of aortic size, and the prophylactic replacement of the ascending aorta for patients with aortic dilatation after aortic valve replacement, all play clinically important roles in preventing an aortic dissection after aortic valve replacement. When an aortic dissection occurs in patients with a previous aortic valve replacement, an aortic root replacement should be performed in order to avoid leaving the fragile diseased aortic wall including the sinus of Valsalva.

Adult↗
PubMed1998

Patterns of expression of fibrinolytic genes and matrix metalloproteinase-9 in dissecting aortic aneurysms.

Although extensive tissue remodeling occurs during the various phases of aortic dissection, the underlying proteinases remain to be identified. Matrix metalloproteinase-9 (MMP-9) and components of the fibrinolytic system have been implicated in numerous tissue remodeling events and were therefore analyzed in surgical specimens of acute (n = 9), subacute (n = 4), and chronic (n = 7) aortic dissection by in situ hybridization. In the acute phase, intense plasminogen activator inhibitor 1 (PAI-1) gene expression was apparent in areas interfacing the dissecting hematoma, but no tissue-type PA (t-PA), urokinase-type PA (u-PA), or MMP-9 mRNAs were detected. Although PAI-1 mRNA was still present in the subacute phase, t-PA, u-PA, and MMP-9 mRNAs were now obvious, with PA gene expression co-localizing with areas of PAI-1 gene expression. In the chronic phase, PAI-1 mRNA was demonstrated around erythrocyte extravasations and surrounding bands of medial degeneration. However, there was little expression of PAs in these areas, and no MMP-9 was detected. Thus, fibrinolytic genes and MMP-9 are differentially expressed during the progression of aortic dissections. The kinetics of expression are consistent with acute fibrinolytic shutdown in response to the initial injury, a secondary subacute phase with active proteolysis, and finally, a chronic hypofibrinolytic state. Extensive neovascularization in the chronic phase may further reduce the physical stability of the dissected wall.

Acute Disease↗
PubMed2005

Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience.

BACKGROUND: Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era. METHODS: A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II). RESULTS: The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II ( P < .001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10). CONCLUSIONS: The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.

Acute Disease↗
PubMed1978

Late results of operation for acute aortic dissection producing aortic insufficiency.

Since July, 1970, 8 patients with acute dissecting aneurysms of the ascending aorta producing aortic insufficiency have undergone immediate operation employing a technique in which the origin of the dissection is resected, the dissected base of the aorta is lined with nondistensible prosthetic cloth for support, and the native aortic valve is resuspended. Aortic continuity is then reestablished with end-to-end anastomosis or use of a short segment of woven graft (not necessarily circumferential). There were no operative deaths. Mean follow-up has been 60 months (range, 25 to 82 months). One late death has occurred (cerebral hemorrhage at 48 months); of the remaining 7 patients, 2 have faint murmurs of aortic insufficiency, but all are in New York Heart Association Functional Class I. This technique of aortic reconstruction in acute ascending dissections allows preservation of the native aortic valve while preventing late aortic root dilatation or major valve insufficiency.

Adult↗
PubMed2006

Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting.

PURPOSE: To retrospectively review the authors' experience with multi-detector row computed tomography (CT) for detection of aortic dissection in the emergency setting. MATERIALS AND METHODS: The investigation was institutional review board approved, did not require informed patient consent, and was HIPAA compliant. In 373 clinical evaluations in the emergency setting, 365 patients suspected of having aortic dissection and/or other aortic disorders underwent multidetector CT. Criteria for acute aortic disorder were confirmed by using surgical and pathologic diagnoses or findings at clinical follow-up and any subsequent imaging as the reference standard. Positive cases were characterized according to type of disorder interpreted. Resulting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by using two-way contingency tables. All cases found to be negative for acute aortic disorders were grouped according to alternative CT findings. RESULTS: Sixty-seven (18.0%) of the 373 cases were interpreted as positive for acute aortic disorder. One hundred twelve acute aortic disorders were identified in these 67 cases: 23 acute aortic dissections, 14 acute aortic intramural hematomas, 20 acute penetrating aortic ulcers, 44 new or enlarging aortic aneurysms, and 11 acute aortic ruptures. Three hundred five (81.8%) cases were interpreted as negative for acute aortic disorder. In 48 negative cases, multidetector CT depicted alternative findings that accounted for the clinical presentation. Of these, three included both acute aortic disorders and alternative findings, and 45 included only alternative findings. One (0.3%) case was indeterminate for acute aortic disorder. Overall, 112 findings were interpreted as positive for acute aortic disorder, an alternative finding, or both at CT. No interpretations were false-positive, one was false-negative, 67 were true-positive, and 304 were true-negative. Sensitivity, specificity, PPV, NPV, and accuracy were 99% (67 of 68), 100% (304 of 304), 100% (67 of 67), 99.7% (304 of 305), and 99.5% (371 of 373), respectively. CONCLUSION: The positivity rate for acute aortic dissection or other acute aortic disorder in 373 cases examined at multi-detector row CT was 18.0%.

Acute Disease↗
PubMed2003

Acute type A aortic dissection complicated by aortic regurgitation: composite valve graft versus separate valve graft versus conservative valve repair.

