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Sample records for aortic dissection presenting

  1. Painless aortic dissection presenting as paraplegia.

    PubMed

    Colak, Necmettin; Nazli, Yunus; Alpay, Mehmet Fatih; Akkaya, Ismail Olgun; Cakir, Omer

    2012-01-01

    Acute dissection of the aorta can be life-threatening. As a presenting manifestation of aortic dissection, neurologic complications such as paraplegia are rare. Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of the legs, with no chest or back pain. His medical history included coronary artery bypass grafting. Physical examination revealed pulseless lower extremities, and computed tomography showed aortic dissection from the ascending aorta to the common iliac arteries bilaterally. A lumbar catheter was inserted for cerebrospinal fluid drainage, and axillary arterial cannulation was established. With the use of cardiopulmonary bypass, the aortic dissection was corrected, and the previous coronary artery grafts were reattached. The surgery restored spinal and lower-extremity perfusion, and the patient walked unaided from the hospital upon his discharge 5 days later. Although acute aortic dissection presenting as paraplegia is rare, it should be considered in patients who have pulseless femoral arteries bilaterally and sudden-onset paraplegia, despite no pain in the chest or back. Prompt diagnosis and intervention can prevent morbidity and death.

  2. Painless, acute aortic dissection presenting as an acute stroke.

    PubMed

    Baydin, Ahmet; Nargis, Cemil; Nural, M Selim; Aygun, Dursun; Karatas, Aydin Deniz; Bahcivan, Muzaffer

    2006-12-01

    Acute aortic dissection is an uncommon disease; however, it has a high mortality rate. Classically, aortic dissection presents with sudden and severe pain in the chest, back, or abdomen. Patients often describe tearing or ripping pain. There are a few reports of atypical findings or no pain in the literature. We report a case of painless, acute aortic dissection presenting as acute stroke.

  3. Aortic dissection

    MedlinePlus

    Aortic aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - dissection ... also cause abnormal widening or ballooning of the aorta ( aneurysm ). The exact cause is unknown, but more common ...

  4. Silent aortic dissection presenting as transient locked-in syndrome.

    PubMed

    Nadour, Wadih; Goldwasser, Brian; Biederman, Robert W; Taffe, Kevin

    2008-01-01

    Acute aortic dissection is a medical emergency. Without prompt recognition and treatment, the mortality rate is high. An atypical presentation makes timely diagnosis difficult, especially if the patient is experiencing no characteristic pain. Many patients with aortic dissection are reported to have presented with various neurologic manifestations, but none with only a presentation of transient locked-in syndrome.Herein, we report a case of completely painless aortic dissection in a woman who presented with a transient episode of anarthria, quadriplegia, and preserved consciousness. On physical examination, she had a 40-point difference in blood pressure between her left and right arms, and a loud diastolic murmur. The diagnosis of acute aortic dissection was reached via a combination of radiography, computed tomography, echocardiography, and a high index of clinical suspicion. The patient underwent emergency surgery and ultimately experienced a successful outcome.To our knowledge, this is the 1st report of aortic dissection that presented solely as locked-in syndrome. We suggest that silent aortic dissection be added to the differential diagnosis for transient locked-in syndrome.

  5. Acute aortic dissection presenting as painless paraplegia: a case report.

    PubMed

    Hdiji, Olfa; Bouzidi, Nouha; Damak, Mariem; Mhiri, Chokri

    2016-04-05

    Acute aortic dissection is an extreme emergency that is generally manifested by violent chest pain irradiating to a patient's back and abdomen. Paraplegia due to spinal cord ischemia and infarction as a presenting manifestation of aortic dissection has been found in 2 to 5% of patients. However, painless paraplegia is exceedingly rare and limited to a few case reports in the literature. We describe a new case with this unusual presentation of aortic dissection and here we emphasize that this condition must be considered in all patients with painless paraplegia. A 70-year-old Arab man with no previous known medical or surgical conditions was hospitalized for brutal heaviness of his lower limbs associated to urinary retention. A neurological examination revealed flaccid paraplegia without sensory disorder. His blood pressure and his pulse were in normal ranges. He was afebrile. His peripheral pulses were not checked. Laboratory investigations eliminated multiple organ failure. Spinal magnetic resonance imaging realized in emergency was normal. He had a cardiopulmonary arrest 1 day after his hospitalization. His autopsy report concluded a type A aortic dissection with an intimal tear at his aortic isthmus with intrapericardial rupture and extension to his intercostal and lumbar arteries. Acute aortic dissection is an extreme emergency that can lead to death unless there is an early diagnosis. It must be considered in any patient with paraplegia even painless. Clinical examination has a major role to play in diagnosing this condition. Apart from the neurological examination, palpation of peripheral pulses and blood pressure measurements in all four limbs is of paramount importance. Then further investigations must be carried out consisting of aortic angiography by computed tomography or by magnetic resonance imaging.

  6. [Aortic dissection].

    PubMed

    Ogino, Hitoshi

    2011-07-01

    Acute aortic dissection suddenly occurrs and results in a variety of catastrophic sequelae including cardiac tamponade, rupture, and organ malperfusion. In acute stage (< 2 weeks), according to the classifications on the region of aortic dissection, the condition of the false channel and the onset, appropriate medical, surgical, or endovascular treatments including endovascular aneurysm repair followed by the rapid and accurate diagnosis of aortic dissection using computed tomography and ultrasound should be performed without delay. In the chronic stage (> 2 weeks), the behavior of the chronic dissection or residual distal dissection after the initial treatment should be followed-up carefully with best medical treatment at the regular intervals. If necessary, appropriate surgical and endovascular treatment should be carried out in the proper timing before rupture.

  7. Spontaneous renal artery dissection presenting as an aortic dissection: a case report.

    PubMed

    Bucher, Joshua; Geib, Ann-Jeanette

    2016-12-20

    Renal artery dissection is a condition that has been associated with traumatic injuries and connective tissue disorders. It has been managed in the past by multiple methods because there is no standard treatment, including vascular intervention with angioplasty and stenting, anticoagulation/antiplatelet therapy, and hypertension management. We present a case of a spontaneous renal artery dissection in a 55-year-old white man with no traditional risk factors who presented twice to our emergency department in a 2-day period with different symptoms; on his first presentation he presented with symptoms consistent with renal colic and on the second visit he presented with symptoms consistent with aortic dissection. Our patient was treated with endovascular stent placement by interventional radiology, heparin infusion, and admission to our medical intensive care unit. Our review here highlights the varied management of this diagnosis for which there is no standard treatment and decisions are made in conjunction with consultants.

  8. Aortic dissection presenting as acute lower extremity ischemia: report of a case.

    PubMed Central

    Liu, Wen-Pin; Chen, Wei-Kung; Ng, Kim-Choy

    2002-01-01

    Although not common, acute leg ischemia is an important element in the clinical presentation of a patient with aortic dissection. This report describes a case of aortic dissection in which the main feature at presentation was acute right leg ischemia. The angiography showed right common iliac artery and external iliac artery occlusion. Diagnosis was made by clinical evaluation and angiography. Embolectomy was then attempted immediately but failed. Aortic dissection was highly suspected and confirmed by emergency computed tomography. Fortunately, the patient had good recovery. Aortic dissection is potentially lethal if misdiagnosed or if recognition is delayed. As such, aortic dissection should be considered in the differential diagnosis. Images Figure 1 Figure 2 PMID:12784971

  9. Unusual presenting of acute aortic dissection due to penetrating atheromatous ulcer.

    PubMed

    Atas, Halil; Durmus, Erdal; Sunbul, Murat; Birkan, Yasar; Ozben, Beste

    2014-07-01

    Penetrating atheromatous ulcer (PAU) is an atherosclerotic ulcer penetrating the internal elastic lamina of the aortic wall causing a hematoma within the media layer of aorta. They are commonly located in the descending aorta of the elderly and hypertensive patients. They may rarely be complicated by aortic dissection. We report a relative young normotensive patient presenting with acute aortic dissection due to PAU located in the ascending aorta.

  10. Aortic Dissection

    MedlinePlus

    ... arteries (atherosclerosis) Weakened and bulging artery (pre-existing aortic aneurysm) An aortic valve defect (bicuspid aortic valve) A ... valve, tell your doctor. If you have an aortic aneurysm, find out how often you need monitoring and ...

  11. Acute thoracic aortic dissection presenting as sore throat: report of a case.

    PubMed Central

    Liu, Wen-Pin; Ng, Kim-Choy

    2004-01-01

    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. Aortic dissection presenting as a sore throat is quite unusual. A 53-year-old man presented with sore throat as the early symptom of an acute thoracic aortic dissection. Unfortunately, the diagnosis was delayed, and the patient died. Given the high morbidity and mortality after delayed recognition or misdiagnosis, aortic dissection should be considered in the differential diagnosis of a patient presenting with sore throat and normal findings of neck and throat, even when there is no classic symptoms. PMID:15829145

  12. A patient with acute aortic dissection presenting with bilateral stroke - A rare experience.

    PubMed

    Kowalska-Brozda, Olimpia; Brozda, Mateusz

    2015-01-01

    Acute aortic dissection is a rare, life-threatening condition requiring early recognition and proper treatment. Although chest pain remains the most frequent initial symptom, clinical manifestation of aortic dissection varies. Rarely aortic dissection starts with neurological symptoms such as ischemic stroke, which is usually right-sided. A danger of performing thrombolytic therapy in these patients exists if aortic dissection is overlooked. Herein, we present a case of a patient with acute aortic dissection without typical chest pain whose initial manifestation was bilateral stroke. The uncommon presentation which masked the underlying condition delayed implementation of appropriate management. Moreover, the late admission to hospital prevented the patient from administration of recombined tissue plasminogen activator that would certainly decrease chances of survival. Presented case highlights the need for thorough physical examination at admission to hospital in all patients with acute stroke and points out the necessity of proper clinical work-up including adequate aorta imaging modalities of patients with acute stroke and suggestive findings of aortic dissection.

  13. Unusual presentation of aortic dissection: post-coital acute paraplegia with renal failure.

    PubMed

    Galabada, Dinith P; Nazar, Abdul L M

    2014-09-01

    We report the case of a 45-year-old chronic smoker who presented with acute paraplegia occurring during coitus and subsequently developed acute renal failure (ARF) requiring dialysis. He had absent peripheral pulses in the lower limbs with evidence of acute ischemia. Doppler study showed dissecting aneurysm of thoracic aorta, thrombotic occlusion of the distal aorta from L1 level up to bifurcation and occlusion of the right renal artery by a thrombus that was confirmed by magnetic resonance imaging of the spine. He was not subjected to any vascular intervention as his lower limbs were not salvageable due to delay in the diagnosis. Post-coital aortic dissection and aortic dissection presenting with acute paraplegia and ARF are very rare. This is probably the first case report with post-coital acute aortic dissection presenting with paraplegia and ARF. This case emphasizes the importance of a careful examination of peripheral pulses in patients presenting with ARF and paraplegia.

  14. Aortic dissection (image)

    MedlinePlus

    Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the ... the inner wall of the artery. Although aortic dissection can affect anybody, it is most often seen ...

  15. Aortic Dissection Presenting as Acute Subtotal Left Main Coronary Artery Occlusion: A Case Approach and Review of the Literature

    PubMed Central

    Ruisi, Michael; Fallahi, Arzhang; Lala, Moinakhtar; Kanei, Yumiko

    2015-01-01

    Aortic dissection is the most common fatal condition of the aorta, yet it is often missed on initial clinical presentation. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare, but if it occurs, it can be diagnostically challenging, and the condition can be fatal. Here we describe a case of aortic dissection presenting as ST-segment elevation myocardial infarction (STEMI) managed via the transradial approach. We describe the current literature on the subject. PMID:25780485

  16. Spontaneous aortic dissection within an infrarenal AAA.

    PubMed

    Griffin, Kathryn J; Bailey, Marc A; McAree, Barry; Mekako, Anthony; Berridge, David C; Nicholson, Tony; Scott, D Julian A

    2012-12-01

    Aortic dissection occurring in the infrarenal abdominal aorta is uncommon. We present the case of a patient presenting with an enlarging abdominal aortic aneurysm and concurrent dissection (with associated radiological imaging) and briefly discuss the literature relating to this phenomenon.

  17. Alpha-1 Antitrypsin Deficiency Presenting with MPO-ANCA Associated Vasculitis and Aortic Dissection

    PubMed Central

    van Schaik, Jan; Crobach, Stijn L. P.; van Rijswijk, Catharina S. P.; Rotmans, Joris I.

    2017-01-01

    The combination of alpha-1 antitrypsin (AAT) deficiency, ANCA-vasculitis, and aortic aneurysm has been rarely described in literature. We report an eventually fatal case in a 70-year-old patient who initially presented with giant cell arteritis and ANCA associated glomerulonephritis. Several years later, he presented with aortic dissection due to large vessel vasculitis, raising the suspicion of AAT deficiency, as two first-line relatives had chronic obstructive pulmonary disease, while they never smoked. This diagnosis was confirmed by AAT electrophoresis and immunohistochemistry on a temporal artery biopsy. Considering AAT deficiency in these cases might lead to a more timely diagnosis. PMID:28367219

  18. Endovascular repair of spontaneous infrarenal aortic dissection presenting as severe lower extremity ischaemia.

    PubMed

    Adam, D J; Roy-Choudhury, S; Bradbury, A W

    2007-12-01

    We report a 90-year old man who presented with severe lower extremity ischaemia due to spontaneous dissection of a non-aneurysmal infrarenal abdominal aorta. The aortic lesion was treated using an aorto-uni-iliac stent-graft with contralateral common iliac artery occlusion and femoro-femoral cross-over bypass. The patient underwent digital amputation and debridement of the foot four weeks post-operatively. At 12 months follow-up, he remains symptom-free with an excluded dissection, patent reconstruction and healed foot.

  19. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    PubMed Central

    Omar, Sabry; Moore, Tyler; Payne, Drew; Momeni, Parastoo; Mulkey, Zachary; Nugent, Kenneth

    2014-01-01

    We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary. PMID:25104961

  20. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection.

  1. Aortic Dissection and Rupture in a Child

    PubMed Central

    Jo, Yun Ju; Lee, Eun Jeong; Oh, Jin Won; Moon, Chang Min; Cho, Deok Kyu; Cho, Yun Hyeong; Byun, Ki Hyun

    2011-01-01

    After developing sudden severe chest pain, an 11-year-old boy presented to the emergency room with chest pain and palpitations and was unable to stand up. The sudden onset of chest pain was first reported while swimming at school about 30 minutes prior to presentation. Arterial blood pressure (BP) was 150/90 mmHg, heart rate was 120/minute, and the chest pain was combined with shortness of breath and diaphoresis. During the evaluation in the emergency room, the chest pain worsened and abdominal pain developed. An aortic dissection was suspected and a chest and abdomen CT was obtained. The diagnosis of aortic dissection type B was established by CT imaging. The patient went to surgery immediately with BP control. He died prior to surgery due to aortic rupture. Here we present this rare case of aortic dissection type B with rupture, reported in an 11-year-old Korean child. PMID:21519516

  2. Local repair of distal thoracal aortic dissections (Locus minoris resistencia).

    PubMed

    Belov, Iu V; Komarov, R N; Stepanenko, A B; Gens, A P; Charchian, E R

    2007-01-01

    The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.

  3. Hypertensive Emergency in Aortic Dissection and Thoracic Aortic Aneurysm—A Review of Management

    PubMed Central

    Gupta, Prateek K.; Gupta, Himani; Khoynezhad, Ali

    2009-01-01

    Over the last few decades, treatment for aortic dissection and thoracic aortic aneurysms has evolved significantly with improvement in outcomes. Treatment paradigms include medical, endovascular and surgical options. As aortic dissection presents as a hypertensive emergency, diligent control of BP is of utmost importance in order to reduce the progression of dissection with possible aortic branch malperfusion. Treatment should begin on arrival to the emergency department and continues in the intensive care unit, endovascular suite or the operating room. Novel antihypertensive medications with improved pharmacological profile and improved surgical techniques, have improved the prognosis of patients with aortic aneurysm and/or aortic dissection. Nevertheless, morbidity and mortality remain high and hypertensive emergency poses a significant challenge in aortic dissection and thoracic aortic aneurysms. PMID:27713224

  4. Diagnostic imaging for aortic dissection.

    PubMed

    Kapustin, Andrew J; Litt, Harold I

    2005-01-01

    Diagnostic imaging for aortic dissection has dramatically changed in recent years. Previously, imaging consisted of conventional X-ray radiography, followed by invasive catheter angiography. Now imaging of dissection is performed primarily with multidetector CT, and to a lesser extent, with ultrasound and MRI. Catheter angiography is used primarily as a means of treating complications. Which modality to choose depends on patient factors, physician preference, and differences in availability of state-of-the-art equipment. All three modalities are highly accurate in experienced hands and have revolutionized the detection and evaluation of this condition.

  5. Fever of unknown origin in aortic dissection.

    PubMed

    Yuan, S-M

    2017-05-01

    Aortic dissection is the most devastating sequela of thoracic aortic disorder. Patients with acute aortic dissection typically manifest as an acute onset of severe chest pain, but occasionally present with atypical symptoms including fever of unknown origin. A total of 50 patients from 41 articles based on a complete literature retrieval were included in this study. More patients had a fever prior to pain. The time to presentation was 40.7 ± 105.6 days, the time to diagnosis was 52.9 ± 110.1 days, and the time to surgery/intervention was 1.8 ± 5.6 days. The patients' temperature on admission was 38.2 ± 0.6 °C and the maximal temperature recorded was 38.8 ± 0.4 °C. Laboratory findings showed increased white blood cell counts, cardiac enzymes, and inflammatory biomarkers. More pronounced laboratory findings of the infectious type than the inflammatory type aortic dissection could be helpful in the differential diagnosis. Half of patients warrant aortic repair with or without valve replacement, less than half of patients were conservatively managed, and a few were interventionally treated or were being followed up. The mortality rate was 9.5 %. Physicians should always bear in mind aortic dissection when patients present with fever of unknown origin particularly in those without chest pain. Laboratory findings may offer inflammatory evidence for the diagnosis. An early diagnosis as well as subsequent treatment is indispensable for patients' outcomes.

  6. Acute aortic dissection at two extreme ages.

    PubMed

    Ramzisham, A R M; Arief, H; Ngoo, K S; Zamrin, D M; Joanna, O S M

    2011-01-01

    Acute aortic dissection is a life-threatening condition, warranting prompt diagnosis and treatment. Management of which incorporates multidisciplinary expertise from the medical, surgical and intensive care. If left untreated, the mortality rate of acute aortic disease exceeds 50% within 48 hours and 80% within two weeks, with a 5-year survival rate of 19%. The most common cause of death in untreated acute aortic dissection, regardless of aetiology, is aortic rupture. We would like to share our successful experience of cases at the two extreme ages of acute aortic dissection. Literature review with their pathogenesis are discussed.

  7. Gallium localization in dissecting aortic aneurysm

    SciTech Connect

    Haden, H.T.; Lippman, H.R.

    1988-08-01

    Gallium concentration was demonstrated in a dissecting aneurysm of the aortic arch, imaged approximately 2 weeks after dissection. Concentration of gallium was apparently due to the inflammatory reaction associated with the organizing intramural hematoma.

  8. Acute aortic dissection provoked by sneeze: a case report.

    PubMed

    Baydin, A; Nural, M S; Güven, H; Deniz, T; Bildik, F; Karaduman, A

    2005-10-01

    The response of the abdominal viscera and the contraction of the intercostal muscles during the respiratory phase of sneezing increases intrathoracic pressure, which may lead to several complications. However, there are no reports in the literature concerning aortic dissection after sneezing. We report a patient in whom the development of dissection was secondary to sneezing, although hypertension was present as a risk factor, and we discuss the relationship between sneezing and aortic dissection. To our knowledge, this is the first report of aortic dissection provoked by sneezing in the literature.

  9. FBN1 Mutations in Patients With Descending Thoracic Aortic Dissections

    PubMed Central

    Brautbar, Ariel; LeMaire, Scott A.; Franco, Luis M.; Coselli, Joseph S.; Milewicz, Dianna M.; Belmont, John W.

    2013-01-01

    Aortic aneurysm and dissection cause significant morbidity and mortality. There are several known single gene disorders that predispose to isolated aortic disease and eventually aneurysm and dissection. FBN1 mutations are associated with multiple clinical phenotypes, including Marfan syndrome (MFS), MASS phenotype, and familial ectopia lentis, but rarely with isolated aortic aneurysm and dissection. In this report, we describe three patients who presented with primary descending thoracic aortic dissection and who were found to have an FBN1 mutation. None of the patients fulfilled clinical criteria for the diagnosis of MFS, and all had few or none of the skeletal features typical of the condition. Two patients had a history of long-term hypertension, and such a history was suspected in the third patient. These observations suggest that some individuals with FBN1 mutations have significant aortic disease involvement of other systems that is typical of FBN1 mutation-related syndromes. Superimposed risk factors, such as hypertension, may weaken the aortic wall and eventually lead to aortic dissection. Given that the cost continues to decrease, we suggest that diagnostic DNA sequencing for FBN1 mutations in patients with thoracic aortic aneurysms and dissection may be a practical clinical step in evaluating such patients and at-risk family members. PMID:20082464

  10. Aortic angiography

    MedlinePlus

    ... problem with the aorta or its branches, including: Aortic aneurysm Aortic dissection Congenital (present from birth) problems AV ... Mean Abnormal results may be due to: Abdominal aortic aneurysm Aortic dissection Aortic regurgitation Aortic stenosis Congenital (present ...

  11. Concomitant reconstruction of arch vessels during repair of aortic dissection.

    PubMed

    Micovic, Slobodan; Nezic, Dusko; Vukovic, Petar; Jovanovic, Marko; Lozuk, Branko; Jagodic, Sinisa; Djukanovic, Bosko

    2014-08-01

    Surgery for acute aortic dissection is challenging, especially in cases of cerebral malperfusion. Should we perform only the aortic repair, or should we also reconstruct the arch vessels when they are severely affected by the disease process? Here we present a case of acute aortic dissection with multiple tears that involved the brachiocephalic artery and caused cerebral and right upper-extremity malperfusion. The patient successfully underwent complete replacement of the brachiocephalic artery and the aortic arch during deep hypothermic circulatory arrest, with antegrade cerebral protection. We have found this technique to be safe and reproducible for use in this group of patients.

  12. Aortic Dissection Type A in Alpine Skiers

    PubMed Central

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  13. [Surgery of aortic dissection: for which patient?].

    PubMed

    Verhoye, Jean-Philippe; Abouliatim, Issam; Larralde, Antoine; Beneux, Xavier; Heautot, Jean-François

    2011-01-01

    In the acute stage (less than two weeks), surgery is indicated for Stanford type A aortic dissections. With respect to the initial work-up, surgery consists in replacing the ascending aorta, sometimes the aortic arch (with supra aortic vessels reimplantation), and aortic valve replacement (valve replacement, Bentall valved tube or valve sparing Tyron David technique). Ischemic visceral complications must be searched for and treated by endovascular techniques or surgery. Aneurismal evolution of chronic dissections must be treated surgically. Replacement can encompass the entire aorta. Copyright © 2010. Published by Elsevier Masson SAS.

  14. Consumption coagulopathy in acute aortic dissection: principles of management.

    PubMed

    Liu, Yuyong; Han, Lu; Li, Jiachen; Gong, Ming; Zhang, Hongjia; Guan, Xinliang

    2017-06-12

    The effect of acute aortic dissection itself on coagulopathy or surgery-related coagulopathy has never been specifically studied. The aim of the present study was to perioperatively describe consumption coagulopathy in patients with acute aortic dissection. Sixty-six patients with acute type A aortic dissection were enrolled in this study from January 2015 to September 2016. Thirty-six patients with thoracic aortic aneurysms were used as a control group during the same period. Consumption coagulopathy was evaluated using standard laboratory tests, enzyme-linked immunosorbent assay and thromboelastograghy at five perioperative time-points. A significant reduction in clotting factors and fibrinogen was observed at the onset of acute aortic dissection. Enzyme-linked immunosorbent assay and thromboelastograghy also revealed a persistent systemic activation of the coagulation system and the consumption of clotting factors. In contrast, although platelet counts were consistently low, we did not find that platelet function was more impaired in the acute aortic dissection group than the control group. After surgery, clotting factors and fibrinogen were more impaired than platelet function. Thus, we proposed that hemostatic therapy should focus on the rapid and sufficient supplementation of clotting factors and fibrinogen to improve consumption coagulopathy in patients with acute aortic dissection.

  15. D-dimer is elevated in acute aortic dissection.

    PubMed

    Martin, Thomas; Shariq, Sohail

    2010-08-31

    This case illustrates that d-dimer is elevated in patients with acute aortic dissection. A 49-year-old woman presented with central, crushing chest pain exacerbated on inspiration. The chest pain was associated with right-leg numbness and pain, although peripheral pulses and blood pressures were normal. Routine bloods demonstrated an elevated d-dimer with a normal ECG and chest x-ray radiograph. A differential diagnosis of pulmonary embolism and acute aortic dissection was made. CT-angiogram showed type B aortic dissection. This case report highlights the mounting evidence that d-dimer is elevated in practically all incidents of aortic dissection and could be useful as a negative predictive marker.

