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At least 1,117 records · Page 62Linked to original sources

PubMed2004

Percutaneous transluminal angioplasty with stenting in extended supra-aortic artery dissection.

A 51-year-old man underwent two percutaneous transluminal angioplasties with stenting for a dissection that extended from the right brachiocephalic trunk into the proximal part of the internal carotid artery. The patient presented with transient dysphasia one month after surgical treatment of a type A dissecting aortic aneurysm. Initially, he was managed with conservative treatment, with no effect on the dissected arteries. Two stents were then successfully placed over the site of dissection to prevent further embolization. At follow-up 29 months after stent implantation, the patient was asymptomatic and ultrasound examination demonstrated no recurrence of dissection at the stented segment. This case suggests that stenting could be a successful treatment of cervical artery dissection.

Aortic Dissection↗

PubMed2004

Cardiac catheterization-induced type-A aortic dissection detected by intra-operative transesophageal echocardiography--a case report.

Cardiac catheterization is not only a diagnostic tool but also a means of treatment of coronary artery disease. Coronary artery dissection is one of the complications of cardiac catheterization. Emergency coronary artery bypass graft (CABG) surgery is indicated when coronary artery dissection is associated with unstable perfusion or residual severe stenosis. We present a case of progressive type-A aortic dissection as a continuity of catheterization-induced dissection of right coronary artery (RCA) with occlusion, disclosed by transesophageal echocardiography (TEE) during the emergent CABG surgery for the iatrogenic injury. Once the aortic dissection has been diagnosed by TEE, the surgical procedure and cannulation site for cardiopulmonary bypass were altered from those used in regular CABG surgery. Therefore, TEE is able and valuable in such situation to detect this rare but severe complication due to catheterization, especially when retrograde coronary artery dissection has been noted preoperatively.

Aged↗

PubMedDate not supplied

[Cerebral dissecting aneurysms].

INTRODUCTION: Blood stream penetrates through the lacerations of the arterial layers determining dissecting aneurysms. Each intramural clot localization determines different clinical form. OBJECTIVE: We present the clinical observations carried out in two patients with vertebrobasilar dissecting aneurysms and we review the state of the art of this process to remark the early identification of these unusual lesions. CASE REPORTS: Two cases of vertebrobasilar dissecting aneurysms were described. They were young patients that debuted, one as posteroinferior artery brain steam infarction and the other one as a subarachnoid hemorrhage caused by a right posterior cerebral artery dissecting aneurysms. Lesions were confirmed by helicoidal cerebral angiotomographic and angiograms. This patient was operated on and we clipped the posterior communicating that irrigated dissecting segment. We carry out an anatomical and hemodynamic analysis of that lesion. Both patients had a satisfactory clinical evolution. CONCLUSIONS: Dissecting intramural hematomas of the vertebrobasilar territory are frequent cause of young people ictus. It has been suggested that the ictus may happen after minor head trauma and pain, main symptom, always precedes neurological dysfunction signs. Hemorrhagic presentation has a high incidence of rebleeding and elevated mortality. It always requires, as soon as possible, direct microsurgical treatment or endovascular methods (coils). Most useful microsurgical procedure, until today, is parent artery clipping. This technique has a low index of isquemic and neural postoperative damage.

Adult↗

PubMed2003

Dissecting aortic aneurysm in computed tomography.

The dissecting aortic aneurysm (DAA) is an emergency, and because of that it requires urgent diagnosis and treatment. Many methods may by used to diagnose dissection, including aortography, CT, MRI, traditional and transesophageal ultrasonography. The computed tomography is often used in diagnostic of DAA, thus the knowledge of morphological characteristic of dissection is very important. The most important features of dissection in CT are presence of dissection of intima and two lumens, true and false. Nevertheless, the CT pictures of dissection not always appears like this, and sometimes the two lumens are identified only by their different rates of opacification with contrast material.

Adult↗

PubMed2004

[Aortic root redissection associated with the use of gelatin-resorcin-formalin glue following surgical treatment for acute type A aortic dissection; report of a case].