OBJECTIVE: To clarify the merits of various surgical approaches, we studied the outcome after composite valve graft versus separate valve and graft replacement versus conservative valve treatment with replacement of the ascending aorta in patients with acute type A aortic dissection complicated by aortic regurgitation. METHODS: Between 1967 and 1999, 123 patients (mean age 56 +/- 15 years) underwent composite valve graft replacement (n = 21), separate valve and graft replacement (n = 20), or conservative valve treatment (n = 82 [commissural resuspension in 46]); follow-up averaged 6.5 years (95% complete). RESULTS: The 30-day, 1-year, and 6-year survival estimates of 85% +/- 4%, 79% +/- 5%, and 69% +/- 5% (+/-1 standard error of mean), respectively, after conservative valve treatment were similar to 86% +/- 8%, 81% +/- 9%, and 65% +/- 16%, respectively, with composite valve graft replacement and better (but insignificantly so) than 70% +/- 10%, 70% +/- 10%, and 45% +/- 11%, respectively, with separate valve and graft replacement. The 6-year freedom from proximal reoperation was 95% +/- 3%, 89% +/- 10%, and 100% in conservative valve graft, separate valve and graft, and composite valve graft subgroups, respectively (P = not significant). Cox regression multivariable analysis identified that previous sternotomy (hazard ratio [or e(beta)] 95% confidence interval 1.4-10.9, P =.006), hypertension (0.99-2.9, P =.05), cardiac tamponade (1.1-4.0, P =.03), and stroke (1.7-7.0, P =.001) increased the hazard of death. No factors predicting a higher likelihood of late proximal reoperation were identified. CONCLUSIONS: In patients with acute type A aortic dissection and aortic regurgitation, there was no significant difference in overall survival or reoperation rates among these surgical approaches. We try to save the valve whenever possible unless the aortic root is pathologically dilated (eg, Marfan syndrome or annuloaortic ectasia) or destroyed by the dissection process, when composite valve graft or valve-sparing aortic root replacement is indicated.

Acute Disease↗
PubMed1992

[Chronic dissecting aortic aneurysm and Turner's syndrome. Apropos of a case].

Turner's syndrome is a genetic abnormality which is associated with cardiovascular anomaly in 20% of cases. Coarctation of the aorta and bicuspid aortic valve are the commonest malformations. Aortic dissection is the most serious complication affecting these patients. The authors report the case of chronic aortic dissection of the ascending and transverse aorta in a 27 year old patient with Turner's syndrome. The dissection was diagnosed on angiography. Transthoracic echocardiography showed aneurysmal dilatation of the aortic root. Surgical treatment consisted in replacement of ascending and transverse aorta with a Dacron tube. The anatomopathological analysis showed cystic medianecrosis of the aortic wall. The immediate postoperative evolution was satisfactory. The long-term outcome with a 4 year follow-up was excellent from the clinical and echocardiographic point of view. Turner's syndrome is probably associated with a congenital abnormality of the connective tissue especially of the elastic fibres of the aortic wall, explaining the development, though rare, of aneurysmal dilatation of the ascending and transverse aorta and dissection. These patients should be followed up regularly clinically and by transthoracic echocardiography. Other investigations such as transoesophageal echocardiography, magnetic resonance imaging and angiography are indicated when aortic dilatation, aortic regurgitation or chest pain suggesting aortic dissection are observed.

Adult↗
PubMed2006

Intracoronary stent visualized on transesophageal echocardiogram in a case of coronary dissection complicated by aortic dissection.

We present a case of a patient presenting with a myocardial infarction with subsequent coronary intervention resulting in a coronary dissection complicated by an aortic dissection. The coronary dissection was treated with coronary stents. Transesophageal echocardiogram visualized the intracoronary stent within the intimal flap of the aortic dissection. The aortic dissection was successfully managed conservatively.

Aortic Dissection↗
PubMed2006

Aortic dissection and bicuspid aortic valve: an autopsy study.

Medico-legal post-mortems referred to the Department of Pathology, for the histopathological examination, revealed six cases of acute aortic dissection--two in isolation, three in combination with congenital bicuspid aortic valve; and one isolated case of congenital bicuspid aortic valve. One case of isolated aortic dissection was associated with Marfan's syndrome; and one case of aortic dissection with bicuspid aortic valve was associated with polycystic kidneys. History of hypertension could be elicited in two cases. Cystic medial degeneration of aorta was seen in three cases; one of which was associated with Marfan's syndrome. All five cases of aortic dissection belonged to type II of DeBakey classification.

Adult↗
PubMed1991

[A case of surgical repair of aortic dissection associated with tear of the right coronary artery].

A 39-year-old female with dissecting aortic aneurysm of DeBakey type I, underwent replacement of the ascending aorta. We found that the right coronary artery originated just distally from the left sinus of Valsalva, run transversally in the aortic wall. Because the entry of dissection occurred at the right coronary artery, it was torn longitudinally. Aorto (graft)-rt. coronary bypass grafting was performed. She had no ischemic heart symptoms postoperatively. It is supposed that the dissecting aortic aneurysm was caused by the anomalous origin of the right coronary artery.

Adult↗
PubMed1992

[Another case of dissecting aortic aneurysm with familial incidence].

Several authors have reported aortic dissection in Marfan's syndrome with familial incidence. Cases of dissecting aortic aneurysms have likewise been described in families whose members had severe systemic arterial hypertension. We report 4 cases of familial aortic aneurysm, 3 of whom had a dissection, in the absence of Marfan's phenotype but with histologic findings and genetic transmission similar to those previously described as formes frustes of Marfan's syndrome.

Aortic Dissection↗