  16. Aortic dissection decades following internal carotid artery dissection--report of two cases.

    PubMed

    Schievink, W I; Mokri, B

    1997-11-01

    Recurrent dissections involving carotid, vertebral, or renal arteries have been described in patients with spontaneous cervical artery dissections, with a maximal interval between dissections of fourteen years. The authors describe 2 patients in whom aortic dissections developed twenty-five and forty years, respectively, following carotid artery dissections. These 2 patients constituted 8% of the total number of patients from Rochester, Minnesota, who were diagnosed with aortic dissection between 1987 and 1992. The first patient, a forty-five-year-old woman, presented in 1948 with right neck pain and headache, associated with several episodes of transient numbness of the right face and numbness and clumsiness of the left upper and lower extremities. Examination showed right miosis. Angiography showed a stenosis of the extracranial right internal carotid artery beginning several centimeters from the bifurcation. She died at age eighty-five from an aortic dissection. The second patient, a thirty-eight-year-old man, noted left orbital and frontotemporal headaches and drooping of the left eyelid in 1962. Examination showed left oculosympathetic palsy. Angiography showed stenosis and an aneurysm in the midportion of the extracranial left internal carotid artery. He died at age sixty-three from an aortic dissection. These cases suggest that following a carotid artery dissection the risk of a recurrent arterial dissection may remain elevated for a prolonged period of time and the recurrent dissection may involve the aorta.

  17. Triple-barrel aorta: dissection of a healed aortic dissection.

    PubMed

    Lie, J T

    1982-08-01

    An unusual case of a triple-barrel aorta in a 51-year-old woman is described. The patient first had a spontaneous type I dissection of the aorta and acute aortic insufficiency, for which she underwent aortic valve replacement and Dacron graft replacement of the ascending aorta. She remained asymptomatic for five years with a healed aortic dissection (double-barrel aorta) distal to the graft. She then underwent a second operation for repair and poppet replacement of the malfunctioned prosthesis. Postoperative cardiac failure necessitated the use of a counterpulsation intra-aortic balloon catheter, which entered and dissected the wall of the false lumen, thus creating a triple-lumen aorta.

  18. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  19. Aortic arch dissection: a controversy of classification.

    PubMed

    Lempel, Jason K; Frazier, Aletta Ann; Jeudy, Jean; Kligerman, Seth J; Schultz, Randall; Ninalowo, Hammed A; Gozansky, Elliott K; Griffith, Bartley; White, Charles S

    2014-06-01

    Aortic dissections originating in the ascending aorta and descending aorta have been classified as type A and type B dissections, respectively. However, dissections with intimal flap extension into the aortic arch between the innominate and left subclavian arteries are not accounted for adequately in the widely used Stanford classification. This gap has been the subject of controversy in the medical and surgical literature, and there is a tendency among many radiologists to categorize such arch dissections as type A lesions, thus making them an indication for surgery. However, the radiologic perspective is not supported by either standard dissection classification or current clinical management. In this special report, the origin of dissection classification and its evolution into current radiologic interpretation and surgical practice are reviewed. The cause for the widespread misconception about classification and treatment algorithms is identified. Institutional review board approval and waiver of informed consent were obtained as part of this HIPAA-compliant retrospective study to assess all aortic dissection studies performed at the University of Maryland Medical Center, Baltimore between 2010 and 2012 to determine the prevalence of arch dissections. Finally, a unified classification system that reconciles imaging interpretation and management implementation is proposed.

  20. Endovascular treatment of acute type B dissection complicating aortic coarctation.

    PubMed

    Kassaian, Seyed Ebrahim; Abbasi, Kyomars; Mousavi, Mehdi; Sahebjam, Mohammad

    2013-01-01

    Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed a balloon-expandable bare-metal stent to correct residual stenosis. To our knowledge, this is the first report of the endovascular treatment of aortic coarctation complicated by type B dissection.

  1. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Genetics Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... PDF Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  2. Acute thoracic aortic dissection: how to defuse a time bomb.

    PubMed

    McClarren-Curry, C; Shaughnessy, K

    1999-01-01

    Acute thoracic aortic dissection is frequently misdiagnosed, and even with surgical intervention, the mortality rate is 50%. This article focuses on assessment, interventions, and postoperative care of patients with aortic dissection.

  3. The Relationship between Tension and Length of the Aortic Adventitia Resected from the Aortic Wall of Acute Aortic Dissection

    PubMed Central

    Kitano, Mitsuru; Teranishi, Hiroo; Kudo, Masahumi; Matsuura, Makoto

    2014-01-01

    Objective: To our knowledge, no previous study has described the measurement of the tensile strength of the human aortic adventitia. In the present study, we examined the relationship between the tension and length of the aortic adventitia resected from the aortic wall of patients with acute aortic dissection. Methods: We obtained rectangular specimens from the aortic adventitia that was resected in patients with acute aortic dissection during surgery. The specimens were placed on a tension meter (Digital Force Gauge FGS-10, SHIMPO, Kyoto, Japan) within 15 min after resection and stretched until they were pulled apart, and the tension and length were recorded. Results: We obtained 18 specimens during surgery from 11 cases of acute aortic dissection. When the specimen was being pulled apart, the mean tension recorded was 10.2 ± 4.9 N/cm specimen width, whereas the mean elongated length recorded was 4.2 ± 1.1 mm/cm specimen length. Discussion: We determined that the aortic adventitia is elastic and expandable up to 140% of its original length. This indicates that dilation of the aorta to >4.2 cm in diameter may result in a rupture if the original aortic diameter prior to dissection was 3 cm. (*English translation of J Jpn Coll Angiol 2013; 53: 77-81) PMID:25298826

  4. Case Report and Review of Literature: Late Retrograde Type A Aortic Dissection With Rupture after Repair of Type B Aortic Dissection with a GORE TAG Endovascular Prosthesis.

    PubMed

    Manetta, Frank; Ajakaiye, Bayo; Scheinerman, S Jacob; Yu, Pey-Jen

    2014-06-01

    Acute aortic dissection is the most common catastrophic condition of the aorta. Treatment options include open surgery and thoracic endovascular aortic reconstruction (TEVAR). We present a late Type A dissection as a complication of the management of descending aortic dissections with TEVAR and a review of the literature. TEVAR of the thoracic aorta is a viable treatment option for the management of complicated descending thoracic aortic dissections. Careful patient selection is necessary as medical therapy successfully treats the majority of uncomplicated Type B dissections. TEVAR should be reserved for patients with complicated Type B dissections or those who fail nonoperative management. Close postoperative monitoring is necessary when TEVAR is performed and should be accompanied by lifelong surveillance. A high level of suspicion is important to identify retrograde Type A dissections in these patients given its rarity and the ambiguity of its clinical presentation.

  5. Advanced, recurrent mesothelioma growth mimicking an aortic dissection.

    PubMed

    Pankhania, Miran; Hardiment, Kate; Marathe, Mandar

    2011-02-02

    In the emergency setting, a cold, clammy, dyspnoeic patient presenting with interscapular chest pain and unequal blood pressures suggests an acute aortic dissection until proven otherwise. By means of a case report, the authors detail one such patient who presented identically to one having an acute aortic dissection. Initial assessment showed unequal blood pressures in left and right arms, a resting tachycardia and indistinct heart sounds. Fluid resuscitation failed to improve the patient's physiological parameters and they rapidly deteriorated. The medical history included mesothelioma and atrial fibrillation. Existing investigations were reviewed and after thorough consideration of the patient's premorbid state and likely prognosis, the decision was made to palliate. The patient died shortly after being transferred to the oncology ward. Imaging is therefore integral to the assessment and management of a patient in whom an aortic dissection is feared.

  6. Acute Aortic Dissection in Third Trimester Pregnancy without Risk Factors

    PubMed Central

    Kinney-Ham, Lisa; Nguyen, H. Bryant; Steele, Robert; Walters, Elizabeth L

    2011-01-01

    Spontaneous aortic dissection in pregnancy is rare and life threatening for both the mother and the fetus. Most commonly, it is associated with connective tissue disorders, cardiac valve variants, or trauma. We present the case of a 23-year-old previously healthy woman, 36 weeks pregnant with a syncopal episode after dyspnea and vomiting. She subsequently developed cardiac arrest and underwent aggressive resuscitation, emergent thoracotomy, and cesarean delivery without recovery. On autopsy, she was found to have an aortic dissection of the ascending aorta. This case is presented to raise awareness and review the literature and the clinical approach to critical care for pregnant patients. PMID:22224164

  7. Endovascular Management of Chronic Type B Dissecting Aortic Aneurysm Utilizing Aortic and Renal Stents

    SciTech Connect

    Taylor, J. D. Dunckley, M.; Thompson, M.; Morgan, R. A.

    2008-07-15

    Over the last 10 years endovascular stent-graft placement has been increasingly used to treat complicated acute Type B thoracic aortic dissections. While studies have demonstrated the use of additional aortic stent-grafts to treat continued false lumen perfusion and case reports have detailed the use of renal artery stents to treat renal ischemia related to aortic dissection, to our knowledge the adjuvant use of renal artery stents to reduce false lumen perfusion has not been reported. We present the case of a 72-year-old male who had previously undergone endovascular repair of a complicated Type B thoracic aortic dissection and presented with an expanding false lumen in the peridiaphragmatic aorta despite coverage of the entire thoracic aorta. This was treated by closure of a right renal fenestration using a renal stent.

  8. Aortic dissection accompanied by preeclampsia in a postpartum young woman

    PubMed Central

    Park, Jin-Wan; Kim, Su-Mi; Yu, Gyu-Bong

    2016-01-01

    Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation. If a patient with preeclampsia complains of severe dyspnea or chest pain, aortic dissection needs to be suspected and a diagnosis should not be delayed. PMID:27668205

  9. Acute ascending aortic dissection after MDMA/ecstasy use: A case report.

    PubMed

    Kanahara, Satoko; El-Refai, Mostafa; Lakkis, Nasser; Tabbaa, Rashed

    Acute aortic dissection is rare among young patients in the absence of connective tissue disorders. One of the risk factors associated with aortic dissection among young patients is amphetamine use. We report a case of a 37-year-old female with a past medical history of hypertension presenting with syncope and altered mental status who was found to have an acute DeBakey Type I aortic dissection after ingestion of 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy. This is the second case in the literature describing aortic dissection in relation to MDMA use. In both cases, the patients were young and had no history of connective tissue disorders or underlying valvular abnormalities. In this case, echocardiography was used to establish the diagnosis early. A transthoracic echocardiogram revealed a possible dissection flap prolapsing in through a normal aortic valve. Subsequently, a transesophageal echocardiogram revealed wide-open aortic regurgitation with several proximal dissection flaps from a normal caliber ascending aorta prolapsing into a normal tricuspid aortic valve. A high index of suspicion is necessary to diagnose and treat aortic dissection in young patients with a history of MDMA use. Recognize MDMA as a risk factor for acute aortic dissection, especially among younger patients with whom clinicians may not often associate aortic dissection. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  10. Current surgical results of acute type A aortic dissection in Japan

    PubMed Central

    2016-01-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  11. Aortic Disease Presentation and Outcome Associated with ACTA2 mutations

    PubMed Central

    Regalado, Ellen S.; Guo, Dongchuan; Prakash, Siddharth; Bensend, Tracy A.; Flynn, Kelly; Estrera, Anthony; Safi, Hazim; Liang, David; Hyland, James; Child, Anne; Arno, Gavin; Boileau, Catherine; Jondeau, Guillaume; Braverman, Alan; Moran, Rocio; Morisaki, Takayuki; Morisaki, Hiroko; Consortium, Montalcino Aortic; Pyeritz, Reed; Coselli, Joseph; LeMaire, Scott; Milewicz, Dianna M.

    2015-01-01

    Background ACTA2 mutations are the major cause of familial thoracic aortic aneurysms and dissections. We sought to characterize these aortic diseases in a large case series of individuals with ACTA2 mutations. Methods and Results Aortic disease, management, and outcome associated with the first aortic event (aortic dissection or aneurysm repair) were abstracted from the medical records of 277 individuals with 41 various ACTA2 mutations. Aortic events occurred in 48% of these individuals, with the vast majority presenting with thoracic aortic dissections (88%) associated with 25% mortality. Type A dissections were more common than type B dissections (54% versus 21%), but the median age of onset of type B dissections was significantly younger than type A dissections (27 years, IQR 18–41 versus 36 years, IQR 26–45). Only 12% of aortic events were repair of ascending aortic aneurysms, which variably involved the aortic root, ascending aorta and aortic arch. Overall cumulative risk of an aortic event at age 85 years was 0.76 (95% CI 0.64, 0.86). After adjustment for intra-familial correlation, gender and race, mutations disrupting p.R179 and p.R258 were associated with significantly increased risk for aortic events, whereas p.R185Q and p.R118Q mutations showed significantly lower risk of aortic events compared to other mutations. Conclusions ACTA2 mutations are associated with high risk of presentation with an acute aortic dissection. The lifetime risk for an aortic event is only 76%, suggesting that additional environmental or genetic factors play a role in expression of aortic disease in individuals with ACTA2 mutations. PMID:25759435

  12. Update in the management of type B aortic dissection.

    PubMed

    Nauta, Foeke Jh; Trimarchi, Santi; Kamman, Arnoud V; Moll, Frans L; van Herwaarden, Joost A; Patel, Himanshu J; Figueroa, C Alberto; Eagle, Kim A; Froehlich, James B

    2016-06-01

    Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

  13. Familial Thoracic Aortic Aneurysms and Dissections: Identification of a Novel Locus for Stable Aneurysms with a Low Risk for Progression to Aortic Dissection

    PubMed Central

    Guo, Dong-Chuan; Regalado, Ellen S.; Minn, Charles; Tran-Fadulu, Van; Coney, Joshua; Cao, Jiumei; Wang, Min; Yu, Robert K.; Estrera, Anthony L.; Safi, Hazim J.; Shete, Sanjay S.; Milewicz, Dianna M.

    2013-01-01

    Background Thoracic aortic aneurysms leading to acute aortic dissections (TAAD) are the major diseases that affect the thoracic aorta. Approximately 20% of patients with TAAD have a family history of TAAD, and these patients present younger with more rapidly enlarging aneurysms than patients without a family history of aortic disease. Methods and Results A large family with multiple members with TAAD inherited in an autosomal dominant manner was identified. The ascending aortic aneurysms were associated with slow enlargement, a low risk of dissection, and decreased penetrance in women. Genome-wide linkage analysis was performed and a novel locus on chromosome 12 was identified for the mutant gene causing disease in this family. Of the 12 male members who carry the disease-linked microsatellite haplotype, nine had ascending aortic aneurysms with an average diameter of 4.7 cm and average age of 55 years (age range, 32-76) at the time of diagnosis; only one individual had progressed to acute aortic dissection and no other members with aortic dissections were identified. Women harboring the disease-linked haplotype did not have thoracic aortic disease, including an 84 year old woman. Sequencing of 9 genes within the critical interval at the chromosome 12 locus did not identify the mutant gene. Conclusion Mapping a locus for ascending thoracic aortic aneurysms associated with a low risk of aortic dissection supports our hypothesis that genes leading to familial disease can be associated with less aggressive thoracic aortic disease. PMID:21163914

  14. Penn classification in acute aortic dissection patients.

    PubMed

    Pisano, Calogera; Balistreri, Carmela Rita; Torretta, Federico; Capuccio, Veronica; Allegra, Alberto; Argano, Vincenzo; Ruvolo, Giovanni

    2016-04-01

    The objective of this study was to evaluate the effectiveness of the Penn classification in predicting in-hospital mortality after surgery in acute type A aortic dissection patients. We evaluated 58 patients (42 men and 16 women; mean age 62.17 ± 10.6 years) who underwent emergency surgery for acute type A aortic dissection between September 2003 and June 2010 in our department. We investigated the correlation between the pre-operative malperfusion and in-hospital outcome after surgery. Twenty-eight patients (48%) were Penn class Aa (absence of branch vessel malperfusion or circulatory collapse), 11 (19%) were Penn class Ab (branch vessel malperfusion with ischaemia), 5 (9%) were Penn class Ac (circulatory collapse with or without cardiac involvement) and 14 (24%) were Penn class Abc (both branch vessel malperfusion and circulatory collapse). The number of patients with localized or generalized ischaemia or both, Penn class non-Aa, was 30 (52%). In-hospital mortality was 24%. In-hospital mortality was significantly higher in Penn class Abc and Penn class non-Aa. Intensive unit care stay, hospital ward stay and overall hospital stay was longer in Penn class non-Aa vs Penn class Aa. De Bakey type I dissection and type II diabetes mellitus were associated with in-hospital mortality. Preoperative malperfusion is important for the evaluation of patients with acute aortic type A dissection. The Penn classification is a simple and quick method to apply and predict in-hospital mortality and outcomes.

  15. Chronic Type A Aortic Dissection and Giant Aortic Root Aneurysm After Aortic Valve Replacement

    PubMed Central

    Puga, Andrés Enríquez; Rodríguez, Sara Castaño; Pañero, Blanca Mateos; Moreira, Beatriz Castaño; López Almodóvar, Luis Fernando

    2016-01-01

    We describe the case of a 61-year-old male with a giant aortic root aneurysm associated with chronic aortic Type A dissection. The patient had been operated on 16 years before due to aortic annuloectasia with mechanical valve replacement. The patient underwent revision aortic surgery with a Bentall-De Bono operation with Svensson modification, using a #21 On-X Valsalva mechanical valve conduit. The postoperative course was uneventful. PMID:28097190

  16. The emerging epidemic of methamphetamine-induced aortic dissections.

    PubMed

    Wako, Elizabeth; LeDoux, Denise; Mitsumori, Lee; Aldea, Gabriel S

    2007-01-01

    The clinical presentation, treatment, and outcomes of six consecutive patients presenting with acute aortic dissection secondary to hypertensive crises from methamphetamine use is described. Data were obtained prospectively from the expanded STS clinical database of the division of cardiothoracic surgery at the University of Washington, but reviewed in a retrospective fashion. These patients represent 5.5% of all patients diagnosed and treated for aortic dissection in the same time period (6/109) and 20% of all patients with aortic dissection under the age of 50 years (6/30). We conclude that young patients (presenting with acute aortic dissections should be routinely tested for methamphetamine. Positive urine tests should be confirmed with chromatography-mass spectrometry (GC-MS). Beta and alpha blockers should be used instead of the more typical beta blockade alone. We recommend the addition and documentation of intense, long-term drug rehabilitation program along with routine periodic clinical and radiographic follow-up to prevent secondary aneurysmal dilation of remaining pathological aorta.

  17. Contemporary insights into the management of type A aortic dissection.

    PubMed

    Tolis, George; Sundt, Thoralf M

    2016-10-01

    Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years. In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.

  18. Professional parachuting: the risk of acute aortic dissection.

    PubMed

    Buchholz, Stefan; Quaden, René Bombien; Schmitz, Christoph; Überfuhr, Peter

    2011-09-01

    Acute aortic dissection is a rare disease, but if it occurs rapid diagnosis and therapy are needed. It is usually seen in elderly patients with long-term persistent arterial hypertension. In younger patients, it is mainly caused by congenital connective tissue disorders, such as Marfan syndrome, or by trauma. We present here a 34-year-old male patient with an acute type A aortic dissection. This patient was a professional parachutist and had carried out a large number of parachute jumps during his lifetime. He was admitted to the emergency department with acute chest pain. The symptoms were not related in time to a parachute jump. During a computed tomography scan, an aortic dissection was diagnosed. The patient was immediately referred to the operating room, and the ascending aorta was replaced by a conduit. After a regular postoperative course, the patient was discharged and recovered completely. Although acute aortic dissection is rare in young patients, it has to be considered in cases of acute chest pain. An immediate diagnosis and adequate therapy are essential to offer the patient a good clinical outcome and long-term survival.

  19. The risk for type B aortic dissection in Marfan syndrome.

    PubMed

    den Hartog, Alexander W; Franken, Romy; Zwinderman, Aeilko H; Timmermans, Janneke; Scholte, Arthur J; van den Berg, Maarten P; de Waard, Vivian; Pals, Gerard; Mulder, Barbara J M; Groenink, Maarten

    2015-01-27

    Aortic dissections involving the descending aorta are a major clinical problem in patients with Marfan syndrome. The purpose of this study was to identify clinical parameters associated with type B aortic dissection and to develop a risk model to predict type B aortic dissection in patients with Marfan syndrome. Patients with the diagnosis of Marfan syndrome and magnetic resonance imaging or computed tomographic imaging of the aorta were followed for a median of 6 years for the occurrence of type B dissection or the combined end point of type B aortic dissection, distal aortic surgery, and death. A model using various clinical parameters as well as genotyping was developed to predict the risk for type B dissection in patients with Marfan syndrome. Between 1998 and 2013, 54 type B aortic dissections occurred in 600 patients with Marfan syndrome (mean age 36 ± 14 years, 52% male). Independent variables associated with type B aortic dissection were prior prophylactic aortic surgery (hazard ratio: 2.1; 95% confidence interval: 1.2 to 3.8; p = 0.010) and a proximal descending aorta diameter ≥27 mm (hazard ratio: 2.2; 95% confidence interval: 1.1 to 4.3; p = 0.020). In the risk model, the 10-year occurrence of type B aortic dissection in low-, moderate-, and high-risk patients was 6%, 19%, and 34%, respectively. Angiotensin II receptor blocker therapy was associated with fewer type B aortic dissections (hazard ratio: 0.3; 95% confidence interval: 0.1 to 0.9; p = 0.030). Patients with Marfan syndrome with prior prophylactic aortic surgery are at substantial risk for type B aortic dissection, even when the descending aorta is only slightly dilated. Angiotensin II receptor blocker therapy may be protective in the prevention of type B aortic dissections. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Moderate aortic enlargement and bicuspid aortic valve are associated with aortic dissection in Turner syndrome: report of the international turner syndrome aortic dissection registry.

    PubMed

    Carlson, Misty; Airhart, Nathan; Lopez, Leo; Silberbach, Michael

    2012-10-30

    Girls and women with Turner syndrome are at risk for aortic dissection and rupture. However, the size of the aorta and the clinical characteristics among those with Turner syndrome and dissection have received little attention. We obtained medical records from 20 individuals who voluntarily participated in the International Turner Syndrome Aortic Dissection Registry. Type A dissections occurred in 17 of 20 (85%) cases, and type B occurred in 3 cases of which 1 occurred after coarctation stent placement. Of those with spontaneous aortic dissections, 18 of 19 (95%) had an associated cardiac malformation that included a bicuspid aortic valve. In 1 individual there was no predisposing finding other than the presence of Turner syndrome. Associated pregnancy was documented in 1 of 19 (5%). More than half (13/19, 68%) came to medical attention >24 hours after the onset of symptoms. For those with type A dissections, the mean ascending aortic size index was 2.7±0.6 cm/m(2) (n=9). Aortic dissection in Turner syndrome occurs in young individuals at smaller aortic diameters than in the general population or other forms of genetically triggered aortopathy. The absence of aortic valve or other cardiac malformations appears to markedly reduce the risk of aortic dissection However, aortic dissection can occur in Turner syndrome without cardiac malformations or hypertension. Individuals with Turner syndrome who are >18 years of age with an ascending aortic size index >2.5 cm/m(2) should be considered for an aortic operation to prevent aortic dissection.

  1. Aortic dissection and rupture in a 16-year-old girl with Turner syndrome following previous progression of aortic dilation.

    PubMed

    Pleskacova, Jana; Rucklova, Kristina; Popelova, Jana; Cerny, Stepan; Syrucek, Martin; Snajderova, Marta; Lebl, Jan

    2010-10-01

    Aortic dissection occurs in Turner syndrome with substantially higher frequency in comparison to the general population, and its prevention is one of the main aims of cardiologic follow-up. Findings of cystic medial necrosis in the aortic wall and a high prevalence of aortic dilation suggest that a form of aortopathy exists in Turner syndrome. However, little is known about natural development of aortic dilation prior to dissection. We present a 16-year-old girl with Turner syndrome with a bicuspid aortic valve, aortic stenosis, and dilation of ascending aorta, who underwent annual echocardiographic examinations from early childhood. Significant progressions of proximal aortic dilation occurred twice at the age of 10 and 15 years. Thereafter, another rapid progression was observed during 8 months and within 3 weeks preceding dissection. Acute aortic dissection was diagnosed while the girl was waiting for elective surgery. She was successfully operated. Frequent estimations of aortic diameter in Turner patients with abnormal findings may help to anticipate this life-threatening event. Additionally, we learned that rapid progression of aortic dilation should lead to immediate surgery to prevent more risky urgent intervention following the dissection.

  2. Undiagnosed DiGeorge syndrome presenting in middle age with an aortic root aneurysm and chronic dissection.

    PubMed

    King, Christopher

    2015-09-21

    DiGeorge syndrome is the second commonest cause of congenital heart disease after trisomy 21. This case illustrates an undiagnosed case of DiGeorge syndrome for a patient who had a ventricular septal defect repair in childhood. He survived well into his adult years, and was only diagnosed post mortem after an unsuccessful repair of an aortic root aneurysm. The case serves as an example supporting genetic screening of children with congenital heart disease, and lifelong cardiology follow-up for patients with a confirmed genotype.

  3. Decreased expression of fibulin-4 in aortic wall of aortic dissection.

    PubMed

    Huawei, P; Qian, C; Chuan, T; Lei, L; Laing, W; Wenlong, X; Wenzhi, L

    2014-02-01

    In this research, we will examine the expression of Fibulin-4 in aortic wall to find out its role in aortic dissection development. The samples of aortic wall were obtained from 10 patients operated for acute ascending aortic dissection and five patients for chronic ascending aortic dissection. Another 15 pieces of samples from patients who had coronary artery bypass were as controls. The aortic samples were stained with aldehyde magenta dyeing to evaluate the arrangement of elastic fibers. The Fibulin-4 protein and mRNA expression were both determined by Western blot and realtime quantitative polymerase chain reaction. Compared with the control group, both in acute and chronic ascending aortic dissection, elastic fiber fragments increased and the expression of fibulin-4 protein significantly decreased (P= 0.045 < 0.05). The level of fibulin-4 mRNA decreased in acute ascending aortic dissection (P= 0.034 < 0.05), while it increased in chronic ascending aortic dissection (P=0.004 < 0.05). The increased amounts of elastic fiber fragments were negatively correlated with the expression of fibulin-4 mRNA in acute ascending aortic dissection. In conclusion, in aortic wall of ascending aortic dissection, the expression of fibulin-4 protein decreased and the expression of fibulin-4 mRNA was abnormal. Fibulin-4 may play an important role in the pathogenesis of aortic dissection.