A late redissection case of the aortic root after total arch replacement for acute Stanford type A aortic dissection was reported. A 55-year-old male was treated with total arch replacement for acute Stanford type A aortic dissection. The aortic valve was bicuspid valve, and the right coronary leaflet was prolapsed because of the dissection of right and non coronary cusp. Resuspension of the commissure and the fixation of the dissected aortic wall with gelatin-resorcin-formalin (GRF) glue was performed during the operation. The initial postoperative course was uneventful and the patient discharged 52 days after the operation. Redissection of aortic root was pointed out on the computed tomography (CT) 3.5 years after the operation. As the second operation, the aortic root replacement was performed. Coronary artery bypass for right coronary artery was simultaneously performed with right internal thoracic artery because the right coronary ostium was stenotic and showed ischemic change on electrocardiogram monitor during the operation. The redissection was seen on the right coronary sinus, which was fixed by the GRF glue during the first operation. The pathological study showed the migration of macrophages and the tear of the fibrous tissue. These findings was thought to be associated with the use of the GRF glue. Careful use of the GRF glue for the fixation of the dissected aorta during the surgical treatment for the Stanford type A aortic dissection was thought to be important.

Aortic Dissection↗

PubMed2004

Paraparesis as the major initial presentation of aortic dissection: report of four cases.

Aortic dissection, which typically manifests as sudden tearing or migratory pain, is a well-known medical emergency. However, in 5% of aortic dissection patients, there is no pain. In these patients, the diagnosis depends on the development of neurologic complications. After analyzing the initial symptoms of a series of patients with aortic dissection, we found 4/211 (1.9%) patients suffered from paraparesis. We suggested that the mid- or low thoracic cord be most vulnerable site during acute aortic dissection. This report highlighted the importance of considering the diagnosis of aortic dissection in a patient with a history of acute onset of transient or permanent neurological symptoms in the lower limbs. Whether paraparesis can be an indicator of the prognosis of aortic dissection requires further researches.

Aged↗

PubMed2004

[Spiral CT in aortic dissection].

Patients with suspected dissection of the thoracic aorta require immediate diagnostic evaluation so that urgent therapeutic interventions can begin. Two women with suspected aortic dissection and one man with abdominal aortic aneurysm underwent color-flow Doppler echocardiography and CT angiography with multiplanar reconstructions. Spiral CT showed ascending aortic dissection (type A Stanford) in two cases and descending aortic dissection (type B Stanford) in one case. It also access the visualization of the intimal flap, the extent of dissection, the size of the aorta, and the presence of pericardial fluid. CT angiography is an accurate diagnostic procedure for patients with suspected aortic dissection and possesses several advantages over other modalities such as transthoracic echocardiography, transesophageal echocardiography and aortography.

Adult↗

PubMed2005

[Surgical management for Stanford A aortic dissection].

OBJECTIVE: To summarize the surgical experience for Stanford A aortic dissection. METHODS: Sixty-eight patients with Stanford A aortic dissection underwent surgery from March 1998 to October 2004, acute aortic dissection in 45 cases, chronic aortic dissection in 23 cases. The operation were performed by using moderate hypothermic cardiopulmonary bypass in 53 cases, deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) in 11 cases; DHCA with antegrade selective cerebral perfusion (SCP) in 4 cases. Surgical procedures included ascending aortic grafting in 7 cases, ascending and hemiarch grafting in 6, ascending and total arch grafting in 3, ascending and total arch grafting with Frozen elephant trunk procedure in 4. Concomitant procedures included Bentall procedure in 34 cases, Wheat procedure in 12 cases, aortic valvuloplasty in 2 cases, mitral valvuloplasty in 1 cases. Urgent surgery was in 39 cases (emergency surgery in 19). RESULTS: Operative mortality was 7% (urgent surgery mortality was 8%, elective surgery mortality was 7%). Fifty-eight cases were followed up for (37 +/- 22) months. Actuarial survival of 58 cases at 1, 3 and 5 years was 100%, 95% and 86% respectively. CONCLUSION: The choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection. Proper surgical indication, technique and brain protections are the key factors of Stanford A aortic dissection surgery.

Adult↗

PubMed1992

Marfan syndrome with aortic dissection and triple-barrel aorta.

A case of Marfan syndrome with spontaneously and subsequently developed dissections of the aorta, one in the form of triple-barrel aorta, three times corrected by grafts is described. The autopsy revealed "healed" and acute dissections in almost the entire aorta outside the grafts. "Healed" thoracoabdominal dissection had true lumen (with entry and re-entry intimal tears), and old false lumen and in addition in its distal portion of a triple-barrel aorta was formed (dissection of healed aortic dissection). Lethal adventitial rupture occurred in the portion with an old false lumen. Dissection of the left subclavian artery, the right common carotid artery, resulting in saccular aneurysm, and avulsion of the right renal artery were also found.

Adult↗

PubMed2005

[Acute myocardial infarction due to spontaneous coronary artery dissection].

BACKGROUND: Spontaneous coronary dissection is a rare cause of acute myocardial infarction (AMI). Its aetiology and treatment have not yet been well defined. In this report, we review the clinical presentation, the aetiology, the risk factors and the treatment of 6 cases of AMI due to spontaneous coronary dissection. METHODOLOGY AND RESULTS: We have reviewed 1100 cases of AMI having undergone coronary angiography in our institution during the period December 1999 to January 2004. Six cases (0.5%; 5 men, mean age: 38 years) in which spontaneous coronary dissection had been retained as final aetiology were further analyzed. Four patients had no cardiovascular risk factors but, interestingly, in all 6 patients we found a clear triggering factor of the acute event: extreme physical stress (5), or psychological stress (1). Thrombolysis had been performed in 5 patients, and the coronary angiography carried out thereafter showed a dissection of the left anterior descending coronary (2 cases), of the right coronary artery (3 cases) or of the left circumflex artery (1 case). All patients had a preserved coronary flow (TIMI 3). On the basis of the angiographical findings, medical treatment (4 patients), coronary artery by-pass grafting (1 patient), or percutaneous angioplasty with stenting (1 patient) were performed. The only major cardiac adverse event observed in the early follow up was a sudden acute thrombosis of the coronary stent. CONCLUSION: In young patients without cardiovascular risk factors and presenting with AMI subsequent to a physical or emotional stress, spontaneous coronary artery dissection should imperatively be taken into consideration as a possible diagnosis. Since intravenous thrombolysis may worsen the dissection, we recommend primary emergency coronarography as a diagnostic and (sometimes) therapeutic treatment option.

Adult↗

PubMed1992

[Myocardial dissection in infarction of the right ventricle. Clinical echocardiographic and pathological aspects].

Dissection of the inferior wall of the right ventricle during the acute phase of myocardial infarction with right ventricular involvement is a mechanical complication which has been recently identified, the diagnosis being almost exclusively post-mortem. The authors report the clinical, echocardiographic and pathological features of myocardial dissection in four patients. Between 1985 and 1988, the diagnosis of myocardial dissection was made by echocardiography in 4 patients aged 77 to 80 years, admitted to hospital for an acute inferior wall myocardial infarction. All 4 patients had signs of acute right ventricular failure indicating right ventricular necrosis and a loud systolic murmur at the left sternal border; 2 patients were in shock. The ECG showed signs of inferior wall infarction with, in 2 patients, electrical changes suggestive of right ventricular involvement. Echocardiography showed dissection of the inferior wall of the right ventricle as a pulsatile, echo-free space in the diaphragmatic wall of the right ventricle which appeared to obstruct right ventricular ejection in end systole to a variable degree. The outcome was fatal in all cases with death resulting from refractory myocardial failure. Pathological analysis confirmed biventricular inferior wall infarction also involving the posterior part of the interventricular system, the site of a small tear on the left side which communicated with a neo-cavity dissecting the RV posterior wall. The right coronary artery was totally occluded in all cases. The anatomical lesions were fully concordant with the echocardiographic data: the dissection filled with blood from the left ventricle at each systole creating a pulsatile space in the diaphragmatic wall of the ventricle obstructing ejection.

Aged↗

PubMed2006

[Multiple acute aortic dissection; report of a case].

A 60-year-old woman has been followed under the diagnosis of De Bakey type Illb acute aortic dissection. She developed sudden backache, and the diagnosis based on the emergent computed tomography (CT) was De Bakey type I dissection. At the operation, previous De Bakey type Illb dissection was far from the new dissection observed in the ascending aorta and arch aorta. We replaced the ascending aorta and aortic arch with woven Dacron graft (arch first technique) under retrograde cerebral perfusion. Since the residual dissection (De Bakey type III) in the multiple aortic dissection has tendency to dilate fast, intensive follow-up of the patient would be necessary.