  4. Spontaneous bilateral carotid artery dissection in a patient with bovine aortic arch.

    PubMed

    Cock, Dries De; Meuris, Bart; Benett, Johan; Desmet, Walter

    2014-08-01

    Carotid artery dissections are commonly associated with trauma or various connective tissue disorders. Dissection of the cerebrovascular arteries can result in ischemic stroke and is a frequent stroke etiology in younger patients. Anatomical variants of aortic arch branching, such as the 'bovine' aortic arch, are assumed to have little or no physiological consequence. To the best of our knowledge, we present for the first time a case of spontaneous dissection of the common origin of the innominate and left common carotid artery in a bovine aortic arch, resulting in bilateral dissection of the carotid arteries.

  5. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  6. A Perspective Review on Numerical Simulations of Hemodynamics in Aortic Dissection

    PubMed Central

    Wan Ab Naim, Wan Naimah; Ganesan, Poo Balan; Hashim, Shahrul Amry

    2014-01-01

    Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment. PMID:24672348

  7. Mutations in Myosin Light Chain Kinase Cause Familial Aortic Dissections

    PubMed Central

    Wang, Li; Guo, Dong-chuan; Cao, Jiumei; Gong, Limin; Kamm, Kristine E.; Regalado, Ellen; Li, Li; Shete, Sanjay; He, Wei-Qi; Zhu, Min-Sheng; Offermanns, Stephan; Gilchrist, Dawna; Elefteriades, John; Stull, James T.; Milewicz, Dianna M.

    2010-01-01

    Mutations in smooth muscle cell (SMC)-specific isoforms of α-actin and β-myosin heavy chain, two major components of the SMC contractile unit, cause familial thoracic aortic aneurysms leading to acute aortic dissections (FTAAD). To investigate whether mutations in the kinase that controls SMC contractile function (myosin light chain kinase [MYLK]) cause FTAAD, we sequenced MYLK by using DNA from 193 affected probands from unrelated FTAAD families. One nonsense and four missense variants were identified in MYLK and were not present in matched controls. Two variants, p.R1480X (c.4438C>T) and p.S1759P (c.5275T>C), segregated with aortic dissections in two families with a maximum LOD score of 2.1, providing evidence of linkage of these rare variants to the disease (p = 0.0009). Both families demonstrated a similar phenotype characterized by presentation with an acute aortic dissection with little to no enlargement of the aorta. The p.R1480X mutation leads to a truncated protein lacking the kinase and calmodulin binding domains, and p.S1759P alters amino acids in the α-helix of the calmodulin binding sequence, which disrupts kinase binding to calmodulin and reduces kinase activity in vitro. Furthermore, mice with SMC-specific knockdown of Mylk demonstrate altered gene expression and pathology consistent with medial degeneration of the aorta. Thus, genetic and functional studies support the conclusion that heterozygous loss-of-function mutations in MYLK are associated with aortic dissections. PMID:21055718

  8. Postpartum Stanford Type A Aortic Dissection: A Case Report and Review of the Literature

    PubMed Central

    Balbay, Esra; Basci, Semih; Bozkurt, Irem; Ozkok, Abdullah; Dogruyol, Sinem; Sirkeci, Emel Erkus; Oguz, Aytekin

    2013-01-01

    Acute aortic dissection is a life-threatening disease. Approximately half of the aortic dissection observed in women under 45 years old has been reported to be related to pregnancy. Herein, we present a case of type A aortic dissection diagnosed in postpartum period. A 37-year-old woman admitted to the emergency department with the complaint of sudden onset of dyspnea. Arterial blood pressure was measured as 170/100 mmHg in left arm and 90/60 mmHg in right arm. With a prediagnosis of aortic dissection, thoracic and abdominal computed tomograpy was performed and type A aortic dissection extending form carotid artery to renal arterial level was detected. Operation of aortic dissection together with coronary arterial repairment and aortic valve replacement were successfully performed. Aortic dissection is not uncommon in pregnancy and furthermore it is potentially life-threatening for both mother and fetus. A high level of suspicion is required for prompt diagnosis and treatment in the peripartum period.

  9. Risk of rupture or dissection in descending thoracic aortic aneurysm.

    PubMed

    Kim, Joon Bum; Kim, Kibeom; Lindsay, Mark E; MacGillivray, Thomas; Isselbacher, Eric M; Cambria, Richard P; Sundt, Thoralf M

    2015-10-27

    Current practice guidelines recommend surgical repair of large thoracic aortic aneurysms to prevent fatal aortic dissection or rupture, but limited natural history data exist to support clinical criteria for timely intervention. Of 3247 patients with thoracic aortic aneurysm registered in our institutional Thoracic Aortic Center Database, we identified and reviewed 257 nonsyndromic patients (age, 72.4±10.5 years; 143 female) with descending thoracic or thoracoabdominal aortic aneurysm without a history of aortic dissection in whom surgical intervention was not undertaken. The primary end point was a composite of aortic dissection/rupture and sudden death. Baseline mean maximal aortic diameter was 52.4±10.8 mm, with 103 patients having diameters ≥55 mm. During a median follow-up of 25.1 months (quartiles 1-3, 8.3-56.4 months), definite and possible aortic events occurred in 19 (7.4%) and 31 (12.1%) patients, respectively. On multivariable analyses, maximal aortic diameter at baseline emerged as the only significant predictor of aortic events (hazard ratio=1.12; 95% confidence interval, 1.08-1.15). Estimated rates of definite aortic events within 1 year were 5.5%, 7.2%, and 9.3% for aortic diameters of 50, 55, and 60 mm, respectively. Receiver-operating characteristic curves for discriminating aortic events were higher for indexed aortic sizes referenced by body size (area under the curve=0.832-0.889) but not significantly different from absolute maximal aortic diameter (area under the curve=0.805). Aortic size was the principal factor related to aortic events in unrepaired descending thoracic or thoracoabdominal aortic aneurysm. Although the risk of aortic events started to increase with a diameter >5.0 to 5.5 cm, it is uncertain whether repair of thoracic aortic aneurysms in this range leads to overall benefit, and the threshold for repair requires further evaluation. © 2015 American Heart Association, Inc.

  10. A sneeze: an unusual trigger for aortic dissection.

    PubMed

    Upadhyaya, Subramanya G N; Large, A

    2013-12-03

    We describe a rare case of type B thoracic aortic dissection resulting from a forceful sneeze in a 57-year-old man. The presenting clinical features were not typical and consisted of pleuritic chest pain and breathlessness following a forceful sneeze. There was no haemodynamic compromise. The diagnosis was made incidentally when he underwent a CT pulmonary angiography as part of pulmonary embolism work-up.

  11. Dissecting aortic aneurysms: accuracy of computed tomographic diagnosis

    SciTech Connect

    Thorsen, M.K.; San Dretto, M.A.; Lawson, T.L.; Foley, W.D.; Smith, D.F.; Berland, L.L.

    1983-09-01

    During a three-year period, fifty patients were evaluated for the possibility of dissecting aortic aneurysm using high-resolution computed tomography (CT). The diagnosis of dissection was made if two contrast-medium-filled channels were identified within the aortic lumen. Eighteen patients were diagnosed with CT as having dissecting aortic aneurysms. Eight patients were evaluated postoperatively and five of these patients had persistence of the double channel. Twenty-four patients had no evidence on CT of aortic dissection. Follow-up was obtained in all patients. There were no known false-negative diagnoses and one false-positive diagnosis. High-resolution CT offers an accurate, noninvasive means to evaluate patients for suspected dissecting aortic aneurysms.

  12. Rare Seagull Cooing Murmur from Acute Aortic Dissection.

    PubMed

    Zhao, J; Cheng, Z; Quan, X; Zhao, Z

    2015-06-01

    Acute aortic dissection is a rare but potentially fatal disease. The early recognition of this disease is important for timely treatment. Some signs and symptoms, such as past history of hypertension, tearing pain and pulselessness, can provide valuable clues to the diagnosis of this disease. In this case study, the mechanism of a seagull murmur from aortic dissection is first described. This information is potentially useful for the differential diagnosis of dissection.

  13. Rare Seagull Cooing Murmur from Acute Aortic Dissection

    PubMed Central

    Zhao, J; Cheng, Z; Quan, X; Zhao, Z

    2015-01-01

    ABSTRACT Acute aortic dissection is a rare but potentially fatal disease. The early recognition of this disease is important for timely treatment. Some signs and symptoms, such as past history of hypertension, tearing pain and pulselessness, can provide valuable clues to the diagnosis of this disease. In this case study, the mechanism of a seagull murmur from aortic dissection is first described. This information is potentially useful for the differential diagnosis of dissection. PMID:26426186

  14. Aortic Dissection in Pregnancy: Management Strategy and Outcomes.

    PubMed

    Zhu, Jun-Ming; Ma, Wei-Guo; Peterss, Sven; Wang, Long-Fei; Qiao, Zhi-Yu; Ziganshin, Bulat A; Zheng, Jun; Liu, Yong-Min; Elefteriades, John A; Sun, Li-Zhong

    2017-04-01

    Aortic dissection in pregnancy is a rare but lethal catastrophe. Clinical experiences are limited. We report our experience in 25 patients focusing on etiology, management strategies, and outcomes. Between June 1998 and February 2015, we treated 25 pregnant women (mean age, 31.6 ± 4.7 years) in whom aortic dissection developed at a mean of 28 ± 10 gestational weeks (GWs). Type A aortic dissection (TAAD) was present in 20 (80%) and type B (TBAD) in 5 (20%). Marfan syndrome was seen in 17 (68%). Management strategy was based on dissection type and GWs. TAADs were managed surgically in 19 (95.0%) and medically in 1 (5.0%). Maternal and fetal mortalities were, respectively, 14.3% (1 of 7) and 0 (0 of 7) in the "delivery first" group (7 of 20), 16.7% (1 of 6) and 33.3% (2 of 6) in "single-stage delivery and aortic repair" group (6 of 20), 16.7% (1 of 6) and 66.7% (4 of 6) in "aortic repair first" group (6 of 20), and 100% (1 of 1) and 100% (1 of 1) in the "medical management" group (1 of 20). TBADs were managed surgically in 60% (3 of 5) and endovascularly and medically in 20% each (1 of 5). No maternal deaths occurred. Fetal mortality was 100% in the surgical group and 0% in the other groups. During late follow-up, which was complete in 95.2% (20 of 21), 3 maternal and 2 fetal deaths occurred in the TAAD group. Overall maternal survival was 68.6% at 5 years. Marfan syndrome predominates among women with aortic dissection in pregnancy. For TAADs, after 28 GWs, delivery followed by surgical repair can achieve maternal and fetal survival adequately; before 28 GWs, maternal survival should be prioritized given the high risk of fetal death. For TBADs in pregnancy, nonsurgical management is preferred. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Computed tomography: the investigation of choice for aortic dissection?

    PubMed Central

    Singh, H; Fitzgerald, E; Ruttley, M S

    1986-01-01

    Computed tomography has become established as complementary to aortography in the investigation of patients with suspected aortic dissection. Two cases of dissecting aneurysm are reported in which extensive aortography failed to show evidence of dissection. In both cases dissection was demonstrated by computed tomography. The diagnosis was confirmed in one case at operation and in the other case by follow up. It is suggested that computed tomography is the diagnostic method of first choice in aortic dissection. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3730218

  16. Acute aortic dissection in pregnancy in a woman with undiagnosed marfan syndrome.

    PubMed

    Master, Mandana; Day, Gavin

    2012-01-01

    We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease.

  17. A case of an aortic dissection in a young adult: a refresher of the literature of this "great masquerader".

    PubMed

    Pineault, Jérôme; Ouimet, Denis; Pichette, Vincent; Vallée, Michel

    2011-01-01

    Aortic dissection is often misdiagnosed, especially among young patients, and it is associated with a high mortality rate. We present here a case of fatal acute aortic dissection in a young man who was misdiagnosed with pericarditis. We reviewed the literature of acute aortic dissection in young people and we focused particularly on clinical presentations, outcomes and investigations of aortic dissection. We report a case of a 33-year-old man with a history of uncontrolled hypertension with acute pleuretic chest pain who was transferred to our hospital for suspected pulmonary embolism and died of acute hemorragic pericardial effusion from an ascendant aortic dissection. We should never rule out aortic dissection off our differential diagnosis on the sole basis of a patient's young age.

  18. Nearly Asymptomatic Eight-Month Thoracic Aortic Dissection

    PubMed Central

    Kumar, Arjun; Kumar, Krishan; Zeltser, Roman; Makaryus, Amgad N.

    2016-01-01

    Thoracic aortic dissection is a rare, but lethal, medical condition that is either misdiagnosed as a myocardial infarction or overlooked completely. Though thoracic aortic dissections are commonly diagnosed in patients exhibiting sharp chest pain, there are some notable cases where patients do not report the expected severity of pain. We report a unique case of a patient with a thoracic aortic dissection who was initially nearly asymptomatic for eight months, in order to heighten awareness, highlight diagnosis protocol, and improve prognosis for this commonly misdiagnosed, but fatal, condition. PMID:27257400

  19. A Type A Aortic Dissection Mimicking an Acute Myocardial Infarction

    PubMed Central

    D’Aloia, Antonio; Vizzardi, Enrico; Bugatti, Silvia; Magatelli, Marco; Bonadei, Ivano; Rovetta, Riccardo; Quinzani, Filippo; Curnis, Antonio; Cas, Livio Dei

    2012-01-01

    We describe a case of a 54 years old man in whom an initial diagnosis of acute coronary syndrome (ACS) revealed to be finally an acute aortic dissection. This case report stresses the importance to maintain a high grade of suspicion of aortic dissection as a possible alternative in presence of eletrocardiographic myocardial ischemic signs. In many medical centers where thrombolitic therapy, antiplatelets receptor blockers, heparin or percutaneous coronary angioplasty is the first line therapy for ACS the outcome may be catastrophic in situation such as aortic dissection.

  20. Pathophysiology and Surgical Treatment of Type A Acute Aortic Dissection

    PubMed Central

    Karube, Norihisa; Yasuda, Shota; Miyamoto, Takuma; Matsuki, Yusuke; Isoda, Susumu; Goda, Motohiko; Suzuki, Shinichi; Masuda, Munetaka; Imoto, Kiyotaka

    2016-01-01

    Objectives: We report the pathophysiology and treatment results of type A acute aortic dissection from our 20-year experience. Methods: We studied 673 patients with type A acute aortic dissection who underwent initial treatment from 1994 through July 2014. We divided these patients into two groups. The former group comprised 448 patients from 1994 through 2008, and the latter group comprised 225 patients from 2009 onward, when the current strategy of initial treatment and surgical technique including the early organ reperfusion therapies were established. Results: Women were significantly often presented than men in patients over 60 years of age. Thrombosed-type dissection accounted for more than half in patients over 70 years, and significantly often complicated pericardial effusion and cardiac tamponade than patent type. Malperfusion occurred in 26% of patients. Central repair operations were performed in 579 patients. In-hospital mortality for all patients was 15%, and for the patients who underwent central repair operations was 10%. Former period of operation, malperfusion, and preoperative cardiopulmonary arrest were significant risk factor of in-hospital death. Preoperative left main trunk (LMT) stents were placed in eight patients and superior mesenteric artery (SMA) intervention was performed in five, they were effective to improve the outcome. From 2009 onward, in-hospital mortality was 5.0% and there was no significant risk factor. Conclusion: Surgical results of type A acute aortic dissection were dramatically improved in the past 20 years. Early reperfusion strategy for the patients with malperfusion improved the outcomes. (This article is a translation of Jpn J Vasc Surg 2015; 24: 127–134.) PMID:27738456

  1. Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant.

    PubMed

    Ucar, Muharrem; Erdil, Feray; Sanlı, Mukadder; Aydogan, Mustafa Said; Durmus, Mahmut

    2016-04-01

    Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on examination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.

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

    PubMed

    Hayter, Robert G; Rhea, James T; Small, Andrew; Tafazoli, Faranak S; Novelline, Robert A

    2006-03-01

    To retrospectively review the authors' experience with multi-detector row computed tomography (CT) for detection of aortic dissection in the emergency setting. 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. 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

  3. Technetium-99m MAG3 renal scintigraphy with demonstration of aortic dissection.

    PubMed

    Nguyen, Ba D

    2005-08-01

    Demonstration of type B aortic dissection is rare during renal scintigraphy. The discordant radionuclide pattern of asymmetric renal flow with equivalent renal function and excretion has been previously reported in aortic dissection. However, delayed scintigraphic features of the false lumen have not been described. The author presents such a case with persistent technetium-99m MAG3 accumulation in the posterior mediastinum on postvoid planar imaging.

  4. Biomechanical roles of medial pooling of glycosaminoglycans in thoracic aortic dissection

    PubMed Central

    Roccabianca, Sara; Ateshian, Gerard A.; Humphrey, Jay D.

    2013-01-01

    Spontaneous dissection of the human thoracic aorta is responsible for significant morbidity and mortality, yet this devastating biomechanical failure process remains poorly understood. In this paper, we present finite element simulations that support a new hypothesis for the initiation of aortic dissections that is motivated by extensive histopathological observations. Specifically, our parametric simulations show that the pooling of glycosaminoglycans/proteoglycans that is singularly characteristic of the compromised thoracic aorta in aneurysms and dissections can lead to significant stress concentrations and intra-lamellar Donnan swelling pressures. We submit that these localized increases in intramural stress may be sufficient both to disrupt the normal cell-matrix interactions that are fundamental to aortic homeostasis and to delaminate the layered microstructure of the aortic wall and thereby initiate dissection. Hence, pathologic pooling of glycosaminoglycans/proteoglycans within the medial layer of the thoracic aortic should be considered as a possible target for clinical intervention. PMID:23494585

  5. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection.

    PubMed

    Harris, Kevin M; Braverman, Alan C; Eagle, Kim A; Woznicki, Elise M; Pyeritz, Reed E; Myrmel, Truls; Peterson, Mark D; Voehringer, Matthias; Fattori, Rossella; Januzzi, James L; Gilon, Dan; Montgomery, Daniel G; Nienaber, Christoph A; Trimarchi, Santi; Isselbacher, Eric M; Evangelista, Arturo

    2012-09-11

    Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996-2011) were evaluated to examine differences between patients (based on the initial imaging test) with IMH or classic dissection (AD). Of 2830 patients, 178 had IMH (64 type A [42%], 90 type B [58%], and 24 arch). Patients with IMH were older and presented with similar symptoms, such as severe pain. Patients with type A IMH were less likely to present with aortic regurgitation or pulse deficits and were more likely to have periaortic hematoma and pericardial effusion. Although type A IMH and AD were managed medically infrequently, type B IMH were more frequently treated medically. Overall in-hospital mortality was not statistically different for type A IMH compared to AD (26.6% versus 26.5%; P=0.998); type A IMH managed medically had significant mortality (40.0%), although less than classic AD (61.8%; P=0.195). Patients with type B IMH had a hospital mortality that was less but did not differ significantly (4.4% versus 11.1%; P=0.062) from classic AD. One-year mortality was not significantly different between AD and IMH. Acute IMH has similar presentation to classic AD but is more frequently complicated with pericardial effusions and periaortic hematoma. Patients with IMH have a mortality that does not differ statistically from those with classic AD. A small subgroup of type A IMH patients are managed medically and have a significant in-hospital mortality.

  6. Aortoesophageal fistula as a late complication of type B aortic dissection.

    PubMed

    Vasquez, Julio C; Delarosa, Jacob; Leon, Juan J

    2011-02-01

    We present a patient with aortoesophageal fistula that occurred years after an acute type B aortic dissection that was treated medically. This patient developed aneurysmal dilatation of the chronically dissected aorta, which finally eroded into the esophagus. Endovascular management with the placement of a stent graft was performed, but the patient ultimately died of multiorgan failure and possible myocardial infarction.

  7. Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

    PubMed

    Babatasi, G; Massetti, M; Bhoyroo, S; Khayat, A

    1997-10-01

    Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

  8. Complicated Postpartum Type B Aortic Dissection and Endovascular Repair

    PubMed Central

    Rosenberger, Laura H.; Adams, Joshua D.; Kern, John A.; Tracci, Margaret C.; Angle, J. Fritz; Cherry, Kenneth J.

    2012-01-01

    BACKGROUND Fifty percent of aortic dissections in women younger than 40 years occur in association with pregnancy. Of these, half of type B dissections occur in the postpartum period. CASE A 30-year-old woman was status post spontaneous vaginal delivery at 30 weeks of gestation for fetal death, complicated by an eclamptic seizure. On post-partum day 4, she suffered an acute, complicated type B aortic dissection treated with endovascular stent graft placement. CONCLUSION Endovascular repair may be an attractive option for the treatment of complicated type B aortic dissections in pregnancy and the peripartum period, with reduced maternal and fetal mortality. This may allow the fetus to remain in situ and avoid the risks of surgery and possible cardiopulmonary bypass, with little radiation risk to the fetus. PMID:22270446

  9. [Immediate results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection].

    PubMed

    Liashenko, M M; Cherniavskiĭ, A M; Al'sov, S A; Sirota, D A; Khvan, D S

    2014-01-01

    Despite obvious progress of surgical technologies in correction of proximal aortic pathology, improvement of methods of protection of the brain, one of the main problems of this direction remains the development of postoperative cerebral ischaemia of various degree of manifestation: strokes, transitory ischaemic attacks, or hypoxic encephalopathy. Of special interest is studying the group of patients presenting with aortic dissection, since this pathology may be accompanied by a wide variety of combinations of occlusive and stenotic lesions of the branches of the ascending portion of the aorta and aortic arch (coronary and brachiocephalic basins) by the detached intima. Over the period from 1999 to 2011, we operated on a total of 124 patients presenting with DeBakey type I aortic dissection. Of these, 194 were men (75.8%) and 30 (24.2%) women. The mean age amounted to 48.7±11.0 years. Etiologically prevailing were systemic atherosclerosis (91 patients, 73.4% of cases) and Marfan's syndrome in 14 (11.3%) cases. In all patients operative intervention included reconstruction of the aortic arch according to one of the following techniques: prosthetic repair according to the type of an aggressive oblique anastomosis ("hemiarch repair") - 78 (62.9%) patients, prosthetic repair of the aortic arch using the multiple-branch prosthesis Plexus Vascutek - 37 (29.8%) patients, and nine patients underwent prosthetic repair of the aortic arch with a vascular graft with reimplantation of the brachiocephalic arteries with a single islet. The average duration of artificial circulation amounted to 230.1±70.0 minutes, the mean time of aortic occlusion was 167.2±44.2 minutes and that of circulatory arrest equalled 51.9±16.2 minutes. The brain during hypothermic circulatory arrest was protected according to the following techniques: 16 (12.9%) patients - isolated hypothermia with no cerebral perfusion, 76 (61.3 %) patients retrograde cerebral perfusion (RCP) through the superior

  10. Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair.

    PubMed

    Casana, R; Tolva, V; Majnardi, A Robecchi; Bianchi, P G; Addobati, L; Bertoni, G B; Cireni, L V; Silani, V

    2011-10-01

    Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery. Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome. According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.

  11. Circadian variation of acute aortic dissection.

    PubMed

    Seguchi, Masaru; Wada, Hiroshi; Sakakura, Kenichi; Nakagawa, Tom; Ibe, Tatsuro; Ikeda, Nahoko; Sugawara, Yoshitaka; Ako, Junya; Momomura, Shin-ichi

    2015-05-13

    Acute aortic dissection (AAD) is a life-threatening cardiovascular disease with high mortality. Hypertension is a well known risk factor of AAD. There have been previous reports about the association between circadian variation of blood pressure (BP) and cardiovascular events. However, little is known about the association between the onset-time of AAD and circadian variation of BP. The purpose of this study was to clarify the characteristics of circadian variation of BP in AAD and its relation to the onset-time of this disease. This study included type B spontaneous AAD patients who were referred to our institution and treated conservatively between January 2008 and June 2013. Patients with type A AAD, secondary to trauma, and type B AAD which preceded surgical intervention were excluded. Data were retrospectively collected from the hospital medical records. Sixty-eight patients with type B AAD were enrolled. The distribution of the circadian pattern in the study patients was as follows: extreme-dipper, 0% (none); dipper, 20.6% (n = 14); nondipper, 50% (n = 34); riser, 29.4% (n = 20). Non-dipper and riser patterns were more frequently observed compared with other population studies reported previously. Moreover, no patient in the dipper group had night-time onset while 31.5% of the patients in the absence of nocturnal BP fall group (non-dipper and riser) did (P = 0.01). Absence of a nocturnal BP fall was frequently seen in AAD patients. Absence of a nocturnal BP fall may be a risk factor of AAD. Circadian variation of BP may also affect the onset-time of type B AAD.