Acute Disease↗

PubMed2006

[The impacts of various types of neck dissection on postoperative shoulder function for patients with oral squamous cell carcinoma].

OBJECTIVE: To compare the impact of various types of neck dissection on postoperative shoulder function. METHODS: The shoulder functions of 66 patients with oral squamous cell carcinoma (OSCC) and cN0 necks who underwent various types of neck dissection were evaluated by Constant's shoulder function test and neck dissection impairment index at least 12 months after surgery. RESULTS: The patients with accessory spinal nerve reserved had better shoulder function than those with accessory spinal nerve resected. In the group with accessory spinal nerve reserved, the patients receiving selective neck dissection (SND) showed better shoulder function than those with modified radical neck dissection (MRND). The shoulder dysfunction and pain arising from SND were minor in patients with selective neck dissection. CONCLUSIONS: The shoulder function after SND was superior to those after RND and MRND.

Adult↗

PubMed2006

Aortocoronary dissection with acute left main artery occlusion: successful treatment with emergent stenting.

Iatrogenic aortocoronary dissection is a rare but devastating complication of percutaneous coronary interventions and cardiac surgery, with a mortality rate up to 35%. Of the type-A dissections in the International Registry of Aortic Dissections (IRAD), 27% were caused by coronary interventions. The mechanism involves an initial dissection in the coronary artery, which then propagates in a retrograde fashion past the sinuses of Valsalva, often several centimeters beyond the aortic valve. With the advent of complex interventions such as left main stent implantation, revascularization of chronic total occlusions and mechanical thrombectomy, this complication may become more prevalent. Here we present a unique case of percutaneous coronary intervention (PCI) of the left circumflex (LCx) artery complicated by a left main coronary dissection that propagated approximately 8 cm into the ascending aorta and caused abrupt left main coronary artery occlusion and hemodynamic collapse. Rescue of the left main artery and sealing of the aortic dissection with stabilization of the patient was possible with rapid ostial left main artery stenting.

Aged↗

PubMed2006

Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling.

BACKGROUND AND PURPOSE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion in intracranial vertebral artery dissections. We describe the efficacy and limitations of this method. METHODS: Fourteen patients with intracranial vertebral artery dissection were treated with stent placement (10 patients) or stent-assisted coiling (4 patients). Double overlapping stents were deployed in 4 of 10 patients with stent placement alone. Angiographic follow-up at 6 to 12 months was available in 13 patients. RESULTS: In 13 patients with dissecting aneurysm, immediate angiographic outcomes were complete occlusion (1 patient), nearly complete (2 patients), and incomplete (10 patients). Follow-up angiograms of 12 of these patients showed complete occlusion (6 patients) and incomplete (6 patients; 1 unstable and 5 stable). Complete occlusion rates in follow-up angiograms were superior in double stent placement (75%) or stent-assisted Guglielmi detachable coil (GDC) embolization to stent placement alone (0%). There were no instances of postprocedural ischemic attacks, new neurologic deficits, and no new minor or major strokes before patient discharge. On the modified Rankin scale applied in follow-up, all patients were assessed as functionally improved or of stable clinical status. CONCLUSIONS: Intracranial vertebral artery dissections were acceptably treated with stent placement or stent-assisted coiling, and the patency could be preserved at follow-up. However, the efficiency of stent placement alone for intracranial vertebral artery dissecting aneurysm was limited. Stent-assisted coil embolization or double stent placements are a viable alternative for complete occlusion of dissecting aneurysms.

Adult↗

PubMed2006

[Transluminal stent-graft placement for the treatment of acute aortic dissection].

We have performed transluminal stent-graft placements (TSGPs) to seal the primary entry site to treat and prevent complications of aortic dissection since 1997. Sixty patients with a primary intimal tear in descending aorta underwent TSGP. TSGP was performed in 27 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Fourteen AOD without complications were treated to prevent aneurysmal enlargement. Nineteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. The hospital mortality rate was 4.9% in AOD and 0% in chronic dissections. The primary success rate was 87.8% in AOD. After hospital discharge, 2 patients died during an average follow-up of 56.2 months. Actuarial survival rate at 5 years was 90.0% in AOD. We conclude that TSGP is a reasonable treatment option for aortic dissection. However, intimal tear formations caused by the stent-graft is a problem that requires further developments of stent-grafts.