  12. Analysis of clinical features of painless aortic dissection.

    PubMed

    Liu, Zhao-yu; Zou, Yuan-lin; Chai, Bo-lan; Zeng, He-song

    2014-08-01

    The clinical characteristics of painless aortic dissection were investigated in order to improve the awareness of diagnosis and treatment of atypical aortic dissection. The 482 cases of aortic dissection were divided into painless group and pain group, and the data of the two groups were retrospectively analyzed. The major clinical symptom was pain in 447 cases (92.74%), while 35 patients (7.26%) had no typical pain. The gender, age, hypertension, hyperlipidemia, diabetes, smoking and drinking history had no statistically significant differences between the two groups (P>0.05). The proportion of Stanford type A in painless group was significantly higher than that in pain group (48.57% vs. 21.03%, P=0.006). The incidence of unconsciousness in the painless group was significantly higher than that in the pain group (14.29% vs. 3.58%, P=0.011). The incidence of hypotension in painless group was significantly higher than that in pain group for 4.26 folds (P=0.01). Computed tomography angiography (CTA) examination revealed that the incidence of aortic arch involved in the painless group was significantly higher than that in the pain group (19.23% vs. 5.52%, P=0.019). It was concluded that the incidence of painless aortic dissection was higher in Stanford A type patients, commonly seen in the patients complicated with hypotension and unconsciousness. CTA examination revealed higher incidence of aortic arch involvement.

  13. A case of painless acute Type-A thoracic aortic dissection.

    PubMed

    Catlow, Jamie; Cross, Tarquin

    2015-01-01

    We describe the case of an 83-year-old lady with a known aneurysmal thoracic aorta, developing acute breathlessness and hypoxia, with no pain and unremarkable cardiovascular examination. As D-dimers were raised, she was treated with low-molecular-weight heparin (LMWH) for suspected pulmonary embolism. CT pulmonary angiography showed acutely dissecting, Type-A, thoracic aortic aneurysm. The patient was treated medically with β-blockers. Despite a poor prognosis, she remains well 2 months later. Observational studies of patients over 70 with Type-A dissection show only 75.3% experience pain, are offered surgery less and have higher mortality. d-Dimers are almost always elevated in aortic dissection. No previous studies document breathlessness as the only presenting symptom. This case emphasises the need, in older populations, for a low suspicion threshold for aortic dissection.

  14. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy.

    PubMed

    Moon, Michael C; Greenberg, Roy K; Morales, Jose P; Martin, Zenia; Lu, Qingsheng; Dowdall, Joseph F; Hernandez, Adrian V

    2011-04-01

    Proximal aortic dissections are life-threatening conditions that require immediate surgical intervention to avert an untreated mortality rate that approaches 50% at 48 hours. Advances in computed tomography (CT) imaging techniques have permitted increased characterization of aortic dissection that are necessary to assess the design and applicability of new treatment paradigms. All patients presenting during a 2-year period with acute proximal aortic dissections who underwent CT scanning were reviewed in an effort to establish a detailed assessment of their aortic anatomy. Imaging studies were assessed in an effort to document the location of the primary proximal fenestration, the proximal and distal extent of the dissection, and numerous morphologic measurements pertaining to the aortic valve, root, and ascending aorta to determine the potential for an endovascular exclusion of the ascending aorta. During the study period, 162 patients presented with proximal aortic dissections. Digital high-resolution preoperative CT imaging was performed on 76 patients, and 59 scans (77%) were of adequate quality to allow assessment of anatomic suitability for treatment with an endograft. In all cases, the dissection plane was detectable, yet the primary intimal fenestration was identified in only 41% of the studies. Scans showed 24 patients (32%) appeared to be anatomically amenable to such a repair (absence of valvular involvement, appropriate length and diameter of proximal sealing regions, lack of need to occlude coronary vasculature). Of the 42 scans that were determined not to be favorable for endovascular repair, the most common exclusion finding was the absence of a proximal landing zone (n = 15; 36%). Appropriately protocoled CT imaging provides detailed anatomic information about the aortic root and ascending aorta, allowing the assessment of which dissections have proximal fenestrations that may be amenable to an endovascular repair. Copyright © 2011 Society for

  15. Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery

    PubMed Central

    Stöger, Guillermo; Ríos, Matías; Battellini, Roberto; Bracco, Daniel; Kotowicz, Vadim

    2015-01-01

    The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively. PMID:27390749

  16. Lymphoplasmacytic aortitis and acute aortic dissection. An uncommon association.

    PubMed

    Faye-Petersen, O M; Arnold, M M; Grizzle, W E; Lie, J T

    1996-04-01

    A 43-year-old white man with a history of cigarette smoking, hypertension, nephrolithiasis, and cervical degenerative arthritis was hospitalized for sudden-onset severe, substernal, and pleuritic chest pain with epigastric radiation. Despite evaluation, the cause remained unclear and the patient expired on hospital day 5. Autopsy revealed acute Stanford type A aortic dissection, hemopericardium, and hemothorax. Grossly, the aorta and its branches, including uninvolved medium-sized arteries, displayed extreme mural fragility. Microscopic examination showed a primary lymphoplasmacytic aortitis-periaortitis without giant cells. Rents within the tunica media, medial-adventitial inflammation, and elastic fiber disruption were limited to sites of gross aortic dissection. Muscular arteries showed patchy, chronic arteritis-periarteritis without giant cell infiltrate or aneurysm formation. This case documents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.

  17. [Late reoperations after repaired Stanford type A aortic dissection].

    PubMed

    Huang, F H; Li, L P; Su, C H; Qin, W; Xu, M; Wang, L M; Jiang, Y S; Qiu, Z B; Xiao, L Q; Zhang, C; Shi, H W; Chen, X

    2017-04-01

    Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun's procedure in 1 patient, Wheat combined with Sun's procedure in 1 patient, Bentall combined with Sun's procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun's procedure. Results: Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were

  18. Acute aortic dissection in a young patient without Marfan fibrillinopathy: a case report

    PubMed Central

    2009-01-01

    Introduction Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. Heavy weightlifting and other fibrillinopathies have been also implicated in the literature. We present here the case of a 26 year old male with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome. Case presentation The patient is a 26-year-old Caucasian Greek male who was presented in the emergency department with acute chest pain. Computerized tomography with contrast material showed the presence of an ascending aortic aneurysm with the question of an acute dissection type A (De Bakey II). The patient was emergently operated with replacement of the affected aortic segment and he had an uneventful clinical course. Three years follow up is essentially normal. Conclusion Although extremely rare, aortic dissection is always a possibility in the differential diagnosis of chest and/or back pain in young patients and should be thoroughly investigated. The presence of an associated aneurysm makes the possibility even higher. The disease, if undiagnosed, carries the same mortality rates as in the older population. Prompt surgical intervention offers a possible cure and long term survival benefit for the patients. PMID:20181187

  19. Possible extracardiac predictors of aortic dissection in Marfan syndrome

    PubMed Central

    2014-01-01

    Background According to previous studies, aortic diameter alone seems to be insufficient to predict the event of aortic dissection in Marfan syndrome (MFS). Determining the optimal schedule for preventive aortic root replacement (ARR) aortic growth rate is of importance, as well as family history, however, none of them appear to be decisive. Thus, the aim of this study was to search for potential predictors of aortic dissection in MFS. Methods A Marfan Biobank consisting of 79 MFS patients was established. Thirty-nine MFS patients who underwent ARR were assigned into three groups based on the indication for surgery (dissection, annuloaortic ectasia and prophylactic surgery). The prophylactic surgery group was excluded from the study. Transforming growth factor-β (TGF-β) serum levels were measured by ELISA, relative expression of c-Fos, matrix metalloproteinase 3 and 9 (MMP-3 and −9) were assessed by RT-PCR. Clinical parameters, including anthropometric variables - based on the original Ghent criteria were also analyzed. Results Among patients with aortic dissection, TGF-β serum level was elevated (43.78 ± 6.51 vs. 31.64 ± 4.99 ng/l, p < 0.0001), MMP-3 was up-regulated (Ln2α = 1.87, p = 0.062) and striae atrophicae were more common (92% vs. 41% p = 0.027) compared to the annuloaortic ectasia group. Conclusions We found three easily measurable parameters (striae atrophicae, TGF-β serum level, MMP-3) that may help to predict the risk of aortic dissection in MFS. Based on these findings a new classification of MFS, that is benign or malignant is also proposed, which could be taken into consideration in determining the timing of prophylactic ARR. PMID:24720641

  20. Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone.

    PubMed

    Lee, Chien-Chang; Lee, Meng-Tse Gabriel; Chen, Yueh-Sheng; Lee, Shih-Hao; Chen, Yih-Sharng; Chen, Shyr-Chyr; Chang, Shan-Chwen

    2015-11-01

    Fluoroquinolones have been associated with collagen degradation, raising safety concerns related to more serious collagen disorders with use of these antibiotics, including aortic aneurysm and dissection. To examine the relationship between fluoroquinolone therapy and the risk of developing aortic aneurysm and dissection. We conducted a nested case-control analysis of 1477 case patients and 147 700 matched control cases from Taiwan's National Health Insurance Research Database (NHIRD) from among 1 million individuals longitudinally observed from January 2000 through December 2011. Cases patients were defined as those hospitalized for aortic aneurysm or dissection. One hundred control patients were matched for each case based on age and sex. Current, past, or any prior-year use of fluoroquinolone. Current use was defined as a filled fluoroquinolone prescription within 60 days of the aortic aneurysm or dissection; past use refers to a filled fluoroquinolone prescription between 61 and 365 days prior to the aortic aneurysm; and any prior-year use refers to having a fluoroquinolone prescription filled for 3 or more days any time during the 1-year period before the aortic aneurysm or dissection. Risk of developing aortic aneurysm or dissection. A total of 1477 individuals who experienced aortic aneurysm or dissection were matched to 147 700 controls. After propensity score adjustment, current use of fluoroquinolones was found to be associated with increased risk for aortic aneurysm or dissection (rate ratio [RR], 2.43; 95% CI, 1.83-3.22), as was past use, although this risk was attenuated (RR, 1.48; 95% CI, 1.18-1.86). Sensitivity analysis focusing on aortic aneurysm and dissection requiring surgery also demonstrated an increased risk associated with current fluoroquinolone use, but the increase was not statistically significant (propensity score-adjusted RR, 2.15; 95% CI, 0.97-4.60). Use of fluoroquinolones was associated with an increased risk of aortic aneurysm and

  1. Acute Type B Aortic Dissection in a Patient with Previous Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Park, Sung Hun; Rha, Seung-Woon

    2017-01-01

    Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR. PMID:28377913

  2. Computational Fluid Dynamics Analysis of Thoracic Aortic Dissection

    NASA Astrophysics Data System (ADS)

    Tang, Yik; Fan, Yi; Cheng, Stephen; Chow, Kwok

    2011-11-01

    Thoracic Aortic Dissection (TAD) is a cardiovascular disease with high mortality. An aortic dissection is formed when blood infiltrates the layers of the vascular wall, and a new artificial channel, the false lumen, is created. The expansion of the blood vessel due to the weakened wall enhances the risk of rupture. Computational fluid dynamics analysis is performed to study the hemodynamics of this pathological condition. Both idealized geometry and realistic patient configurations from computed tomography (CT) images are investigated. Physiological boundary conditions from in vivo measurements are employed. Flow configuration and biomechanical forces are studied. Quantitative analysis allows clinicians to assess the risk of rupture in making decision regarding surgical intervention.

  3. Aortic Dissection in Patients With Bicuspid Aortic Valve–Associated Aneurysms

    PubMed Central

    Wojnarski, Charles M.; Svensson, Lars G.; Roselli, Eric E.; Idrees, Jay J.; Lowry, Ashley M.; Ehrlinger, John; Pettersson, Gösta B.; Gillinov, A. Marc; Johnston, Douglas R.; Soltesz, Edward G.; Navia, Jose L.; Hammer, Donald F.; Griffin, Brian; Thamilarasan, Maran; Kalahasti, Vidyasagar; Sabik, Joseph F.; Blackstone, Eugene H.; Lytle, Bruce W.

    2016-01-01

    Background Data regarding the risk of aortic dissection in patients with bicuspid aortic valve and large ascending aortic diameter are limited, and appropriate timing of prophylactic ascending aortic replacement lacks consensus. Thus our objectives were to determine the risk of aortic dissection based on initial cross-sectional imaging data and clinical variables and to isolate predictors of aortic intervention in those initially prescribed serial surveillance imaging. Methods From January 1995 to January 2014, 1,181 patients with bicuspid aortic valve underwent cross-sectional computed tomography (CT) or magnetic resonance imaging (MRI) to ascertain sinus or tubular ascending aortic diameter greater than or equal to 4.7 cm. Random Forest classification was used to identify risk factors for aortic dissection, and among patients undergoing surveillance, time-related analysis was used to identify risk factors for aortic intervention. Results Prevalence of type A dissection that was detected by imaging or was found at operation or on follow-up was 5.3% (n = 63). Probability of type A dissection increased gradually at a sinus diameter of 5.0 cm—from 4.1% to 13% at 7.2 cm—and then increased steeply at an ascending aortic diameter of 5.3 cm—from 3.8% to 35% at 8.4 cm—corresponding to a cross-sectional area to height ratio of 10 cm2/m for sinuses of Valsalva and 13 cm2/m for the tubular ascending aorta. Cross-sectional area to height ratio was the best predictor of type A dissection (area under the curve [AUC] = 0.73). Conclusions Early prophylactic ascending aortic replacement in patients with bicuspid aortic valve should be considered at high-volume aortic centers to reduce the high risk of preventable type A dissection in those with aortas larger than approximately 5.0 cm or with a cross-sectional area to height ratio greater than approximately 10 cm2/m. PMID:26209494

  4. The 100 most-cited articles on aortic dissection.

    PubMed

    Lai, Ping; Liu, Yuan-Hui; Xue, Jin-Hua; He, Peng-Cheng; Qiu, Yue-Qun

    2017-01-17

    To identify and characterize the most frequently cited articles that have been published on aortic dissection. A list of the 100 most frequently cited publications (T100) about aortic dissection was generated by performing a searching of the Science Citation Index--Expanded using "aortic dissection" as the search term. Basic information about the articles was recorded, including number of citations, journal title, journal impact factor, time since publication, first author's country, topic/subspecialty of the research, and publication type. We finally included 180 articles on aortic dissection, from which we identified the 100 most frequently cited articles (T100). The most frequently cited article received 1079 citations, while the least frequently cited article received 68 (mean140.5 citations per article). The T100 originated from 19 countries, with more than half of them originating from the USA (n = 97). The T100 articles were published from 1955 to 2013, with 79% published during the period 1990-2009. In addition, there were 40 different journals with Circulation having the most citations (n = 38). Regarding the article type, there were 21 basic and 140 clinical research articles, one meta-analysis, and 18 review articles. Reviews had the highest mean number of citations (mean 235.5 citations per article). Our study provides a historical perspective on the progress of dissection research, and helps to identify the quality of the work, the discoveries made, and the trends steering the studies.

  5. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review.

    PubMed

    Singh, Balraj; Treece, Jennifer M; Murtaza, Ghulam; Bhatheja, Samit; Lavine, Steven J; Paul, Timir K

    2016-01-01

    A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

  6. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review

    PubMed Central

    Singh, Balraj; Treece, Jennifer M.; Bhatheja, Samit; Lavine, Steven J.

    2016-01-01

    A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal. PMID:27738530

  7. Acute aortic dissection in a young patient without Marfan fibrillinopathy: a case report.

    PubMed

    Hountis, Panagiotis; Dedeilias, Panagiotis; Bolos, Konstadinos

    2009-04-28

    Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. Heavy weightlifting and other fibrillinopathies have been also implicated in the literature. We present here the case of a 26-year-old male with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome. The patient is a 26-year-old Caucasian Greek male who was presented in the emergency department with acute chest pain. Computerized tomography with contrast material showed the presence of an ascending aortic aneurysm with the question of an acute dissection type A (De Bakey II). The patient was emergently operated with replacement of the affected aortic segment and he had an uneventful clinical course. Three years follow up is essentially normal. Although extremely rare, aortic dissection is always a possibility in the differential diagnosis of chest and/or back pain in young patients and should be thoroughly investigated. The presence of an associated aneurysm makes the possibility even higher. The disease, if undiagnosed, carries the same mortality rates as in the older population. Prompt surgical intervention offers a possible cure and long term survival benefit for the patients.

  8. [Aortic dissection and pregnancy. Apropos of a case].

    PubMed

    Helms, E; Uguen, T; Amaranto, P; Carton, M J; Ducreux, J C; Tempelhoff, C

    1995-03-01

    Aortic dissection is a serious disease which rarely affects young women. In this context, it occurs in nearly one out of two cases during pregnancy, usually during the third term. The authors report acute dissection of the ascending aorta (de Bakey type 2) during pregnancy for which rapid cardiothoracic surgical management as a semi-emergency resulted in a favourable outcome for mother and child.

  9. Using D-Dimer to Diagnose Painless Acute Aortic Dissection: A Case Report

    PubMed Central

    Barniol, Caroline; Vallé, Baptiste; Dehours, Emilie; Charpentier, Sandrine; Bounes, Vincent; Lauque, Dominique

    2011-01-01

    Introduction. Aortic dissection is a cardiovascular emergency; the most frequent symptom is chest pain, but clinical presentation can be varied and atypical. Case Presentation. We report the case of a 66-year-old Caucasian male who presented a syncope immediately followed by a left-arm weakness while driving his car. Clinical examination was normal, but bilateral jugular vein distension was noted. Electrocardiogram and chest radiography were unremarkable. Among blood tests performed, troponin I test result was negative, and D-dimer test concentration was >4000 ng/mL. Since D-dimer test result was positive, chest computer tomography angiogram was performed and found a thoracic aortic dissection. Conclusion. Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement. It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis. PMID:23326692

  10. [Redo surgery for residual distal dissection after the limited proximal aortic replacement for Stanford type A acute aortic dissection].

    PubMed

    Ogino, Hitoshi

    2013-07-01

    Redo surgery for residual distal dissection after the limited proximal aortic repair for Stanford type A acute aortic dissection remains challenging with some difficulties. In essence, redo aortic repair predominantly depends on the significantly dilated parts of the residual dissection. According to that, the strategy including median or lateral approach and 1 or 2 staged repair would be determined with careful consideration for patients' age and function of the vital organs such as brain, heart, lung, liver, and kidney. Generally, for relatively young and low-risk patients, an aggressive 1 stage repair of the entire arch to descending aorta through a left thoracotomy is feasible. Meanwhile, 2 stage repair is beneficial for elderly high-risk patients, which consists of the 1st total arch replacement with elephant trunk through a median sternotomy followed secondly by the open descending aortic repair through a lateral thoracotomy or recently-advanced less-invasive endovascular aortic repair. In the initial repair, more aggressive total arch replacement with elephant trunk or frozen elephant trunk might be another useful option to potentially prevent such troublesome behaviors of the residual dissecting aorta requiring redo surgery in the late stage.

  11. FOXE3 mutations predispose to thoracic aortic aneurysms and dissections.

    PubMed

    Kuang, Shao-Qing; Medina-Martinez, Olga; Guo, Dong-Chuan; Gong, Limin; Regalado, Ellen S; Reynolds, Corey L; Boileau, Catherine; Jondeau, Guillaume; Prakash, Siddharth K; Kwartler, Callie S; Zhu, Lawrence Yang; Peters, Andrew M; Duan, Xue-Yan; Bamshad, Michael J; Shendure, Jay; Nickerson, Debbie A; Santos-Cortez, Regie L; Dong, Xiurong; Leal, Suzanne M; Majesky, Mark W; Swindell, Eric C; Jamrich, Milan; Milewicz, Dianna M

    2016-03-01

    The ascending thoracic aorta is designed to withstand biomechanical forces from pulsatile blood. Thoracic aortic aneurysms and acute aortic dissections (TAADs) occur as a result of genetically triggered defects in aortic structure and a dysfunctional response to these forces. Here, we describe mutations in the forkhead transcription factor FOXE3 that predispose mutation-bearing individuals to TAAD. We performed exome sequencing of a large family with multiple members with TAADs and identified a rare variant in FOXE3 with an altered amino acid in the DNA-binding domain (p.Asp153His) that segregated with disease in this family. Additional pathogenic FOXE3 variants were identified in unrelated TAAD families. In mice, Foxe3 deficiency reduced smooth muscle cell (SMC) density and impaired SMC differentiation in the ascending aorta. Foxe3 expression was induced in aortic SMCs after transverse aortic constriction, and Foxe3 deficiency increased SMC apoptosis and ascending aortic rupture with increased aortic pressure. These phenotypes were rescued by inhibiting p53 activity, either by administration of a p53 inhibitor (pifithrin-α), or by crossing Foxe3-/- mice with p53-/- mice. Our data demonstrate that FOXE3 mutations lead to a reduced number of aortic SMCs during development and increased SMC apoptosis in the ascending aorta in response to increased biomechanical forces, thus defining an additional molecular pathway that leads to familial thoracic aortic disease.

  12. FOXE3 mutations predispose to thoracic aortic aneurysms and dissections

    PubMed Central

    Kuang, Shao-Qing; Medina-Martinez, Olga; Guo, Dong-chuan; Gong, Limin; Regalado, Ellen S.; Reynolds, Corey L.; Boileau, Catherine; Jondeau, Guillaume; Prakash, Siddharth K.; Kwartler, Callie S.; Zhu, Lawrence Yang; Peters, Andrew M.; Duan, Xue-Yan; Bamshad, Michael J.; Shendure, Jay; Nickerson, Debbie A.; Santos-Cortez, Regie L.; Dong, Xiurong; Leal, Suzanne M.; Majesky, Mark W.; Swindell, Eric C.; Jamrich, Milan; Milewicz, Dianna M.

    2016-01-01

    The ascending thoracic aorta is designed to withstand biomechanical forces from pulsatile blood. Thoracic aortic aneurysms and acute aortic dissections (TAADs) occur as a result of genetically triggered defects in aortic structure and a dysfunctional response to these forces. Here, we describe mutations in the forkhead transcription factor FOXE3 that predispose mutation-bearing individuals to TAAD. We performed exome sequencing of a large family with multiple members with TAADs and identified a rare variant in FOXE3 with an altered amino acid in the DNA-binding domain (p.Asp153His) that segregated with disease in this family. Additional pathogenic FOXE3 variants were identified in unrelated TAAD families. In mice, Foxe3 deficiency reduced smooth muscle cell (SMC) density and impaired SMC differentiation in the ascending aorta. Foxe3 expression was induced in aortic SMCs after transverse aortic constriction, and Foxe3 deficiency increased SMC apoptosis and ascending aortic rupture with increased aortic pressure. These phenotypes were rescued by inhibiting p53 activity, either by administration of a p53 inhibitor (pifithrin-α), or by crossing Foxe3–/– mice with p53–/– mice. Our data demonstrate that FOXE3 mutations lead to a reduced number of aortic SMCs during development and increased SMC apoptosis in the ascending aorta in response to increased biomechanical forces, thus defining an additional molecular pathway that leads to familial thoracic aortic disease. PMID:26854927

  13. Predicting false lumen thrombosis in patient-specific models of aortic dissection

    PubMed Central

    Menichini, Claudia; Cheng, Zhuo; Gibbs, Richard G. J.

    2016-01-01

    Aortic dissection causes splitting of the aortic wall layers, allowing blood to enter a ‘false lumen’ (FL). For type B dissection, a significant predictor of patient outcomes is patency or thrombosis of the FL. Yet, no methods are currently available to assess the chances of FL thrombosis. In this study, we present a new computational model that is capable of predicting thrombus formation, growth and its effects on blood flow under physiological conditions. Predictions of thrombus formation and growth are based on fluid shear rate, residence time and platelet distribution, which are evaluated through convection–diffusion–reaction transport equations. The model is applied to a patient-specific type B dissection for which multiple follow-up scans are available. The predicted thrombus formation and growth patterns are in good qualitative agreement with clinical data, demonstrating the potential applicability of the model in predicting FL thrombosis for individual patients. Our results show that the extent and location of thrombosis are strongly influenced by aortic dissection geometry that may change over time. The high computational efficiency of our model makes it feasible for clinical applications. By predicting which aortic dissection patient is more likely to develop FL thrombosis, the model has great potential to be used as part of a clinical decision-making tool to assess the need for early endovascular intervention for individual dissection patients. PMID:27807275

  14. Frequency of abdominal aortic expansion after thoracic endovascular repair of type B aortic dissection.

    PubMed

    Weber, Tim F; Böckler, Dittmar; Müller-Eschner, Matthias; Bischoff, Moritz; Kronlage, Moritz; von Tengg-Kobligk, Hendrik; Kauczor, Hans-Ulrich; Hyhlik-Dürr, Alexander

    2016-12-01

    To determine abdominal aortic expansion after thoracic endovascular aortic repair (TEVAR) in patients with aortic dissection type B and 36 months minimum follow-up. Retrospective study of 18 TEVAR patients with follow-up >36 months. Abdominal aortic diameters at celiac trunk (location B) and infrarenal aorta (location C) were recorded on the first and last imaging after TEVAR. False lumen thrombosis was determined at level of endograft (A) and at B and C. Aortic expansion was defined as diameter increase of 5 mm or 15%. Correlation analyses were performed to investigate potential determinants of expansion. Median follow-up was 75.2 months. Sixteen of 18 patients (88.9%) demonstrated abdominal expansion. Mean expansion was 9.9 ± 6.1 mm at B and 11.7 ± 6.5 mm at C, without a difference between acute and chronic dissections. Critical diameters of 55 mm were reached in two patients treated for chronic dissection (11.1%). Annual diameter increase was significantly greater at locations with baseline diameters >30 mm (2.1 ± 1.1 mm vs. 1.0 ± 0.6 mm, p = 0.009). Baseline diameters were greater in patients with chronic dissections. Abdominal aortic expansion can be frequently recognized after TEVAR for aortic dissection type B and occurs independently from thoracic false lumen thrombosis. Clinical significant abdominal aortic expansion may occur more frequently in patients treated with TEVAR for chronic dissection. © The Author(s) 2016.

  15. Early recognition of acute thoracic aortic dissection and aneurysm

    PubMed Central

    2013-01-01

    Background Thoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary. Methods A retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant. Results In total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS. Conclusions Increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms. PMID:24499618

  16. [Stanford type a acute aortic dissection with pectus excavatum].

    PubMed

    Kuwata, Toshiyuki; Fukuda, Hirotsugu; Yoshitatsu, Masao; Yamada, Yasuyuki; Shibasaki, Ikuko; Inoue, Yuho; Hori, Takayuki; Ogawa, Hironaga; Tsuchiya, Go; Shimizu, Riha; Takei, Yusuke

    2012-11-01

    Pectus excavatum is generally an isolated abnormality of the chest wall. However, some patients have a concomitant pectus deformity and cardiac & aortic disease. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. We report 2 patients with acute Stanford type A aortic dissection and pectus excavatum who underwent emergency operation. In case 1, median sternotomy is an unsuitable approach for open heart surgery, since the heart and great vessels are displace into the left hemithorax. But combined sternotomy and left anterior thoracotomy provided excellent surgical exposure. In case 2, we proceeded with a leftsided costotomy of four ribs and place a normal chest retractor providing as excellent exposure as combined sternotomy and left anterior thoracotomy. A left-sided costotomy of four ribs can be performed safely, eliminating the risks of median sternotomy in acute stanford type A aortic dissection with pectus excavatum.

  17. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    PubMed

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  18. Precision medical and surgical management for thoracic aortic aneurysms and acute aortic dissections based on the causative mutant gene.

    PubMed

    Milewicz, Dianna; Hostetler, Ellen; Wallace, Stephanie; Mellor-Crummey, Lauren; Gong, Limin; Pannu, Hariyadarshi; Guo, Dong-chuan; Regalado, Ellen

    2016-04-01

    Almost one-quarter of patients presenting with thoracic aortic aneurysms (TAAs) or acute aortic dissections (TAADs) have an underlying mutation in a specific gene. A subset of these patients will have systemic syndromic features, for example, skeletal features in patients with Marfan Syndrome. It is important to note that the majority of patients with thoracic aortic disease will not have these syndromic features but many will have a family history of the disease. The genes predisposing to these thoracic aortic diseases are inherited in an autosomal dominant manner, and thirteen genes have been identified to date. As the clinical phenotype associated with each specific gene is defined, the data indicate that the underlying gene dictates associated syndromic features. More importantly, the underlying gene also dictates the aortic disease presentation, the risk for dissection at a given range of aortic diameters, the risk for additional vascular diseases and what specific vascular diseases occur associated with the gene. These results lead to the recommendation that the medical and surgical management of these patients be dictated by the underlying gene, and for patients with mutations in ACTA2, the specific mutation in the gene.

  19. Loeys-Dietz syndrome: life threatening aortic dissection diagnosed on routine family screening

    PubMed Central

    Martin, Claire A; Clowes, Virginia E; Cooper, John P

    2014-01-01

    A 52-year-old man was found to have a severely dilated aortic root and a Stanford type A dissection on familial screening echocardiography, following diagnosis of a dilated aorta in his son. The dissection required urgent surgical repair. Clinical examination suggested features of Loeys-Dietz syndrome type II, and subsequent demonstration of a mutation in the TGFBR1 gene in the patient and his son confirmed the diagnosis. This article highlights the high prevalence of inherited conditions in dilated aortic root presentations and the importance of family screening and surveillance to allow early surgical intervention. PMID:24495977

  20. Repair of Late Retrograde Type A Aortic Dissection After TEVAR: Causes and Management.

    PubMed

    Mosquera, Victor X; Marini, Milagros; Fraga-Manteiga, Daniel; Gulias, Daniel; Cuenca, Jose J

    2016-03-01

    One of the most feared complications of thoracic endovascular aortic repair (TEVAR) and hybrid arch repair is retrograde type A aortic dissection (RTAD). More than two-thirds of RTAD occurs in the immediate postoperative period and first postoperative month. In presentations beyond that point, progression of the native aortopathy must be considered. We report a late presentation of an RTAD seven months after hybrid repair of an aortic intramural hematoma with an ulcer-like projection, and review the causes and management of this TEVAR complication. © 2016 Wiley Periodicals, Inc.

  1. First case of a left atrial dissection after transcatheter aortic valve replacement.

    PubMed

    Sardar, M Rizwan; Kaddissi, Georges I; Sabir, Sajjad A; Topalian, Simon K

    2016-06-01

    The left atrial dissection is a very infrequently encountered complication after valve replacement and never seen after Transcatheter aortic valve replacement (TAVR). We present an 84-year-old female, who underwent successful transapical TAVR and consequently developed contained left atrial dissection seen on transesophageal echocardiogram. The patient remained stable throughout the procedure and was monitored in critical care unit with conservative management. Although there is low associated intraop mortality, prompt recognition is paramount with follow-up serial imaging.

  2. Recurrent Gain-of-Function Mutation in PRKG1 Causes Thoracic Aortic Aneurysms and Acute Aortic Dissections

    PubMed Central

    Guo, Dong-chuan; Regalado, Ellen; Casteel, Darren E.; Santos-Cortez, Regie L.; Gong, Limin; Kim, Jeong Joo; Dyack, Sarah; Horne, S. Gabrielle; Chang, Guijuan; Jondeau, Guillaume; Boileau, Catherine; Coselli, Joseph S.; Li, Zhenyu; Leal, Suzanne M.; Shendure, Jay; Rieder, Mark J.; Bamshad, Michael J.; Nickerson, Deborah A.; Kim, Choel; Milewicz, Dianna M.

    2013-01-01

    Gene mutations that lead to decreased contraction of vascular smooth-muscle cells (SMCs) can cause inherited thoracic aortic aneurysms and dissections. Exome sequencing of distant relatives affected by thoracic aortic disease and subsequent Sanger sequencing of additional probands with familial thoracic aortic disease identified the same rare variant, PRKG1 c.530G>A (p.Arg177Gln), in four families. This mutation segregated with aortic disease in these families with a combined two-point LOD score of 7.88. The majority of affected individuals presented with acute aortic dissections (63%) at relatively young ages (mean 31 years, range 17–51 years). PRKG1 encodes type I cGMP-dependent protein kinase (PKG-1), which is activated upon binding of cGMP and controls SMC relaxation. Although the p.Arg177Gln alteration disrupts binding to the high-affinity cGMP binding site within the regulatory domain, the altered PKG-1 is constitutively active even in the absence of cGMP. The increased PKG-1 activity leads to decreased phosphorylation of the myosin regulatory light chain in fibroblasts and is predicted to cause decreased contraction of vascular SMCs. Thus, identification of a gain-of-function mutation in PRKG1 as a cause of thoracic aortic disease provides further evidence that proper SMC contractile function is critical for maintaining the integrity of the thoracic aorta throughout a lifetime. PMID:23910461

  3. Recurrent gain-of-function mutation in PRKG1 causes thoracic aortic aneurysms and acute aortic dissections.

    PubMed

    Guo, Dong-chuan; Regalado, Ellen; Casteel, Darren E; Santos-Cortez, Regie L; Gong, Limin; Kim, Jeong Joo; Dyack, Sarah; Horne, S Gabrielle; Chang, Guijuan; Jondeau, Guillaume; Boileau, Catherine; Coselli, Joseph S; Li, Zhenyu; Leal, Suzanne M; Shendure, Jay; Rieder, Mark J; Bamshad, Michael J; Nickerson, Deborah A; Kim, Choel; Milewicz, Dianna M

    2013-08-08

    Gene mutations that lead to decreased contraction of vascular smooth-muscle cells (SMCs) can cause inherited thoracic aortic aneurysms and dissections. Exome sequencing of distant relatives affected by thoracic aortic disease and subsequent Sanger sequencing of additional probands with familial thoracic aortic disease identified the same rare variant, PRKG1 c.530G>A (p.Arg177Gln), in four families. This mutation segregated with aortic disease in these families with a combined two-point LOD score of 7.88. The majority of affected individuals presented with acute aortic dissections (63%) at relatively young ages (mean 31 years, range 17-51 years). PRKG1 encodes type I cGMP-dependent protein kinase (PKG-1), which is activated upon binding of cGMP and controls SMC relaxation. Although the p.Arg177Gln alteration disrupts binding to the high-affinity cGMP binding site within the regulatory domain, the altered PKG-1 is constitutively active even in the absence of cGMP. The increased PKG-1 activity leads to decreased phosphorylation of the myosin regulatory light chain in fibroblasts and is predicted to cause decreased contraction of vascular SMCs. Thus, identification of a gain-of-function mutation in PRKG1 as a cause of thoracic aortic disease provides further evidence that proper SMC contractile function is critical for maintaining the integrity of the thoracic aorta throughout a lifetime.

  4. Momentary and wide aortic regurgitation as an indicator of aortic dissection.

    PubMed

    Inokuchi, Takafumi; Sasaki, Osamu; Nishioka, Toshihiko; Ito, Hiroyuki; Yoshimoto, Nobuo; Yamabi, Hideaki; Imanaka, Kazuhito; Sasaki, Hideki

    2017-03-01

    A 55-year-old female with a history of hypertension was admitted for dyspnea, epigastralgia and nausea. A chest X-ray showed pulmonary congestion. Transthoracic echocardiography (TTE) revealed severe left ventricular dysfunction with akinesis of the infero-posterior wall and Doppler color-flow mode showed mild aortic regurgitation (AR). Noninvasive positive pressure ventilation, intravenous heparin and diuretics were administered. Follow-up TTE revealed a dissection flap as well as momentary and wide AR only during isovolumetric relaxation. Contrast-enhanced computed tomography of the chest revealed Stanford type A aortic dissection. A momentary and wide AR in echocardiograms might serve as an important and useful indicator of aortic dissection in patients with acute myocardial infarction and congestive heart failure.

  5. Endovascular treatment of spontaneous isolated abdominal aortic dissection

    PubMed Central

    Giribono, Anna Maria; Ferrara, Doriana; Spalla, Flavia; Narese, Donatella; Bracale, Umberto; Pecoraro, Felice; Bracale, Renata; del Guercio, Luca

    2016-01-01

    Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible. PMID:27994881

  6. Acute aortic dissections with pregnancy in women with ACTA2 mutations.

    PubMed

    Regalado, Ellen S; Guo, Dong-chuan; Estrera, Anthony L; Buja, L Maximilian; Milewicz, Dianna M

    2014-01-01

    Mutations in ACTA2 predispose to thoracic aortic aneurysms and dissection as well as coronary artery and cerebrovascular disease. Here we examined the risk of aortic dissections, stroke and myocardial infarct with pregnancy in women with ACTA2 mutations. Of the 53 women who had a total of 137 pregnancies, eight had aortic dissections in the third trimester or the postpartum period (6% of pregnancies). One woman also had a myocardial infarct that occurred during pregnancy that was independent of her aortic dissection. Compared to the population-based frequency of peripartum aortic dissections of 0.6%, the rate of peripartum aortic dissections in women with ACTA2 mutations is much higher (8 out of 39; 20%). Six of these dissections initiated in the ascending aorta (Stanford type A), three were fatal. Three women had ascending aortic dissections at diameters less that 5.0 cm (range 3.8-4.7 cm). Aortic pathology showed mild to moderate medial degeneration of the aorta in three women. Of note, five of the women had hypertension either during or before the pregnancy. In summary, the majority of women with ACTA2 mutations did not have aortic or other vascular complications with pregnancy. However, these findings show that pregnancy is associated with significant risk for aortic dissection in women with ACTA2 mutations. Women with ACTA2 mutations who are planning to get pregnant should be counseled about this risk of aortic dissection, and proper clinical management should be initiated to reduce this risk.

  7. Modelling of aortic aneurysm and aortic dissection through 3D printing.

    PubMed

    Ho, Daniel; Squelch, Andrew; Sun, Zhonghua

    2017-03-01

    The aim of this study was to assess if the complex anatomy of aortic aneurysm and aortic dissection can be accurately reproduced from a contrast-enhanced computed tomography (CT) scan into a three-dimensional (3D) printed model. Contrast-enhanced cardiac CT scans from two patients were post-processed and produced as 3D printed thoracic aorta models of aortic aneurysm and aortic dissection. The transverse diameter was measured at five anatomical landmarks for both models, compared across three stages: the original contrast-enhanced CT images, the stereolithography (STL) format computerised model prepared for 3D printing and the contrast-enhanced CT of the 3D printed model. For the model with aortic dissection, measurements of the true and false lumen were taken and compared at two points on the descending aorta. Three-dimensional printed models were generated with strong and flexible plastic material with successful replication of anatomical details of aortic structures and pathologies. The mean difference in transverse vessel diameter between the contrast-enhanced CT images before and after 3D printing was 1.0 and 1.2 mm, for the first and second models respectively (standard deviation: 1.0 mm and 0.9 mm). Additionally, for the second model, the mean luminal diameter difference between the 3D printed model and CT images was 0.5 mm. Encouraging results were achieved with regards to reproducing 3D models depicting aortic aneurysm and aortic dissection. Variances in vessel diameter measurement outside a standard deviation of 1 mm tolerance indicate further work is required into the assessment and accuracy of 3D model reproduction. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

  8. Extensive Bilateral Extraluminal Perivascular Pulmonary Haemorrhage Associated with Stanford Type A Aortic Dissection

    PubMed Central

    Reid, Angeline; Stride, Peter; Hunter, Jonathan; Liew, Katerina; Wood, T.; Seleem, Mostafa

    2011-01-01

    We present the case of an 80-year old man with a Stanford Type A dissecting thoracic aortic aneurysm plus the unusual CT finding of extramural haemorrhage along the pulmonary vessels. The clinical and radiological picture has an extremely high mortality PMID:21860626

  9. Frozen Elephant Trunk and Antegrade Visceral Debranching in the Surgical Treatment of Type B Aortic Dissection: An Alternative Method

    PubMed Central

    Tuncer, Altug; Akbulut, Mustafa; Adademir, Taylan; Tas, Serpil; Ak, Adnan; Arslan, Özgür; Erden, Benay; Şişmanoğlu, Mesut

    2016-01-01

    Intervention is inevitable in complicated Type B aortic dissections. Classical surgical procedures and endovascular interventions are far from ideal treatments due to their high risk of periprocedural complications and mortality. There is often a need for alternative method in cases of difficult anatomy. We present the combined use of frozen elephant trunk and antegrade visceral debranching methods in the treatment of a 54-year-old male patient with complicated Type B aortic dissection. PMID:28516092

  10. Aortic Dissection in Patients With Genetically Mediated Aneurysms

    PubMed Central

    Weinsaft, Jonathan W.; Devereux, Richard B.; Preiss, Liliana R.; Feher, Attila; Roman, Mary J.; Basson, Craig T.; Geevarghese, Alexi; Ravekes, William; Dietz, Harry C.; Holmes, Kathryn; Habashi, Jennifer; Pyeritz, Reed E.; Bavaria, Joseph; Milewski, Karianna; LeMaire, Scott A.; Morris, Shaine; Milewicz, Dianna M.; Prakash, Siddharth; Maslen, Cheryl; Song, Howard K.; Silberbach, G. Michael; Shohet, Ralph V.; McDonnell, Nazli; Hendershot, Tabitha; Eagle, Kim A.; Asch, Federico M.

    2016-01-01

    BACKGROUND Aortic dissection (AoD) is a serious complication of thoracic aortic aneurysm (TAA). Relative risk for AoD in relation to TAA etiology, incidence, and pattern after prophylactic TAA surgery are poorly understood. OBJECTIVES This study sought to determine the incidence, pattern, and relative risk for AoD among patients with genetically associated TAA. METHODS The population included adult GenTAC participants without AoD at baseline. Standardized core laboratory tests classified TAA etiology and measured aortic size. Follow-up was performed for AoD. RESULTS Bicuspid aortic valve (BAV) (39%) and Marfan syndrome (MFS) (22%) were the leading diagnoses in the studied GenTAC participants (n = 1,991). AoD occurred in 1.6% over 3.6 ± 2.0 years; 61% of AoD occurred in patients with MFS. Cumulative AoD incidence was 6-fold higher among patients with MFS (4.5%) versus others (0.7%; p < 0.001). MFS event rates were similarly elevated versus those in patients with BAV (0.3%; p < 0.001). AoD originated in the distal arch or descending aorta in 71%; 52% of affected patients, including 68% with MFS, had previously undergone aortic grafting. In patients with proximal aortic surgery, distal aortic size (descending thoracic, abdominal aorta) was larger among patients with AoD versus those without AoD (both p < 0.05), whereas the ascending aorta size was similar. Conversely, in patients without previous surgery, aortic root size was greater in patients with subsequent AoD (p < 0.05), whereas distal aortic segments were of similar size. MFS (odds ratio: 7.42; 95% confidence interval: 3.43 to 16.82; p < 0.001) and maximal aortic size (1.86 per cm; 95% confidence interval: 1.26 to 2.67; p = 0.001) were independently associated with AoD. Only 4 of 31 (13%) patients with AoD had pre-dissection images that fulfilled size criteria for prophylactic TAA surgery at a subsequent AoD site. CONCLUSIONS Among patients with genetically associated TAA, MFS augments risk for AoD even after

  11. Dissection of Ascending Aorta After Aortic Valve Replacement and Reduction Aortoplasty.

    PubMed

    Hashmi, Maria; Dar, Mudasser Iqbal; Khan, Asad Ullah; Khan, Farhan; Khan, Abdul Bari

    2015-12-01

    A case of Debakey type-II (Stanford type-A) dissecting aortic aneurysm, after aortic valve replacement and reduction aortoplasty, is reported. The patient was 35 years male who was diagnosed of severe aortic regurgitation along with aortic root dilatation of 7 cm. He underwent aortic valve replacement with 27-ASt Jude's mechanical aortic valve along with reduction aortoplasty. Nine months later, he was admitted to our hospital with complaint of severe sudden anterior chest pain. Computed tomography with aortic enhancement showed dilatation and dissection of ascending aorta. Successful operation of aortic root replacement with composite graft was performed and patient was discharged without any postoperative complication. The aortic diameter at the time of aortic valve replacement is an independent risk factor for the late aortic dissection.

  12. Genetic Variants in LRP1 and ULK4 Are Associated with Acute Aortic Dissections.

    PubMed

    Guo, Dong-Chuan; Grove, Megan L; Prakash, Siddharth K; Eriksson, Per; Hostetler, Ellen M; LeMaire, Scott A; Body, Simon C; Shalhub, Sherene; Estrera, Anthony L; Safi, Hazim J; Regalado, Ellen S; Zhou, Wei; Mathis, Michael R; Eagle, Kim A; Yang, Bo; Willer, Cristen J; Boerwinkle, Eric; Milewicz, Dianna M

    2016-09-01

    Acute aortic dissections are a preventable cause of sudden death if individuals at risk are identified and surgically repaired in a non-emergency setting. Although mutations in single genes can be used to identify at-risk individuals, the majority of dissection case subjects do not have evidence of a single gene disorder, but rather have the other major risk factor for dissections, hypertension. Initial genome-wide association studies (GWASs) identified SNPs at the FBN1 locus associated with both thoracic aortic aneurysms and dissections. Here, we used the Illumina HumanExome array to genotype 753 individuals of European descent presenting specifically with non-familial, sporadic thoracic aortic dissection (STAD) and compared them to the genotypes of 2,259 control subjects from the Atherosclerosis Risk in Communities (ARIC) study matched for age, gender, and, for the majority of cases, hypertension. SNPs in FBN1, LRP1, and ULK4 were identified to be significantly associated with STAD, and these results were replicated in two independent cohorts. Combining the data from all cohorts confirmed an inverse association between LRP1 rs11172113 and STAD (p = 2.74 × 10(-8); OR = 0.82, 95% CI = 0.76-0.89) and a direct association between ULK4 rs2272007 and STAD (p = 1.15 × 10(-9); OR = 1.35, 95% CI = 1.23-1.49). Genomic copy-number variation analysis independently confirmed that ULK4 deletions were significantly associated with development of thoracic aortic disease. These results indicate that genetic variations in LRP1 and ULK4 contribute to risk for presenting with an acute aortic dissection.

  13. Endovascular Repair for Type A Aortic Dissection After Transcatheter Aortic Valve Replacement With a Medtronic CoreValve.

    PubMed

    Berfield, Kathleen K S; Sweet, Matthew P; McCabe, James M; Reisman, Mark; Mackensen, G Burkhard; Mokadam, Nahush A; Dean, Larry S; Smith, Jason W

    2015-10-01

    Transcatheter aortic valve replacement is being used with increasing frequency in patients with severe aortic stenosis who are otherwise deemed to be at high surgical risk. Aortic dissection is a rare complication of transcatheter aortic valve replacement and poses a unique management dilemma. We describe the treatment of an acute Stanford type A aortic dissection after transcatheter aortic valve replacement with a modified thoracic endovascular stent graft in a 95-year-old woman. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Type B Aortic Dissection: A Review of Prognostic Factors and Meta-analysis of Treatment Options Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

    PubMed Central

    Luebke, Thomas; Brunkwall, Jan

    2014-01-01

    According to international guidelines, stable patients with uncomplicated Type B aortic dissection (TBAD) should receive optimal medical treatment. Despite adequate antihypertensive therapy, the long-term prognosis of these patients is characterized by a significant aortic aneurysm formation in 25-30% within four years, and survival rates from 50 to 80% at five years and 30 to 60% at 10 years. In a prospective randomized trial, preemptive thoracic endovascular aortic repair (TEVAR) in patients with chronic uncomplicated TBAD was associated with an excess early mortality (due to periprocedural hazards), but the procedure showed its benefit in prevention of aortic-specific mortality at five years of follow-up. However, preemptive TEVAR may not be the treatment of choice in all patients with uncomplicated TBAD because of the inherent periprocedural complications like stroke, paraparesis, and death, as well as stent graft-induced complications (i.e., retrograde dissection or endoleaks). Thus, the TEVAR-related deaths and complications (especially paraplegia and stroke) raise concerns that moderate the better survival with TEVAR at five years. By timely identification of those patients prone for developing complications, early intervention, preferably in the subacute or early chronic phase, may improve the overall long-term outcome for these patients. Therefore, early detectable and reliable prognostic factors for adverse events are essential to stratify patients who can be treated medically and those who will benefit from rigorous follow-up and, in the long-term, from timely, or even prophylactic, TEVAR. Several studies have identified prognostic factors in TBAD such as aortic diameter, partial false lumen thrombosis, false lumen thickness, and location of the primary entry tear. Combining these clinical and radiological predictors may be essential to implement a patient-specific approach designed to intervene only in those patients who are at high risk of developing

  15. Hemorrhagic infiltration of the aortopulmonary adventitia: A complication of acute aortic dissection.

    PubMed

    Guilmette, J; Semionov, A; Dennie, C; Gahide, G; Pressacco, J; Fraser, R; Cordeau, M-P; Chartrand-Lefebvre, C

    2016-01-01

    Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute aortic dissection, most frequently Stanford type A. The radiological interpretation of this finding may be a diagnostic challenge. The objective of this multicenter case series is to review the radiological and pathological findings of hemorrhagic infiltration of the aortopulmonary adventitia secondary to acute aortic dissection, and to describe the pathophysiology underlying this complication. The study includes 20 cases of aortic dissection with hemorrhagic infiltration of the aortopulmonary adventitia. These are 17 cases with computed tomography (CT) data obtained from 5 academic centers. Three other cases were retrieved through a search of autopsy reports. Clinical, radiological and pathological data were collected. Linear foci of moderately increased attenuation were seen along the wall of the proximal pulmonary arteries in 4 cases on unenhanced CT. Contrast-enhanced CT showed soft-tissue thickening along these walls in all imaging cases, with some degree of narrowing of the lumen of the pulmonary arteries. Peribronchovascular ground-glass opacities or consolidation were present in 4 cases. Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute type A aortic dissection. The radiologist should be aware of its pathophysiology and imaging findings in order to make a prompt diagnosis in an urgent setting. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Factitious aortic dissection leading to thoracotomy in a 20-year-old man.

    PubMed

    Chambers, Elise; Yager, Joel; Apfeldorf, William; Camps-Romero, Eduardo

    2007-01-01

    A 20-year-old man presented to an emergency department with dramatic, sudden-onset, tearing chest pain. He also claimed to have been previously diagnosed with Ehler-Danlos syndrome and a previous Type I aortic dissection (intimal tear of ascending aorta), rapidly increasing his treating physician's suspicion of an emergent aortic dissection. The patient was quickly transferred to a large university hospital, where he underwent a median sternotomy and thoracotomy, with no aortic pathology found on operation and biopsy. After the patient's postoperative recovery, he was treated at a mental health facility, where he remained ambivalent about his psychiatric condition and did not respond well to treatment. This case report describes a unique case of factitious disorder that led to a serious operative intervention and subsequent psychiatric care and assesses factors that might have contributed to his hospital course.