Acute Disease↗

PubMed2006

[One stage thyroidectomy and bilateral neck dissection for well-differentiated thyroid carcinoma].

OBJECTIVE: To investigate the indications, safety and difficulties of one stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma. METHODS: A retrospective review was carried out in 36 well-differentiated thyroid carcinoma patients so treated from 1990 to 2004. Various incisions including H, L and modified Kocher types were selected according to the location of primary tumor and status of cervical lymph node metastasis. Either total thyroidectomy or sub-total thyroidectomy combined with bilateral neck lymph node dissection according to the principles of modified radical neck lymph node dissection: preserving the internal jugular vein, spinal accessory nerve and sternocleidomastoid muscles. RESULTS: There was no operative death in this group. Postoperative complications included: 2 wound bleeding, 3 recurrent laryngeal nerve resection due to tumor involvement, 1 recurrent laryngeal nerve injury, 2 unilateral internal branch of superior laryngeal nerve injury, 9 unilateral external branch of superior laryngeal nerve injury, 3 unilateral accessory nerve injury, 5 unilateral sympathetic nerve injury, 2 unilateral phrenic nerve injury, 6 chylus fistula, 13 temporary hypoparathyroidism, 2 permanent hypoparathyroidism. The dissected lymph nodes were found to be positive from 0 to 21 in each patient with a mean of 8.3. Of the 36 patients: 31 had bilateral positive lymph nodes; 3 unilateral positive; 2 bilateral negative lymph nodes. The follow up period ranged from 1 to 13 years, Three patients died of distant metastasis, 1 died of cerebral vascular accident. 7 patients lost in follow-up. Totally, 25 patients are still alive, 3 patients had local relapse and were surgically treated again. CONCLUSION: The procedure of one-stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma is safe, as it is mandatory that at least one unilateral internal jugular vein should be preserved; one unilateral recurrent laryngeal nerves and accessory nerves should not be injured. Well-differentiated thyroid carcinoma patients whose bilateral cervical lymph nodes are clinically suspected to be positive (obviously enlarged, hard, purplish grapelike lymph node) or are confirmed pathologically to be positive are indications for one-stage thyroidectomy and bilateral neck lymph node dissection. Total or sub-total thyroidectomy should be undertaken with emphasis that at least one parathyroid with blood supply should be preserved. It is of utmost importance that not only the cancer be completely resected but the function of the organs be preserved.

Adenocarcinoma, Follicular↗

PubMed1991

[Histopathological study of aortic wall dissection].

To determine the etiology of aortic wall dissection, a histopathological study of the aorta in 20 cases with dissecting aortic aneurysm (DA), 3 cases with Marfan syndrome and 3 cases with annulo-aortic ectasia (AAE) was performed. Controls consisted of 348 cases of normally-aging aorta. In cases with aortic wall dissection, the histopathological changes in the undissected media were also carefully examined. In Marfan syndrome and AAE, there was a marked accumulation of acid mucopolysaccharide (AMPS) and its distribution in the wall was diffuse in patients under 50 years old, resulting in changes in elastic fibers including fragmentation, elastolysis and reticulation. In contrast, DA was histopathologically characterized by zonal fibrosis and abnormally-dilated vessels in the aortic media. These lesions were found in 8 (40%) of the 20 DA cases. The remaining 12 cases also had increased vascularization and fragmentation of elastic fibers. This medial fibrosis and increased vascularization were particularly marked in older patients. Among the 3 diseased entities responsible for aortic wall dissection, DA differed distinctly from Marfan syndrome or AAE as to the amount and site of AMPS accumulation in the media as well as fibrosis and hypervascularity in the outer half of the aortic media. In conclusion, aortic wall dissection in younger patients may be etiologically associated with the increased AMPS accumulation in the aortic media which may always be accompanied by degeneration of elastic fibers in this study, however, in older patients zonal fibrosis and abnormal vessels developing in the media are responsible for the dissection.

Adolescent↗