  17. Long-term results of modified sandwich repair of aortic root in 151 patients with acute type A aortic dissection.

    PubMed

    Tang, Yangfeng; Liao, Zilin; Han, Lin; Tang, Hao; Song, Zhigang; Xu, Zhiyun

    2017-07-01

    Acute type A aortic dissection frequently induces aortic root disease; however, the optimal surgical strategy for aortic root dissection remains a challenge. The objective of this study was to introduce a novel technique for reconstruction of type A dissection to improve patient prognosis. We performed a retrospective review of 791 consecutive patients with acute type A aortic dissection between January 2003 and July 2015. Among these patients, 151 were selected (72% men, age 51.7 ± 9.8 years) to have the modified sandwich repair of aortic root dissection. The in-hospital mortality rate of the 151 patients was 6.6% (10/151). During a mean follow-up period of 52.7 ± 28.6 months, the survival rate was 100, 89.1 and 69.7% at 1, 5 and 10 years, respectively. Echocardiography and computed tomographic angiography were performed every year to monitor the pathological change in the aortic root. Freedom from severe aortic regurgitation at 5 years was 100%. No patients required reintervention due to dissection or pseudoaneurysm of the proximal aortic root. Aortic valve resuspension and repair of the sinus of Valsalva with the modified sandwich technique using Teflon felt strips for acute type A dissection could be reliable and effective.

  18. Early and late management of type B aortic dissection.

    PubMed

    Nienaber, Christoph A; Divchev, Dimitar; Palisch, Holger; Clough, Rachel E; Richartz, Barbara

    2014-10-01

    The management of type B aortic dissection is undergoing profound changes with timely TEVAR accepted as first-line strategy in the setting of complicated dissection; with recent technological advances and in experienced hands this intervention is considered safe and life-saving. With the ability to remodel the dissected aorta as a result of scaffolding even pre-emptive endovascular treatment is being considered and supported by long-term stability and often prevention of aneurysmal expansion. This insight and a growing number of silent risk conditions (resistant hypertension, partial false lumen thrombosis) may lower the threshold for TEVAR in asymptomatic patients in the subacute phase. In the chronic phase of a type B dissection patients are usually free of symptoms, however, with the expanding false lumen at risk of rupture. Advanced TEVAR options (including branches and fenestrations) are likely to be used more often than open surgical replacement of such aneurysmatic segment of the dissected aorta in that chronic phase. All dissection patients should be offered lifelong surveillance.

  19. A survival case of painless chronic type A aortic dissection with a history of stroke and anticoagulant use.

    PubMed

    Tugcu, Aylin; Yildirimturk, Ozlem; Demiroglu, I C Cemsid; Aytekin, Saide

    2010-10-01

    We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy.

  20. Hereditary Influence in Thoracic Aortic Aneurysm and Dissection.

    PubMed

    Isselbacher, Eric M; Lino Cardenas, Christian Lacks; Lindsay, Mark E

    2016-06-14

    Thoracic aortic aneurysm is a potentially life-threatening condition in that it places patients at risk for aortic dissection or rupture. However, our modern understanding of the pathogenesis of thoracic aortic aneurysm is quite limited. A genetic predisposition to thoracic aortic aneurysm has been established, and gene discovery in affected families has identified several major categories of gene alterations. The first involves mutations in genes encoding various components of the transforming growth factor beta (TGF-β) signaling cascade (FBN1, TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3 and SKI), and these conditions are known collectively as the TGF-β vasculopathies. The second set of genes encode components of the smooth muscle contractile apparatus (ACTA2, MYH11, MYLK, and PRKG1), a group called the smooth muscle contraction vasculopathies. Mechanistic hypotheses based on these discoveries have shaped rational therapies, some of which are under clinical evaluation. This review discusses published data on genes involved in thoracic aortic aneurysm and attempts to explain divergent hypotheses of aneurysm origin. © 2016 American Heart Association, Inc.

  1. Long-term durability of preserved aortic root after repair of acute type A aortic dissection.

    PubMed

    Kamohara, Keiji; Koga, Shugo; Takaki, Jun; Yoshida, Nozomi; Furukawa, Kojiro; Morita, Shigeki

    2017-08-01

    Optimal management of aortic root in type A aortic dissection (AAD) is controversial. To determine the most appropriate strategy, we studied the late outcomes after conservative repair of aortic root. 234 AAD patients (mean age 68 ± 12 years) underwent surgical repair using supracommissural replacement (SCR) for aortic root reconstruction from 1989 to 2014. Ascending aortic replacement or hemi-arch replacement was performed in 180 patients (non-arch group), whereas total arch replacement (TAR) was performed in 54 patients. In both groups, proper and firm reapproximation of proximal edge was performed exactly at the sinotubular junction (STJ). The long-term durability of preserved aortic root (mean follow-up 89 months) was evaluated. Hospital mortality occurred in 25 of 234 patients (10.6%). Aorta-related deaths occurred in five patients (four in non-arch; one in TAR), with over 90% 10-year actuarial survival rate in each group. Among 19 aorta-related events, there were only four proximal events (three in non-arch; one in TAR). The 10-year freedom rate from proximal aorta-related events exceeded 90%, with no significant difference in both groups. Freedom rate from moderate aortic regurgitation at 10 years was statistically similar between non-arch (86.3%) and TAR (85.7%) groups. The long-term durability of SCR with proximal aortic reapproximation exactly at the STJ was acceptable with low rates of proximal aortic events. This technique can be the standard technique for aortic root reconstruction in AAD patients, except those with aortic root pathology.

  2. Aortic Valve Pathology as a Predictive Factor for Acute Aortic Dissection.

    PubMed

    Berdajs, Denis; Mosbahi, Selim; Ferrari, Enrico; Charbonnier, Dominique; von Segesser, Ludwig K

    2017-10-01

    In this study, the effect of aortic valve (AV) pathology on local hemodynamic conditions was evaluated as a potential trigger for the onset of acute type A and B aortic dissection. A time- and pressure-related four-dimensional (4-D) computed fluid dynamic model of the aorta was established. In an experimental setup, AV stenosis and AV insufficiency were created. 4-D pressure-related geometry of the aortic root (AR) with valve insufficiency and valve stenosis were determined by high-fidelity (200 Hz) microsonometric crystals. Flow and pressure were obtained at the left ventricle, ascending aorta, and aortic arch. Expansion of the AR in AV insufficiency was higher with expansion in AV stenosis, at peak ejection, and at the end of systole. In AV insufficiency, there was low shear stress (0 to 0.6 Pa), turbulent flow, and high pressure (80 to 95 mm Hg) at the anterior wall of the ascending aorta, at the proximal aortic arch, and at the aortic isthmus. In stenosis, high shear stress (>2 Pa) and high pressure (>95 mm Hg) were found at the ascending aorta and at the bifurcation of the brachiocephalic trunk. In AV insufficiency, low shear stresses and turbulent flow regions were documented at the traditional levels of entry tears for acute type A and B dissection. In AV stenosis, high shear stress with elevated pressure at the ascending aorta may be a trigger element for vessel dilatation, aneurysm formation, and intimal tear, which is typical for type A aortic dissection. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. LOX Mutations Predispose to Thoracic Aortic Aneurysms and Dissections

    PubMed Central

    Guo, Dong-chuan; Regalado, Ellen S.; Gong, Limin; Duan, Xueyan; Santos-Cortez, Regie Lyn P.; Arnaud, Pauline; Ren, Zhao; Cai, Bo; Hostetler, Ellen M.; Moran, Rocio; Liang, David; Estrera, Anthony; Safi, Hazim J; Leal, Suzanne M.; Bamshad, Michael J.; Shendure, Jay; Nickerson, Deborah A.; Jondeau, Guillaume; Boileau, Catherine; Milewicz, Dianna M.

    2016-01-01

    Rationale Mutations in several genes have been identified that are responsible for approximately 25% of families with familial thoracic aortic aneurysms and dissections (TAAD). However, the causative gene remains unknown in 75% of families. Objectives To identify the causative mutation in families with autosomal dominant inheritance of TAAD. Methods and Results Exome sequencing was used to identify the mutation responsible for a large family with TAAD. A heterozygous rare variant, c.839G>T (p.Ser280Arg), was identified in LOX, encoding a lysyl oxidase, that segregated with disease in the family. Sanger and exome sequencing was performed to investigate mutations in candidate genes in an additional 410 probands from unrelated families. Additional LOX rare variants that segregated with disease in families were identified, including c.125G>A (p.Trp42*), c.604G>T (p.Gly202*), c.743C>T (p.Thr248Ile), c.800A>C (p.Gln267Pro), and c.1044T>A (p.Ser348Arg). The altered amino acids cause haploinsufficiency for LOX or are located at a highly conserved LOX catalytic domain, which is relatively invariant in the population. Expression of the LOX variants p.Ser280Arg and p.Ser348Arg had significantly lower lysyl oxidase activity when compared with the wild type protein. Individuals with LOX variants had fusiform enlargement of the root and ascending thoracic aorta, leading to ascending aortic dissections. Conclusions These data, along with previous studies showing the deficiency of LOX in mice or inhibition of lysyl oxidases in turkeys and rats causes aortic dissections, support the conclusion that rare genetic variants in LOX predispose to thoracic aortic disease. PMID:26838787

  4. Diagnostic implication of fibrin degradation products and D-dimer in aortic dissection

    NASA Astrophysics Data System (ADS)

    Dong, Jian; Duan, Xianli; Feng, Rui; Zhao, Zhiqing; Feng, Xiang; Lu, Qingsheng; Jing, Qing; Zhou, Jian; Bao, Junmin; Jing, Zaiping

    2017-03-01

    Fibrin degradation products (FDP) and D-dimer have been considered to be involved in many vascular diseases. In this study we aimed to explore the diagnostic implication of FDP and D-dimer in aortic dissection patients. 202 aortic dissection patients were collected as the case group, 150 patients with other cardiovascular diseases, including myocardial infarction (MI, n = 45), pulmonary infarction (n = 51) and abdominal aortic aneurysm (n = 54) were collected as non-dissection group, and 27 healthy people were in the blank control group. The FDP and D-dimer levels were detected with immune nephelometry. Logist regression analysis was performed to evaluate the influence of FDP and D-dimer for the aortic dissection patients. ROC curve was used to determine the diagnostic value of FDP and D-dimer. The FDP and D-dimer levels were significantly higher in aortic dissection patients than in non-dissection patients and the healthy controls. FDP and D-dimer were both the risk factors for patients with aortic dissection. From the ROC analysis, diagnostic value of FDP and D-dimer were not high to distinguish aortic dissection patients from the non-dissection patients. However FDP and D-dimer could be valuable diagnostic marker to differentiate aortic dissection patients and healthy controls with both AUC 0.863.

  5. Diagnostic implication of fibrin degradation products and D-dimer in aortic dissection

    PubMed Central

    Dong, Jian; Duan, Xianli; Feng, Rui; Zhao, Zhiqing; Feng, Xiang; Lu, Qingsheng; Jing, Qing; Zhou, Jian; Bao, Junmin; Jing, Zaiping

    2017-01-01

    Fibrin degradation products (FDP) and D-dimer have been considered to be involved in many vascular diseases. In this study we aimed to explore the diagnostic implication of FDP and D-dimer in aortic dissection patients. 202 aortic dissection patients were collected as the case group, 150 patients with other cardiovascular diseases, including myocardial infarction (MI, n = 45), pulmonary infarction (n = 51) and abdominal aortic aneurysm (n = 54) were collected as non-dissection group, and 27 healthy people were in the blank control group. The FDP and D-dimer levels were detected with immune nephelometry. Logist regression analysis was performed to evaluate the influence of FDP and D-dimer for the aortic dissection patients. ROC curve was used to determine the diagnostic value of FDP and D-dimer. The FDP and D-dimer levels were significantly higher in aortic dissection patients than in non-dissection patients and the healthy controls. FDP and D-dimer were both the risk factors for patients with aortic dissection. From the ROC analysis, diagnostic value of FDP and D-dimer were not high to distinguish aortic dissection patients from the non-dissection patients. However FDP and D-dimer could be valuable diagnostic marker to differentiate aortic dissection patients and healthy controls with both AUC 0.863. PMID:28262748

  6. [Chronic type A aortic dissection associated with Turner syndrome; report of a case].

    PubMed

    Tanaka, Hideyuki; Kozaki, Tomofumi; Kume, Masazumi; Miyamoto, Shinji

    2014-12-01

    Aortic dissection is a critical but rare complication of Turner syndrome. This report describes a case of chronic aortic dissection in a patient with Turner syndrome. A 54-year-old woman, suffering from mild back pain for 1 month, was referred to our hospital with a diagnosis of Stanford type A chronic aortic dissection and a bicuspid aortic valve with moderate regurgitation. Computed tomography revealed aortic dissection, involving all arch branches, extending from the ascending to the abdominal aorta. The true lumen of the brachial artery was nearly obstructed by the thrombosed false lumen. Elective aortic arch repair and aortic valve replacement were successfully performed. The patient was diagnosed with 45, XO Turner syndrome after surgery. Taking aortopathy of Turner syndrome into consideration, surveillance of the residual aorta was performed. No rapidly progressive dilatation of the residual aorta was detected during the 6 years' follow-up.

  7. Heparin-Induced-Thrombocytopenia Causing Massive Aortic Thrombosis after Ascending Aortic Replacement for Type A Acute Aortic Dissection

    PubMed Central

    Imoto, Kiyotaka; Uchida, Keiji; Isoda, Susumu; Karube, Norihisa; Yasuda, Shota; Masuda, Munetaka

    2016-01-01

    A 77-year-old woman underwent emergency ascending aortic replacement for type A acute aortic dissection. Fifteen days after the operation, she had motor and sensory disturbances in the lower limbs. Computed tomography revealed multiple aortic thrombi and disrupted blood flow in the right external iliac and left common iliac arteries. She underwent an emergency thrombectomy for acute limb ischemia. Because heparin- induced-thrombocytopenia (HIT) was suspected to have caused the multiple aortic thrombi, we postoperatively changed the anticoagulant therapy from heparin to argatroban. Seventeen days after the first operation, gastrointestinal bleeding developed, and the patient died of mesenteric ischemia caused by HIT. Arterial embolization caused by HIT after cardiovascular surgery is a rare, but fatal event. To avoid fatal complications, early diagnosis and early treatment are essential. Use of a scoring system would probably facilitate early diagnosis. PMID:26780951

  8. Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management.

    PubMed

    Sayer, D; Bratby, M; Brooks, M; Loftus, I; Morgan, R; Thompson, M

    2008-11-01

    The study aimed to define early clinical outcomes, and medium term morphological changes, following endovascular treatment of acute (AAD) and chronic (CAD) Type B aortic dissections. The cohort comprised 78 patients who underwent endovascular repair for AAD (38) and CAD (40). Early and late clinical outcomes were prospectively recorded. All patients underwent serial follow up with CT scanning. False lumen thrombosis rates, true, false and total aortic short axis diameter were recorded at the mid point of the endograft and below this level in the thoracic aorta. The total maximum aortic diameter in the thoracic, abdominal aorta was quantified. The 30-d mortality was 2.6% in AAD and 7.5% in CAD. The 30-d stroke and paraplegia rates were 5.3% and 0% in AAD. There were no cases of stroke or paraplegia in patients with CAD. At 30 months follow up, the cumulative survival for the two groups was 93% for AAD and 66.5% for CAD (P=0.015, Kaplan Meier) and the cumulative re-intervention rate was 62% and 55% in AAD and CAD respectively (P=0.961, Kaplan-Meier). False lumen thrombosis rates were equivalent in the two groups and were higher at the level of the endograft than below this level (P<0.05). Aortic remodelling was greater in AAD, whereas the aortic dimensions after treatment of CAD remained relatively static. Up to 20% of patients in both groups demonstrated enlargement of the thoracic aorta. The data support the use of endovascular repair of the thoracic aorta in Type B aortic dissection. 30-d outcomes are acceptable. Patients with AAD demonstrate significant aortic remodelling whereas patients with CAD do not. This has significant implications for practice as patients with CAD must rely on maintenance of false lumen thrombosis to preserve the integrity of the endovascular repair.

  9. Evolving strategies for treatment of acute aortic dissection type A.

    PubMed

    Kallenbach, Klaus; Oelze, Timm; Salcher, Rolf; Hagl, Christian; Karck, Matthias; Leyh, Rainer G; Haverich, Axel

    2004-09-14

    To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA). Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending aorta was applied to 145 pts, 64 pts received a composite replacement (comp), and 48 pts were treated with the aorta valve-sparing (AVS) reimplantation technique. Pts in SCR were older compared with AVS and comp (P=0.002), gender (overall 65% male, P=0.143) and presence of Marfan syndrome (overall 5%, P=0.109) were comparable. Cannulation of the aorta was performed more often in AVS (58%) than in comp (19%) or SCR (22%; P<0.001). Mean operation time, extracorporeal circulation time, and aortic cross-clamp time differ significantly between groups (P<0.001, respectively). Stay in the intensive care unit (P=0.12) and time of hospitalization (P=0.32) were comparable. Overall perioperative mortality was 24% and did not show significant differences between groups (AVS 10.4% versus comp 28% versus SCR 26%; P=0.053). Incidence of neurological complications was similar between groups (P=0.95). Mean time of follow-up was shorter for AVS (19+/-20 months) compared with comp (48+/-48 months) and SCR (46+/-45 months). Survival at 5 years was comparable with 89% for AVS, 85% for comp, and 80% for SCR (P=0.61). Two patients from AVS (4.1%) required reoperation for failure of the reconstructed valve. Pts in comp required less aortic reoperations than pts in SCR (comp 6.3% versus SCR 22%; P=0.005). In acute aortic dissection type A, the reimplantation technique leads to results comparable to established techniques. Complete removal of diseased tissue, low incidence of reoperation, and lack of anticoagulation may favor this approach in selected patients.

  10. Thoracic aortitis and aortic dissection following pegfilgrastim administration.

    PubMed

    Sato, Yuki; Kaji, Shuichiro; Ueda, Hiroyuki; Tomii, Keisuke

    2017-05-26

    The patient was a 67-year-old woman with a history of advanced lung adenocarcinoma. Eight days after pegfilgrastim administration, her computed tomography scan revealed thickened bilateral common carotid arteries and thoracic aorta, which led to the diagnosis of pegfilgrastim-associated aortitis. Thirty-six days after pegfilgrastim administration, asymptomatic Stanford type B aortic dissection was detected. Her serum biomarker analysis suggested that interleukin-6 might be involved in the pathogenesis. Physicians should be aware of these adverse effects of filgrastim. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Twins with progressive thoracic aortic aneurysm, recurrent dissection and ACTA2 mutation.

    PubMed

    Ware, Stephanie M; Shikany, Amy; Landis, Benjamin J; James, Jeanne F; Hinton, Robert B

    2014-10-01

    Thoracic aortic aneurysm (TAA) is a genetically mediated disease with variable age of onset. In the pediatric age range, nonsyndromic TAA frequently has a milder course than syndromic forms of TAA, such as Marfan syndrome or Loeys-Dietz syndrome. Herein, we describe 17-year-old identical twin brothers with severe progressive TAA due to a novel de novo ACTA2 mutation. Interestingly, both boys were diagnosed at age 11 with congenital mydriasis, a recently recognized manifestation of some ACTA2 mutations due to smooth muscle dysfunction. One of the brothers presented with acute-onset lower back pain that was identified as dissection of an abdominal aortic aneurysm. Imaging of the chest at this time showed severe fusiform TAA. Cardiac imaging in his twin showed similar TAA, but no abdominal aortic aneurysm. Both brothers underwent valve-sparing aortic root replacement, but have had progressive aortic disease with recurrent dissection requiring multiple surgeries. This case emphasizes the importance of identifying physical stigmata of smooth muscle dysfunction, such as mydriasis, as potential markers for associated aortopathy and vascular diseases. Copyright © 2014 by the American Academy of Pediatrics.

  12. Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.

    PubMed

    Tsukube, Takuro; Haraguchi, Tomonori; Okada, Yasushi; Matsukawa, Ritsu; Kozawa, Shuichi; Ogawa, Kyoichi; Okita, Yutaka

    2014-09-01

    The management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent rate of recovery of consciousness provided aortic repair was performed within 5 hours of the onset of symptoms. This study evaluates the early and long-term outcomes using this approach. Between August 2003 and July 2013, of the 241 patients with acute type A aortic dissection brought to the Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, 30 (12.4%) presented with coma; Glasgow Coma Scale was less than 11 on arrival. Surgery was performed in 186 patients, including 27 (14.5%) who were comatose. Twenty-four comatose patients underwent successful aortic repair immediately (immediate group). Their mean age was 71.0 ± 11.1 years, Glasgow Coma Scale was 6.5 ± 2.4, and prevalence of carotid dissection was 79%. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative induced hypothermia was performed. Neurologic evaluations were performed using the Glasgow Coma Scale, National Institutes of Health Stroke Scale, and modified Rankin Scale. In the immediate group, the time from the onset of symptoms to arrival in the operating theater was 222 ± 86 minutes. Hospital mortality was 12.5%. Full recovery of consciousness was achieved in 79% of patients in up to 30 days. Postoperative Glasgow Coma Scale and National Institutes of Health Stroke Scale improved significantly when compared with the preoperative score (P < .05), and postoperative activities of daily living independence (modified Rankin Scale <3) was achieved in 50% of patients. The mean follow-up period was 56.5 months, and the cumulative survival was 48.2% after 10 years. Cox proportional hazards regression analysis indicated that immediate repair (hazard ratio, 4.3; P = .007) was the only significant predictor of postoperative survival over a 5-year period. The early and long-term outcomes as a result of immediate aortic

  13. Chronic type B aortic dissection in association with Hemolyticuremic syndrome in a child

    PubMed Central

    Gera, D. N.; Ghuge, P. P.; Gandhi, S.; Vanikar, A. V.; Shrimali, J. D.; Kute, V. B.; Trivedi, H. L.

    2013-01-01

    Aortic dissection (AD) is a potentially life-threatening medical emergency usually encountered in the elderly. Here, we report a 9-year-old child who was incidentally detected to have asymptomatic chronic type B dissecting aneurysm of aorta when he presented with relapse of Hemolytic uremic syndrome (HUS) without any genetic abnormalities like Marfan or Ehler-Danlos syndrome. To the best of our knowledge, this is the first case of AD associated with HUS in a child without any known associated genetic or inherited risk factors. PMID:24339527

  14. Chronic type B aortic dissection in association with Hemolyticuremic syndrome in a child.

    PubMed

    Gera, D N; Ghuge, P P; Gandhi, S; Vanikar, A V; Shrimali, J D; Kute, V B; Trivedi, H L

    2013-11-01

    Aortic dissection (AD) is a potentially life-threatening medical emergency usually encountered in the elderly. Here, we report a 9-year-old child who was incidentally detected to have asymptomatic chronic type B dissecting aneurysm of aorta when he presented with relapse of Hemolytic uremic syndrome (HUS) without any genetic abnormalities like Marfan or Ehler-Danlos syndrome. To the best of our knowledge, this is the first case of AD associated with HUS in a child without any known associated genetic or inherited risk factors.

  15. Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

    PubMed Central

    Weiss, Andrew S; Ludkowski, Michael; Parikh, Chirag R

    2004-01-01

    Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD). Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L) on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population. PMID:15125782

  16. Acute Aortic Dissections with Pregnancy in Women with ACTA2 Mutations

    PubMed Central

    Regalado, Ellen S.; Guo, Dong-chuan; Estrera, Anthony L.; Buja, L. Maximilian; Milewicz, Dianna M.

    2014-01-01

    Mutations in ACTA2 predispose to thoracic aortic aneurysms and dissections as well as coronary artery and cerebrovascular disease. Here we examined the risk of aortic dissections, stroke and myocardial infarct with pregnancy in women with ACTA2 mutations. Of the 53 women who had a total of 137 pregnancies, eight had aortic dissections in the third trimester or the postpartum period (6% of pregnancies). One woman also had a myocardial infarct that occurred during pregnancy that was independent of her aortic dissection. Compared to the population-based frequency of peripartum aortic dissections of 0.6%, the rate of peripartum aortic dissections in women with ACTA2 mutations is much higher (8 out of 39; 20%). Six of these dissections initiated in the ascending aorta (Stanford type A), three of which were fatal. Three women had ascending aortic dissections at diameters less that 5.0 cm (range 3.8 to 4.7 cm). Aortic pathology showed mild to moderate medial degeneration of the aorta in three women. Of note, five of the women had hypertension either during or before the pregnancy. In summary, the majority of women with ACTA2 mutations did not have aortic or other vascular complications with pregnancy. However, these findings show that pregnancy is associated with significant risk for aortic dissections in women in whom diagnosis of ACTA2 mutation has not been made. Women with ACTA2 mutations who are planning to get pregnant should be counseled about this risk of aortic dissections, and proper clinical management should be initiated to reduce this risk. PMID:24243736

  17. Aortic dissection and Turner's syndrome: case report and review of the literature.

    PubMed

    Bordeleau, L; Cwinn, A; Turek, M; Barron-Klauninger, K; Victor, G

    1998-01-01

    Cardiovascular abnormalities are frequently encountered in patients with Turner's syndrome. These include coarctation of the aorta, aortic root dilatation, bicuspid aortic valve, atrial and ventricular septal defects. Aortic dissection is a rare but devastating complication of Turner's syndrome that usually occurs in adulthood. We report a case of Turner's syndrome with coarctation of the aorta and chronic aortic dissection, and review the relevant literature. There have been 21 prior reported cases of aortic dissection in patients with Turner's syndrome. Possible etiologic factors contributing to the occurrence of aortic dissection in this syndrome are protean. They include the presence of cystic medial necrosis, coarctation of the aorta, bicuspid aortic valve, aortic root dilatation, and hypertension, although cases of aortic dissection and Turner's syndrome have been described in patients without any risk factors. As our knowledge of the natural history of congenital heart defects and risk factors for aortic dissection in Turner's syndrome is limited, periodic cardiac evaluation of these patients may be warranted. Early recognition and treatment of this potentially lethal complication of Turner's syndrome is essential.

  18. Successful staged operation for acute type A aortic dissection with paraplegia.

    PubMed

    Ando, Takashi; Abe, Hiroyuki; Nagata, Tokuichiro; Makuuchi, Haruo

    2013-06-01

    A 75-year-old man presented with both paraplegia and acute occlusion of the abdominal aorta at onset. Extraanatomical bypass was performed following spinal drainage. After 3 days, the ascending aorta replaced under cardiopulmonary bypass using the extraanatomical bypass graft for arterial cannulation. The abdominal aorta was replaced after 6 months. A staged operation is one of the options for acute aortic dissection with paraplegia and acute occlusion of the abdominal aorta.

  19. [Post-cesarean acute aortic dissection in a Marfan syndrome patient].

    PubMed

    Onofriescu, M; Gavriluţ, Maria; Tinică, G; Diaconescu, V; Holicov, Monica; Radu, E; Aldea, Marie-Jeanne

    2007-01-01

    Marfan syndrome is an uncommon condition in pregnancy. We present the case of 37 years old gravida 1, para 1 with Marfan syndrome. She delivered at term by cesarean section, a healthy male infant weighing 3500 grams with Apgar's of 9. During the postoperative period she developed aortic dissection and was referred to the Cardiovascular Surgery Department. We described such a case and the difficult decisions that we faced.

  20. Carotid Ultrasonography Can Identify Stroke Patients Ineligible for Intravenous Thrombolysis Therapy due to Acute Aortic Dissection.

    PubMed

    Hama, Yuka; Koga, Masatoshi; Tokunaga, Keisuke; Takizawa, Hotake; Miyashita, Kotaro; Iba, Yutaka; Toyoda, Kazunori

    2015-01-01

    Acute aortic dissection is the most common acute aortic condition requiring urgent surgical therapy. Due to lack of typical symptoms, it is sometimes difficult to identify acute aortic dissection causing ischemic stroke. We report a case of a patient with acute ischemic stroke who was deemed ineligible for intravenous recombinant tissue plasminogen activator treatment based on a finding of acute aortic dissection detected by carotid ultrasonography. After urgent aortic replacement surgery, the patient recovered with no neurological deficit. This case underscores the crucial role of carotid ultrasonography for the investigation of possible underlying acute aortic dissection when considering the use of intravenous recombinant tissue plasminogen activator therapy for hyperacute stroke. Copyright © 2014 by the American Society of Neuroimaging.

  1. Successes and challenges of using whole exome sequencing to identify novel genes underlying an inherited predisposition for thoracic aortic aneurysms and acute aortic dissections.

    PubMed

    Milewicz, Dianna M; Regalado, Ellen S; Shendure, Jay; Nickerson, Deborah A; Guo, Dong-chuan

    2014-02-01

    Thoracic aortic aneurysms involving the aortic root and/or ascending aorta can lead to acute aortic dissections. Approximately 20% of patients with thoracic aortic aneurysms and dissections (TAAD) have a family history of the disease, referred to as familial TAAD (FTAAD) that can be inherited in an autosomal dominant manner with variable expression with respect to disease presentation, age of onset and associated features. Whole exome sequencing (WES) has been used to identify causative mutations in novel genes for TAAD. The strategy used to reduce the large number of rare variants identified using WES is to sequence distant relatives with TAAD and filter for heterozygous rare variants that are shared between the relatives, predicted to disrupt protein function and segregate with the TAAD phenotype in other family members. Putative genes are validated by identifying additional families with a causative mutation in the genes. This approach has successfully identified novel genes for FTAAD.

  2. Successes and Challenges of Using Whole Exome Sequencing to Identify Novel Genes Underlying an Inherited Predisposition for Thoracic Aortic Aneurysms and Acute Aortic Dissections

    PubMed Central

    Milewicz, Dianna M.; Regalado, Ellen; Shendure, Jay; Nickerson, Deborah A.; Guo, Dongchuan

    2013-01-01

    Thoracic aortic aneurysms involving the aortic root and/or ascending aorta can lead to acute aortic dissections. Approximately 20% of patients with thoracic aortic aneurysms and dissections (TAAD) have a family history of the disease, referred to as familial TAAD (FTAAD), which can be inherited in an autosomal dominant manner with variable expression with respect to disease presentation, age of onset and associated features. Whole exome sequencing (WES) has been used to identify causative mutations in novel genes for TAAD. The strategy used to reduce the large number of rare variants identified using WES is to sequence distant relatives with TAAD and filter for heterozygous rare variants that are shared between the relatives, predicted to disrupt protein function and segregate with the TAAD phenotype in other family members. Further validation of putative genes by sequencing of additional families with TAAD has successfully identified novel genes for FTAAD. PMID:23953976

  3. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    PubMed

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  4. Type-A acute aortic dissection: combined operation plus stent management.

    PubMed

    Roux, Daniel; Brouchet, Laurent; Concina, Philippe; Elghobary, Tamer; Glock, Yves; Fournial, Gérard

    2002-05-01

    When the port of entry of acute type-A aortic dissection is at the level of the horizontal portion of the aortic arch, the latter should be replaced by a prosthesis. To avoid performing this difficult procedure in an emergency situation, we place a stent in the aortic arch. Then we replace the ascending aorta by a prosthesis.

  5. Modified 'candy-plug' technique for chronic type B aortic dissection with aneurysmal dilatation: a case report.

    PubMed

    Kotani, Sohsyu; Inoue, Yoshito; Kasai, Mio; Suzuki, Satoru; Hachiya, Takashi

    2017-09-05

    The original 'candy-plug' technique has been reported to be beneficial for the treatment of residual perfused false lumen in patients with aortic dissection. However, this technique is also associated with several problems, such as narrowing of the true lumen and damage to the flap or vessel wall. Therefore, we modified the procedure to overcome these problems. Here we report a case in which the patient was successfully treated using the modified procedure. A 59-year-old man presented with chronic type B aortic dissection with aneurysmal dilatation. The patient had undergone prosthetic graft replacement of the ascending aorta for acute type A aortic dissection 3 years previously and replacement of the descending aorta for residual type B aortic dissection with aneurysmal dilatation 1 year previously. After these procedures, the residual false lumen aneurysm of the distal descending aorta expanded to 57-mm in diameter. Endovascular stent grafting was successfully performed using the modified 'candy-plug' technique with relining of the true lumen and occlusion of the false lumen. The patient was discharged 10 days after the procedure. Follow-up imaging at 1 year showed a completely thrombosed false lumen aneurysm. The modified 'candy-plug' technique is useful for treatment of residual type B aortic dissection with aneurysmal dilatation.

  6. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature.

    PubMed

    Smith, Katherine; Gros, Bernard

    2017-04-02

    A well-established association exists between acute aortic dissection and pregnancy, particularly in women with Marfan syndrome. However, there is debate regarding appropriate management guidelines. In particular, there are differing opinions regarding when prophylactic aortic root repair should be recommended as well as the efficacy of beta blockers in this clinical scenario. The current study evaluated 10 years of published literature (2005-2015) in the PubMed/Medline database. Fifty articles, describing 72 cases of women who presented with aortic dissection in the antepartum or postpartum period were identified. Comparisons on demographic variables and clinical outcomes between cases of women with Marfan syndrome (n = 36) and without Marfan syndrome (n = 36) were conducted. There were no significant differences in demographics (age, gravidity, parity) between the Marfan and non-Marfan cases. Marfan patients presented with antepartum dissections significantly earlier in pregnancy than those without Marfan syndrome (P = .002). However, there were no significant difference between the 2 groups in maternal mortality, fetal mortality, or obstetric outcomes (mode of delivery and gestational age at delivery). Eight cases described events in Marfan women with an aortic root diameter ≤40 mm. Six events occurred in Marfan women who were managed with beta blockers. Current guidelines rely on aortic root diameter for stratification of Marfan women into risk categories, but we identified several cases that would be missed by these guidelines. Specifically, the existing literature suggest that women with Marfan syndrome should take precautions throughout pregnancy, rather than the third trimester.

  7. Cocaine induces apoptosis in primary cultured rat aortic vascular smooth muscle cells: possible relationship to aortic dissection, atherosclerosis, and hypertension.

    PubMed

    Su, Jialin; Li, Jianfeng; Li, Wenyan; Altura, Bella; Altura, Burton

    2004-01-01

    Cocaine abuse is known to induce many adverse cardiovascular effects, including hypertension, atherosclerosis, and aortic dissection. A major physiological event leading to these pathophysiological actions of cocaine could be apoptosis. This study was designed to investigate if primary cultured rat aortic vascular smooth muscle cells (VSMCs) can undergo apoptosis when treated with cocaine. After treatment with cocaine (10(-6) to 10(-4) M), morphological analysis of aortic VSMCs using confocal fluoresence microscopy showed that the percentage of apoptotic aortic VSMCs increased after cocaine (10(-6) to 10(-4) M) treatment for 12, 24, and 48 h. These results demonstrate that aortic VSMCs can undergo rapid apoptosis in response to cocaine in a concentration-dependent manner. Cocaine-induced apoptosis may thus play a major role in cocaine abuse-induced aortic dissection, atherosclerosis, and hypertension.

  8. Aortic Disease in the Young: Genetic Aneurysm Syndromes, Connective Tissue Disorders, and Familial Aortic Aneurysms and Dissections

    PubMed Central

    Cury, Marcelo; Zeidan, Fernanda; Lobato, Armando C.

    2013-01-01

    There are many genetic syndromes associated with the aortic aneurysmal disease which include Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), Loeys-Dietz syndrome (LDS), familial thoracic aortic aneurysms and dissections (TAAD), bicuspid aortic valve disease (BAV), and autosomal dominant polycystic kidney disease (ADPKD). In the absence of familial history and other clinical findings, the proportion of thoracic and abdominal aortic aneurysms and dissections resulting from a genetic predisposition is still unknown. In this study, we propose the review of the current genetic knowledge in the aortic disease, observing, in the results that the causative genes and molecular pathways involved in the pathophysiology of aortic aneurysm disease remain undiscovered and continue to be an area of intensive research. PMID:23401778

  9. Analysis of flow patterns in a patient-specific aortic dissection model.

    PubMed

    Cheng, Z; Tan, F P P; Riga, C V; Bicknell, C D; Hamady, M S; Gibbs, R G J; Wood, N B; Xu, X Y

    2010-05-01

    Aortic dissection is the most common acute catastrophic event affecting the thoracic aorta. The majority of patients presenting with an uncomplicated type B dissection are treated medically, but 25% of these patients develop subsequent aneurysmal dilatation of the thoracic aorta. This study aimed at gaining more detailed knowledge of the flow phenomena associated with this condition. Morphological features and flow patterns in a dissected aortic segment of a presurgery type B dissection patient were analyzed based on computed tomography images acquired from the patient. Computational simulations of blood flow in the patient-specific model were performed by employing a correlation-based transitional version of Menter's hybrid k-epsilon/k-omega shear stress transport turbulence model implemented in ANSYS CFX 11. Our results show that the dissected aorta is dominated by locally highly disturbed, and possibly turbulent, flow with strong recirculation. A significant proportion (about 80%) of the aortic flow enters the false lumen, which may further increase the dilatation of the aorta. High values of wall shear stress have been found around the tear on the true lumen wall, perhaps increasing the likelihood of expanding the tear. Turbulence intensity in the tear region reaches a maximum of 70% at midsystolic deceleration phase. Incorporating the non-Newtonian behavior of blood into the same transitional flow model has yielded a slightly lower peak wall shear stress and higher maximum turbulence intensity without causing discernible changes to the distribution patterns. Comparisons between the laminar and turbulent flow simulations show a qualitatively similar distribution of wall shear stress but a significantly higher magnitude with the transitional turbulence model.

  10. Reversible cerebral vasoconstriction syndrome with multivessel cervical artery dissections and a double aortic arch.

    PubMed

    Nouh, Amre; Ruland, Sean; Schneck, Michael J; Pasquale, David; Biller, José

    2014-02-01

    Reversible cerebral vasoconstriction syndrome (RCVS) has been associated with exposure to vasoactive substances and few reports with cervical arterial dissections (CADs). We evaluated a 32-year-old woman with history of depression, migraines without aura, and cannabis use who presented with a thunderclap headache unresponsive to triptans. She was found to have bilateral occipital infarcts, bilateral extracranial vertebral artery dissections, bilateral internal carotid artery dissecting aneurysms, and extensive distal multifocal segmental narrowing of the anterior and posterior intracranial circulation with a "sausage on a string-like appearance" suggestive of RCVS. Subsequently, she was found to have a distal thrombus of the basilar artery, was anticoagulated, and discharged home with no residual deficits. We highlight the potential association of CADs and RCVS. The association of RCVS and a double aortic arch has not been previously reported. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Thoracic endovascular repair for acute type A aortic dissection: operative technique

    PubMed Central

    Shah, Aamir

    2016-01-01

    Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair. New endovascular devices and advanced image-guided procedures are continually evolving. This article summarizes the pathology of aortic dissection and focuses on currently available endovascular solutions for transapical and transfemoral stent graft deployment for acute aortic dissection involving the ascending aorta for selected patients who are ineligible for open surgical repair. PMID:27563553

  12. Computational Biomechanics in Thoracic Aortic Dissection: Today's Approaches and Tomorrow's Opportunities.

    PubMed

    Doyle, Barry J; Norman, Paul E

    2016-01-01

    Dissection of an artery is characterised by the separation of the layers of the arterial wall causing blood to flow within the wall. The incidence rates of thoracic aortic dissection (AoD) are increasing, despite falls in virtually all other manifestations of cardiovascular disease, including abdominal aortic aneurysm (AAA). Dissections involving the ascending aorta (Type A) are a medical emergency and require urgent surgical repair. However, dissections of the descending aorta (Type B) are less lethal and require different clinical management whereby the patient may not be offered surgery unless complicating factors are present. But how do we tell if a patient will develop a complication later on? Currently, there is no consensus and the evidence base is limited. There is an opportunity for computational biomechanics to help clinicians decide as to which cases to repair and which to manage with blood pressure control. In this review article, we look at AoD from both the clinical and biomechanical perspective and discuss some of the recent computational studies of both Type A and B AoD. We then focus more on Type B where the real opportunity for patient-specific modelling exists. Finally, we look ahead at some of the promising areas of research that may help clinicians improve the decision-making process surrounding Type B AoD.

  13. [Pre- and postoperative imaging of type B aortic dissection].

    PubMed

    Ohana, M; Labani, A; Georg, Y; Jeung, M-Y; Thaveau, F; Schwein, A; Karmonik, C; Bismuth, J; Chakfé, N; Roy, C

    2016-07-01

    Type B aortic dissections are serious diseases with a 60 to 80 % 5-year survival rate. Although typically managed with a medical treatment, surgery may be necessary in the acute/subacute or the chronic phase if significant complications are encountered. For these patients, CT angiography is the first-line imaging modality, used for indicating and preparing the surgical procedure as well as for follow-up. Physicians in charge of these patients should be familiar with the key reading points. Visceral malperfusion is the most common acute complication, while aneurysmal dilatation of the false lumen is the most common chronic complication, with surgical management generally indicated when the axial diameter of the aorta exceeds 55mm. Endovascular treatment tends to replace open surgery: it requires precise measurements and identification of the entry tear (contribution of 4D-MRA). Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Sympathetic hyperactivity and aortic sympathetic nerve sprouting in patients with thoracic aortic dissection.

    PubMed

    Zhipeng, Hu; Zhiwei, Wang; Lilei, Yu; Hao, Zhang; Hongbing, Wu; Zongli, Ren; Hao, Chen; Xiaoping, Hu

    2014-07-01

    To determine the yet unknown relation between thoracic aortic dissection (TAD) and sympathetic nervous system activity. Variables such as electrocardiography, blood pressure, respiratory activity, postganglionic muscle sympathetic nerve activity (MSNA), plasma norepinephrine, tyrosine hydroxylase-positive nerve fiber density, and growth-associated protein 43-positive nerve fiber density were detected and statistically analyzed. TAD Patients showed a significant lower R-R interval variance and higher blood pressure, heart rate, respiratory rate, MSNA, plasma norepinephrine (reflecting elevated sympathetic nervous system [SNS] activity), higher tyrosine hydroxylase, growth-associated protein 43-positive nerve fiber density (reflecting sympathetic sprouting and innervation) than those of the control group. In TAD patients, both overall and regional aortic SNS activities are elevated. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. [Impact of Patent False Lumen at the Descending Aorta after Total Aortic Replacement for Acute type A Aortic Dissection].

    PubMed

    Mogi, Kenji; Sakurai, Manabu; Nomura, Anan; Wakabayashi, Yutaka; Fujii, Masahiko; Takahara, Yoshiharu

    2016-04-01

    Acute type A aortic dissection remains one of the most challenging diseases facing cardiovascular surgeons. It is associated with high mortality and morbidity. However, prevention of disease process progression in the residual dissected aorta is an important aspect of the patient's long-term outcome. The aim of this study was to examine the impact of patent false lumen at the descending aorta after total arch replacement for acute type A aortic dissection. Between December 1994 and August 2014, a total of 145 patients underwent total arch replacement for acute type A aortic dissection. The hospital mortality was 5.5%.Of these 145 patients, 33 had patent false lumen at the descending aorta after surgery, and 94 had thrombosed false lumen. The perioperative variables and late results were statistically analyzed. The incidence of residual thoracic patent false lumen was 26.0%.No significant difference was observed in the cumulative survival rate between groups. The patent false lumen group was associated with significant higher risk of the descending aortic event than the thrombosed group. By multivariate analysis, younger age and non-resection of the primary tear were significant prospective factors for the patent false lumen at the descending aorta. The patent false lumen at the descending aorta was associated with the late aortic critical events after total arch replacement for aortic dissection.

  16. Endovascular Treatment of Thoracic Aortic Dissection: Hemodynamic Shear Stress Study

    NASA Astrophysics Data System (ADS)

    Tang, Yik Sau; Lai, Siu Kai; Cheng, Stephen Wing Keung; Chow, Kwok Wing

    2012-11-01

    Thoracic Aortic Dissection (TAD), a life threatening cardiovascular disease, occurs when blood intrudes into the layers of the aortic wall, creating a new artificial channel (the false lumen) beside the original true lumen. The weakened false lumen wall may expand, enhancing the risk of rupture and resulting in high mortality. Endovascular treatment involves the deployment of a stent graft into the aorta, thus blocking blood from entering the false lumen. Due to the irregular geometry of the aorta, the stent graft, however, may fail to conform to the vessel curvature, and would create a ``bird-beak'' configuration, a wedge-shaped domain between the graft and the vessel wall. Computational fluid dynamics analysis is employed to study the hemodynamics of this pathological condition. With the `beaking' configuration, the local hemodynamic shear stress will drop below the threshold of safety reported earlier in the literature. The oscillating behavior of the shear stress might lead to local inflammation, atherosclerosis and other undesirable consequences. Supported by the Innovation and Technology Fund of the Hong Kong Government.

  17. Plasma Amino Acid Profile in Patients with Aortic Dissection.

    PubMed

    Wang, Linlin; Liu, Sha; Yang, Wengang; Yu, Haitao; Zhang, Li; Ma, Ping; Wu, Peng; Li, Xue; Cho, Kenka; Xue, Song; Jiang, Baohong

    2017-01-10

    Aortic dissection (AD), a severe cardiovascular disease with the characteristics of high mortality, is lack of specific clinical biomarkers. In order to facilitate the diagnosis of AD, we investigated plasma amino acid profile through metabolomics approach. Total 33 human subjects were enrolled in the study: 11 coronary heart disease (CHD) patients without aortic lesion and 11 acute AD and 11 chronic AD. Amino acids were identified in plasma using liquid chromatography and mass spectrometry (LC-MS/MS), and were further subjected to multiple logistic regression analysis. The score plots of principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed clear discrimination of CHD patients with AD, acute AD or chronic AD patients, respectively. The contents of histidine, glycine, serine, citrate, ornithine, hydroxyproline, proline and sarcosine were significant different in acute AD patients comparing with CHD patients. The levels of citrate, GABA, glutamate and cysteine were significant different in chronic AD patients comparing with CHD patients. The contents of glutamate and phenylalanine were significant changed in acute AD patients comparing with chronic AD patients. Plasma aminograms were significantly altered in patients with AD comparing with CHD, especially in acute AD, suggesting amino acid profile is expected to exploit a novel, non-invasive, objective diagnosis for AD.

  18. Plasma Amino Acid Profile in Patients with Aortic Dissection

    PubMed Central

    Wang, Linlin; Liu, Sha; Yang, Wengang; Yu, Haitao; Zhang, Li; Ma, Ping; Wu, Peng; Li, Xue; Cho, Kenka; Xue, Song; Jiang, Baohong

    2017-01-01

    Aortic dissection (AD), a severe cardiovascular disease with the characteristics of high mortality, is lack of specific clinical biomarkers. In order to facilitate the diagnosis of AD, we investigated plasma amino acid profile through metabolomics approach. Total 33 human subjects were enrolled in the study: 11 coronary heart disease (CHD) patients without aortic lesion and 11 acute AD and 11 chronic AD. Amino acids were identified in plasma using liquid chromatography and mass spectrometry (LC-MS/MS), and were further subjected to multiple logistic regression analysis. The score plots of principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed clear discrimination of CHD patients with AD, acute AD or chronic AD patients, respectively. The contents of histidine, glycine, serine, citrate, ornithine, hydroxyproline, proline and sarcosine were significant different in acute AD patients comparing with CHD patients. The levels of citrate, GABA, glutamate and cysteine were significant different in chronic AD patients comparing with CHD patients. The contents of glutamate and phenylalanine were significant changed in acute AD patients comparing with chronic AD patients. Plasma aminograms were significantly altered in patients with AD comparing with CHD, especially in acute AD, suggesting amino acid profile is expected to exploit a novel, non-invasive, objective diagnosis for AD. PMID:28071727

  19. Hereditary Influence in Thoracic Aortic Aneurysm and Dissection

    PubMed Central

    Isselbacher, Eric M.; Cardenas, Christian Lacks Lino; Lindsay, Mark E.

    2016-01-01

    Thoracic aortic aneurysm (TAA) is a potentially life-threatening condition in that it places patients at risk for aortic dissection (AoD) or rupture. Nevertheless, our modern understanding of the pathogenesis of TAA is quite limited. A genetic predisposition to TAA has been established, and gene discovery in affected families has identified two major categories of gene alterations. The first involves mutations in genes encoding various components of the transforming growth factor beta (TGF-β) signaling cascade (FBN1, TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3 and SKI), and these conditions are known collectively as the TGF-β vasculopathies (TGFβVs). The second set of genes encodes components of the smooth muscle contractile apparatus (ACTA2, MYH11, MYLK, and PRKG1), a group termed the smooth muscle contraction vasculopathies (SMCVs). Mechanistic hypotheses based on these discoveries have shaped rational therapies, some of which are under clinical evaluation. This review will discuss published data on genes involved in TAA and attempt to explain divergent hypotheses of aneurysm etiology. PMID:27297344

  20. Hybrid repair of type A acute aortic dissections with the Lupiae technique: ten-year results.

    PubMed

    Esposito, Giampiero; Cappabianca, Giangiuseppe; Bichi, Samuele; Cricco, Antonio; Albano, Giovanni; Anzuini, Angelo

    2015-02-01

    Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. From 2003 to 2013, 89 patients with type A acute aortic dissections underwent replacement of the ascending aorta, the arch, and the rerouting of the neck vessels on the ascending aorta, creating a proximal Dacron landing zone for a completion with thoracic endovascular aortic repair if necessary. In-hospital mortality was 8.9%. In 16 patients, the false lumen healed spontaneously, whereas the remaining 65 patients underwent thoracic endovascular aortic repair. One patient died after thoracic endovascular aortic repair. Eighty patients were followed up. Complete thrombosis of the false lumen was obtained in 93.8% of patients. The median follow-up was 46 ± 35 months. Overall 8-year survival was 93.7% ± 5%, 100% for patients with spontaneously healed residual false lumen after just type A acute aortic dissection repair and 92.3% ± 7.7% for patients who underwent thoracic endovascular aortic repair after type A acute aortic dissection repair. In 10 years, 1 patient underwent a reoperation on the distal aorta (1.25%). The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  1. Surgical repair for acute type A aortic dissection in octogenarians.

    PubMed

    El-Sayed Ahmad, Ali; Papadopoulos, Nestoras; Detho, Faisal; Srndic, Edin; Risteski, Petar; Moritz, Anton; Zierer, Andreas

    2015-02-01

    Despite limited data, the necessity for immediate surgical intervention in octogenarians with acute type A aortic dissection (AAD) has recently been questioned because the surgical risk may outweigh its potential benefits. At the same time, evolving stent graft technologies are pushing in the market for pathology within the ascending aorta, even for treatment of AAD. Against this background, we analyzed our institutional experience in this patient cohort during the last 8 years. Between October 2005 and October 2013, 39 patients aged older than 80 years (82 ± 2 years) underwent surgical repair for AAD, of which 29 patients (74%) were men. Owing to patient age and comorbidities, we aimed to limit the operation to supracoronary hemiarch replacement whenever possible. Clinical data were prospectively entered into our institutional database. Late follow-up was 3.6 ± 2.8 years and was 100% complete. Hemiarch replacement was performed in 32 patients (82%), and full arch replacement was necessary in the remaining 7. In 31 patients (79%), the aortic root could be glued and reconstructed or remained untouched. The remaining 8 patients (21%) underwent the bio-Bentall procedure. Mean ventilation time was 46 ± 23 hours, and the intensive care unit stay was 5 ± 9 days. We observed new postoperative permanent neurologic deficits in 2 patients (5%) and transient neurologic deficits in 3 (8%). The 30-day mortality was 26% (n = 10). Kaplan-Meier estimates for late survival were 46% ± 16% at 5 years. Given the guidelines regarding the predicted risk of death in patients with untreated AAD, current data suggest a survival benefit with immediate open surgical intervention even in octogenarians. Similarly to the early days of transcatheter-based aortic valve implantation, open surgical reference data are warranted to set the bar for upcoming endovascular treatment of AAD in octogenarians. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  2. Iatrogenic Aortic Dissection During Left Subclavian Artery Stenting: Immediate Detection by Calcium Sign Under Fluoroscope

    SciTech Connect

    Wang, Yi-Chih Hwang, Juey-Jen; Lai, Ling-Ping; Tseng, Chuen-Den

    2011-02-15

    Calcified aorta with acute iatrogenic aortic dissection is a potential but rarely reported complication of subclavian or innominate artery intervention. We report a patient who developed aortic dissection during stenting for left subclavian artery. A newly developed 'calcium sign,' signifying displacement of the intimal calcification from the outer soft-tissue margin and which is traditionally recognized on chest radiograph, was detected by real-time fluoroscopy and served as the diagnostic clue. Type B aortic dissection was further confirmed by chest computed tomography.

  3. Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery.

    PubMed

    Cruz, Inês; Stuart, Bruno; Caldeira, Daniel; Morgado, Gonçalo; Gomes, Ana C; Almeida, Ana R; Loureiro, Maria J; João, Isabel; Cotrim, Carlos; Pereira, Hélder

    2015-04-01

    Cardiac tamponade has been reported in 18.7% of patients with acute type A aortic dissection and its presence is associated with worse outcomes. Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach. However, controversy surrounds how to manage patients with haemopericardium and cardiac tamponade who cannot survive until surgery. To describe a case series of patients with critical cardiac tamponade complicating aortic dissection admitted to a hospital without cardiothoracic surgery, and in whom preoperative controlled pericardial drainage was performed. Single centre retrospective study: during a nine-year period, 21 patients with Stanford type A aortic dissection were admitted at our centre; six of them (28.6%) presented clinical and echocardiographic signs of cardiac tamponade (four males; mean age 58±17 years). In this subgroup, controlled pericardiocentesis was safely performed with no major immediate complications and it was effective in five patients, improving haemodynamic instability and allowing transfer to the operating room. Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available. © The European Society of Cardiology 2014.

  4. Mosaic double aneuploidy (45,X/47,XX,+8) with aortic dissection.

    PubMed

    Lee, M N; Choi, K H; Kim, D K; Kim, S H

    2014-01-01

    Chromosomal aneuploidy is considerably frequent and may involve either autosomes or sex chromosomes. While double aneuploidy involving both autosomal and sex chromosomes is rare, several reports described the cases of sex chromosomal aneuploidies in combination with trisomy 21, such as Down-Klinefelter and Down-Turner syndrome. However, trisomy 8-Turner syndrome has been rarely described to date. Here we report a case of a 28-year-old female with mosaic trisomy 8-Turner syndrome. The patient was referred to our hospital for aortic dissection. On physical evaluation, features of her phenotype, which included short stature, webbed neck and cubitus valgus, suggested congenital anomalies such as Turner syndrome. Chest CT revealed aortic dissection with bicuspid aortic valve and coarctation. G-banding cytogenetic analysis of peripheral blood showed mosaicism with two cell lines (45,X[17]/47,XX,+8[33]). FISH analysis indicated that 15% of the cells were of monosomy X karyotype and 85% of the cells were with XX karyotype and trisomy 8 was detected only in XX cells. Though the patient exhibited clinical features of Turner syndrome, somatic stigmas present were not clearly distinguishable from those of trisomy 8, such as short stature, skeletal and cardiac abnormalities. Observations from most of the double aneuploidy cases indicated that the patient's phenotype was not necessarily in correlation to the ratio of autosomal and sex chromosomal aberrations. Mosaicism in trisomy 8-Turner syndrome was rarely documented and we believe this is the first reported case of mosaicism in trisomy 8-Turner syndrome presenting with aortic dissection and surviving into adulthood.

  5. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans

    PubMed Central

    Lee, Vivian S.; Halabi, Carmen M.; Hoffman, Erin P.; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G.; Bierhals, Andrew J.; Vuzman, Dana; Mecham, Robert P.; Frank, Natasha Y.; Stitziel, Nathan O.

    2016-01-01

    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause. PMID:27432961

  6. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans.

    PubMed

    Lee, Vivian S; Halabi, Carmen M; Hoffman, Erin P; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G; Bierhals, Andrew J; Vuzman, Dana; Mecham, Robert P; Frank, Natasha Y; Stitziel, Nathan O

    2016-08-02

    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause.

  7. Diagnostic value of multislice computerized tomography angiography for aortic dissection: A comparison with DSA

    PubMed Central

    Lu, Dong; Li, Cheng-Li; Lv, Wei-Fu; Ni, Ming; Deng, Ke-Xue; Zhou, Chun-Ze; Xiao, Jing-Kun; Zhang, Zhen-Feng; Zhang, Xing-Ming

    2017-01-01

    The aim of the present study was to compare multislice computed tomography angiography (MSCTA) and digital subtraction angiography (DSA) in the diagnosis of aortic dissection. In total, 49 patients with aortic lesions received enhanced computed tomography scanning, and three-dimensional (3D) images were reconstructed by volume rendering (VR), maximum intensity projection (MIP), multiplanar reformation (MPR) and curved planar reconstruction (CPR). The display rate of the entry tear site, intimal flap, true and false lumen from each reconstruction method was calculated. For 30 patients with DeBakey type III aortic dissection, the entry tear site and size of the first intimal flap, aortic maximum diameter at the orifice of left subclavian artery (LSCA), distance between the first entry tear site and the orifice of LSCA, and maximum diameter of aortic true and false lumens were measured prior to implantation of endovascular covered stent-grafts. Data obtained by MSCTA and DSA were then compared. For the entry tear site, MPR, CPR and VR provided a display rate of 95.92, 95.92 and 18.37%, respectively, and the display rate of the intimal flap was 100% in the three methods. MIP did not directly display the entry tear site and intimal flap. For true and false lumens, MPR, CPR, and VR showed a display rate of 100%, while MIP only provided a display rate of 67.35%. When MSCTA was compared with DSA, there was a significant difference in the display of entry site number and position (P<0.05), whereas no significant difference was shown in the measurement of aortic maximum diameter at the orifice of LSCA and the maximum diameter of true and false lumens (P>0.05). In conclusion, among the 3D post-processing reconstruction methods of MSCTA used, MPR and CPR were optimal, followed by VR, and MIP. MSCTA may be the preferable imaging method to diagnose aortic dissection and evaluate treatment of endovascular-covered stent-grafting, preoperatively. PMID:28352308

  8. Genetic testing in patients with aortic aneurysms/dissections: a novel genotype/phenotype correlation?

    PubMed

    Waldmüller, Stephan; Müller, Melanie; Warnecke, Henning; Rees, Wolfgang; Schöls, Wolfgang; Walterbusch, Gerhard; Ennker, Jürgen; Scheffold, Thomas

    2007-06-01

    Mutations in the genes encoding fibrillin-1 (FBN1) and transforming growth factor beta receptor type II (TGFBR2) are known causes of Marfan syndrome (MFS) and related disorders. However, a sound correlation between the genotype and the cardiovascular phenotype has not yet been established. The objective of the present study was to identify novel mutations in FBN1 and TGFBR2 and to assess whether the type of mutation is linked to a particular clinical subtype of the cardiovascular condition. The clinical records of 36 patients referred to us for molecular genetic diagnosis were reviewed to assess the course and severity of the vascular deterioration. A semiautomatic protocol was established enabling a rapid and cost-effective screening of the genes FBN1 and TGFBR2 by direct sequencing of all coding exons and flanking intronic regions. Novel mutations in FBN1 and TGFBR2 were detected in 12 and 2 patients, respectively. Four individuals carried a recurrent mutation in FBN1. Throughout the study cohort, the incidence of aortic dissections per se did not depend on the type of mutation. However, we found that mutations affecting the calcium-binding epidermal growth factor-like domain were more frequently associated with a dissection of distal parts of the aorta than mutations that lead to a premature termination codon (chi(1)(2): p=0.013), suggesting that the spatio-temporal pattern of vascular deterioration may vary with the type of mutation. Detecting a mutation in the genes FBN1 and TGFBR2 proves the genetic origin of vascular findings and allows the identification of family members at risk who should undergo preventive checkups. Routine genetic testing of patients with suspected MFS or thoracic aortic aneurysms/dissections could provide further insight into genotype/phenotype correlations related to aortic dissection.

  9. Postponed surgery of an acute aortic dissection (type A) in a Jehovah's Witness with significant hemostatic disorders

    PubMed Central

    Waligórski, Szymon; Mokrzycki, Krzysztof; Brykczyński, Mirosław

    2016-01-01

    In this case report, we present the treatment of an acute type A aortic dissection in a Jehovah's Witness patient. In accordance with the will of the patient, blood products were not used. Additionally, the patient had significant hemostatic disorders due to the use of antiplatelet drugs. PMID:27785141

  10. Unusual false aneurysm of the ascending aorta associated with ruptured acute type A aortic dissection.

    PubMed

    Morimoto, Hironobu; Tsuchiya, Koji; Nakajima, Masato; Akashi, Okihiko

    2008-01-01

    False aneurysm of the thoracic aorta unrelated to trauma, or to previous aortic or cardiac surgery, is extremely rare. We encountered a case of ascending aortic false aneurysm formation associated with ruptured acute type A aortic dissection. The false aneurysm, which was contained by thin connective tissue surrounding the aortic wall, was located beside the false lumen of the dissected ascending aorta, expanding toward the transverse sinus. We immediately decided to perform an emergency operation. We noted the large entry site at the anterior wall of the dissected ascending aorta after resection of the flap. We identified the false aneurysm arising from a small tear of the false lumen. Graft replacement of the ascending aorta using a tube graft was performed. The postoperative course was satisfactory. This pathology was believed to be not only a consequence of hemostasis, but also a process of re-rupture of the dissected aorta.

  11. Histopathological studies of aortic dissection in streptozotocin-induced diabetic APA hamsters.

    PubMed

    Horiuchi, Keiko; Takatori, Atsushi; Inenaga, Toshiaki; Ohta, Etsuko; Ishii, Yoshiyuki; Kyuwa, Shigeru; Yoshikawa, Yasuhiro

    2005-07-01

    Syrian hamsters of the APA strain (APA hamsters) are known to show continuous diabetes accompanied by its complications, such as glomerulosclerosis and atherosclerosis, following a single injection of streptozotocin (SZ). Recently, we observed Stanford type B aortic dissection in three diabetic APA hamsters and histopathological analysis was performed. The histopathologic observations in the false lumen, such as proliferation of granulation tissues, neointima and pseudoneointima, corresponded to the non-thrombosed type of human aortic dissection, and blood clots of the thrombosed type were similar to the remodeling structures of aortic dissection found in human cases. Thus, this model may be useful for investigating the etiology and pathogenesis of aortic dissection accompanying diabetes mellitus in humans.

  12. Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography.

    PubMed

    Ampanozi, Garyfalia; Flach, Patricia M; Ruder, Thomas D; Filograna, Laura; Schweitzer, Wolf; Thali, Michael J; Ebert, Lars C

    2017-03-28

    The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as "aortic dissection", "myocardial wall rupture" or "undetermined". Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.

  13. Therapeutics Targeting Drivers of Thoracic Aortic Aneurysms and Acute Aortic Dissections: Insights from Predisposing Genes and Mouse Models.

    PubMed

    Milewicz, Dianna M; Prakash, Siddharth K; Ramirez, Francesco

    2017-01-14

    Thoracic aortic diseases, including aneurysms and dissections of the thoracic aorta, are a major cause of morbidity and mortality. Risk factors for thoracic aortic disease include increased hemodynamic forces on the ascending aorta, typically due to poorly controlled hypertension, and heritable genetic variants. The altered genes predisposing to thoracic aortic disease either disrupt smooth muscle cell (SMC) contraction or adherence to an impaired extracellular matrix, or decrease canonical transforming growth factor beta (TGF-β) signaling. Paradoxically, TGF-β hyperactivity has been postulated to be the primary driver for the disease. More recently, it has been proposed that the response of aortic SMCs to the hemodynamic load on a structurally defective aorta is the primary driver of thoracic aortic disease, and that TGF-β overactivity in diseased aortas is a secondary, unproductive response to restore tissue function. The engineering of mouse models of inherited aortopathies has identified potential therapeutic agents to prevent thoracic aortic disease.

  14. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection

    PubMed Central

    Jiménez-Trujillo, Isabel; González-Pascual, Montserrat; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; de Miguel-Yanes, José Mª; Méndez-Bailón, Manuel; de Miguel-Diez, Javier; Salinero-Fort, Miguel Ángel; Perez-Farinos, Napoleón; Carrasco-Garrido, Pilar; López-de-Andrés, Ana

    2016-01-01

    Abstract To describe trends in the rates of discharge due to thoracic aortic aneurysm and dissection (TAAD) among patients with and without type 2 diabetes in Spain (2001–2012). We used national hospital discharge data to select all of the patients who were discharged from the hospital after TAAD. We focused our analysis on patients with TAAD in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or nondiabetic). Incidence was calculated overall and stratified by diabetes status. We divided the study period into 4 periods of 3 years each. We analyzed diagnostic and surgical procedures, length of stay, and in-hospital mortality. We identified 48,746 patients who were discharged with TAAD. The rates of discharge due to TAAD increased significantly in both diabetic patients (12.65 cases per 100,000 in 2001/2003 to 23.92 cases per 100,000 in 2010/2012) and nondiabetic patients (17.39 to 21.75, respectively). The incidence was higher among nondiabetic patients than diabetic patients in 3 of the 4 time periods. The percentage of patients who underwent thoracic endovascular aortic repair increased in both groups, whereas the percentage of patients who underwent open repair decreased. The frequency of hospitalization increased at a higher rate among diabetic patients (incidence rate ratio 1.14, 95% confidence interval [CI] 1.07–1.20) than among nondiabetic patients (incidence rate ratio 1.08, 95% CI 1.07–1.11). The in-hospital mortality was lower in diabetic patients than in nondiabetic patients (odds ratio 0.83, 95% CI 0.69–0.99). The incidence rates were higher in nondiabetic patients. Hospitalizations seemed to increase at a higher rate among diabetic patients. Diabetic patients had a significantly lower mortality, possibly because of earlier diagnoses, and improved and more readily available treatments. PMID:27149499

  15. Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus.

    PubMed

    Zhu, Limin; Vranckx, Roger; Khau Van Kien, Philippe; Lalande, Alain; Boisset, Nicolas; Mathieu, Flavie; Wegman, Mark; Glancy, Luke; Gasc, Jean-Marie; Brunotte, François; Bruneval, Patrick; Wolf, Jean-Eric; Michel, Jean-Baptiste; Jeunemaitre, Xavier

    2006-03-01

    We have recently described two kindreds presenting thoracic aortic aneurysm and/or aortic dissection (TAAD) and patent ductus arteriosus (PDA) and mapped the disease locus to 16p12.2-p13.13 (ref. 3). We now demonstrate that the disease is caused by mutations in the MYH11 gene affecting the C-terminal coiled-coil region of the smooth muscle myosin heavy chain, a specific contractile protein of smooth muscle cells (SMC). All individuals bearing the heterozygous mutations, even if asymptomatic, showed marked aortic stiffness. Examination of pathological aortas showed large areas of medial degeneration with very low SMC content. Abnormal immunological recognition of SM-MHC and the colocalization of wild-type and mutant rod proteins in SMC, in conjunction with differences in their coimmunoprecipitation capacities, strongly suggest a dominant-negative effect. Human MYH11 gene mutations provide the first example of a direct change in a specific SMC protein leading to an inherited arterial disease.

  16. 5B.05: MARFAN SYNDROME: ASSESSMENT OF AORTIC DISSECTION RISK BY ANALYSIS OF AORTIC VISCOELASTIC PROPERTIES.

    PubMed

    Grillo, A; Pini, A; Marelli, S; Gan, L; Giuliano, A; Trifirò, G; Santini, F; Salvi, L; Salvi, P; Viecca, F; Carretta, R; Parati, G

    2015-06-01

    Marfan syndrome is an autosomal dominant genetic disorder characterized by an abnormal fibrillin-1 synthesis. Aortic root dilation and dissection are the main problems affecting patients prognosis in these patients. Their pharmacological prophylaxis with losartan or with a beta-blocker counteracts the aortic root dilation, but a close follow-up is required to assess therapeutic response rate and to identify non-responders. Unfortunately genotype-phenotype studies do not allow to determine the exact risk profile in these patients and there is no reliable method to accurately predict their risk of aortic dissection. Aim of this study was to evaluate non-invasive markers for identification of Marfan patients at higher risk of aortic complications. We studied 187 Marfan patients (identified according to 2010 Revised Ghent Criteria and positive genetic analysis), age 32.3 ± 16.5 yrs (mean ± SD). 52 patients (27.8%) had undergone surgical ascending aorta replacement (David or Bentall procedure). Central pressure curves were recorded by PulsePen tonometer, and the aortic viscoelastic aortic properties were studied by determination of carotid-femoral pulse wave velocity (PWV). With reference to the age related distribution of PWV values in a normal population, defined according to Arterial-Stiffness-Collaboration, PWV mean values in Marfan patients corresponded to 60th percentile in non- operated patients and to the 67th percentile in those operated. Adult Marfan patients (n = 146) generally displayed a low blood pressure, because of the pharmacological prophylaxis, and were compared with a population of 189 adult healthy subjects (81 males), matched by age (38 ± 13 vs 38 ± 16 yrs.), heart rate (64 ± 9 bpm vs 64 ± 11 bpm) and blood pressure (mean BP = 78 ± 9 mmHg vs 79 ± 4 mmHg) values. Average PWV value was higher than in healthy controls (PWV = 7.0 ± 1.7) both in not operated (PWV = 7.6 ± 1.6; p = 0

  17. Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

    SciTech Connect

    Huang, Chen; Tang, Hanfei; Qiao, Tong; Liu, Changjian; Zhou, Min

    2016-01-15

    ObjectiveTo summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.MethodsFrom September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.ResultsThe technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.ConclusionBased on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

  18. Novel morphological features for prediction of distal thoracic aortic enlargement after thoracic endovascular aortic repair of DeBakey IIIb aortic dissection.

    PubMed

    Ge, Yang Yang; Xue, Yan; Guo, Wei; Zhang, Hong Peng; Liu, Xiao Ping; Xiong, Jiang; Jia, Xin; Ma, Xiao Hui; Wang, Li Jun

    2017-09-05

    To assess the novel morphological features for DeBakey IIIb aortic dissection in predicting distal thoracic aortic enlargement after thoracic endovascular aortic repair (TEVAR). Sixty-seven patients who underwent TEVAR for DeBakey IIIb aortic dissection between January 2011 and December 2013 at our center were divided based on preoperative computer tomography angiography (CTA) features into 3 groups: I (n = 27) and III (n = 9), with true and false lumen, respectively, coursing closely along thoracic vertebral bodies; and II, spiral configuration (n = 31). Distal thoracic aortic enlargement was determined using pre- and postoperative CTA images. At median 12.2 (interquartile range, 4.3-26.6) months, 12 patients developed distal thoracic aortic enlargement, with estimated cumulative incidence tending to increase from categories I to III (P for trend < .01). Categories II and III vs. I had more frequently concave location of primary entry tear (P < .01), larger dissection length and height index (L/Hi) (P = .05), and greater number of abdominal small branches involved preoperatively (P = .03), with otherwise similar baseline characteristics; and significantly greater total aortic diameter increase and lower false lumen regression up to 24 months, and lower true lumen expansion up to 12 months. In multivariable regression analysis, categories II and III were independently associated with distal thoracic aortic enlargement (hazard ratio, 19.95 [95% confidence interval, 2.14-186.09]; 41.23 [3.61-470.22], respectively) after adjustment for Society of Vascular Surgery score, preoperative maximum total aortic diameter, L/Hi, and number of abdominal small branches involved preoperatively. The CTA-based morphological features described in this study might improve preoperative risk stratification of DeBakey IIIb aortic dissection, with categories II and III having higher risk of distal thoracic aortic enlargement after TEVAR. Copyright © 2017. Published by Elsevier Inc.

  19. The pitfalls of premature closure: clinical decision-making in a case of aortic dissection

    PubMed Central

    Kumar, Bharat; Kanna, Balavenkatesh; Kumar, Suresh

    2011-01-01

    Premature closure is a type of cognitive error in which the physician fails to consider reasonable alternatives after an initial diagnosis is made. It is a common cause of delayed diagnosis and misdiagnosis borne out of a faulty clinical decision-making process. The authors present a case of aortic dissection in which premature closure was avoided by the aggressive pursuit of the appropriate differential diagnosis, and discuss the importance of disciplined clinical decision-making in the setting of chest pain. PMID:22679162

  20. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.

    PubMed

    Rylski, Bartosz; Bavaria, Joseph E; Beyersdorf, Friedhelm; Branchetti, Emanuela; Desai, Nimesh D; Milewski, Rita K; Szeto, Wilson Y; Vallabhajosyula, Prashanth; Siepe, Matthias; Kari, Fabian A

    2014-04-01

    Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection. Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95±3%, 88±5%, and 79±5% and in patients who underwent supracoronary ascending replacement was 83±9%, 60±13%, 20±16% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement. Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (>40%) for root reintervention.

  1. Operative Strategies and Outcomes in Type A Aortic Dissection After the Enactment of a Multidisciplinary Aortic Surgery Team.

    PubMed

    Beller, Jared P; Scheinerman, Joshua A; Balsam, Leora B; Ursomanno, Patricia; DeAnda, Abe

    2015-01-01

    The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery team. Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005-2009, N = 39) and after (2010-2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

  2. Autosomal Dominant Inheritance of a Predisposition to Thoracic Aortic Aneurysms and Dissections and Intracranial Saccular Aneurysms

    PubMed Central

    Regalado, Ellen; Medrek, Sarah; Tran-Fadulu, Van; Guo, Dong-Chuan; Pannu, Hariyadarshi; Golabbakhsh, Hossein; Smart, Suzanne; Chen, Julia H.; Shete, Sanjay; Kim, Dong H.; Stern, Ralph; Braverman, Alan C.; Milewicz, Dianna M.

    2013-01-01

    A genetic predisposition for thoracic aortic aneurysms and dissections (TAAD) can be inherited in an autosomal dominant manner with decreased penetrance and variable expression. Four genes identified to date for familial TAAD account for approximately 20% of the heritable predisposition. In a cohort of 514 families with two or more members with presumed autosomal dominant TAAD, 48 (9.3%) families have one or more members who were at 50% risk to inherit the presumptive gene causing TAAD had an intracranial vascular event. In these families, gender is significantly associated with disease presentation (p <0.001), with intracranial events being more common in women (65.4%) while TAAD events occurred more in men (64.2%,). Twenty-nine of these families had intracranial aneurysms (ICA) that could not be designated as saccular or fusiform due to incomplete data. TGFBR1, TGFBR2, and ACTA2 mutations were found in 4 families with TAAD and predominantly fusiform ICAs. In 15 families, of which 14 tested negative for 3 known TAAD genes, 17 family members who were at risk for inheriting TAAD had saccular ICAs. In 2 families, women who harbored the genetic mutation causing TAAD had ICAs. In 2 additional families, intracranial, thoracic and abdominal aortic aneurysms were observed. This study documents the autosomal dominant inheritance of TAADs with saccular ICAs, a previously recognized association that has not been adequately characterized as heritable.I these families, routine cerebral and aortic imaging for at risk members could prove beneficial for timely medical and surgical management to prevent a cerebral hemorrhage or aortic dissection. PMID:21815248

  3. Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

    PubMed Central

    2011-01-01

    Acute aortic type A dissection is a life-threatening disease that requires immediate surgical intervention. When dissection occurs during pregnancy, it is of high risk for both the mother and the fetus. In this study, we reported two cases of acute aortic dissection in late pregnancy at 28 weeks and 32 weeks of gestation respectively. After the two patients underwent a cesarean section and delivered a baby, we performed composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries into the graft (Bentall procedure) instead of repairing the arch with deep hypothermia and circulation arrest. Both mothers and children survived and recovered well. PMID:21999207

  4. Fatal Delayed Esophageal Rupture Following Aortic Clamping for Treatment of Stanford Type B Dissection

    SciTech Connect

    Ito, Hisao; Yamada, Takayuki; Ishibashi, Tadashi; Akiyama, Masatoshi; Nakame, Takahiko; Ito, Yasuhiro; Konnai, Toshiaki

    2003-11-15

    A 65-year-old man underwent a thromboexclusionoperation for management of chronic Stanford type B dissecting aneurysmin 1991. However, long-term follow-up CT scans after the operation revealed that the ascending aorta gradually enlarged and was eventually complicated by recurrent aortic dissection. The patient complained of frequent bloody sputum, whereas chest roentogenography showed no pulmonary abnormalities. Subsequent swallow esophagogram demonstrated that the upper esophagus was deviated to the right and the middle esophagus was greatly compressed by the aortic clamp. Esophageal endoscopy showed a bloody inner surface and marked swelling of the middle esophagus. The patient eventually died of massive hematemesis in 2001. We describe the imaging features of unanticipated complications such as recurrent dissecting aneurysm or impending esophageal rupture.Furthermore, we discuss the cause of hematemesis and document that the aortic clamp migrated and resulted in development of a recurrent aneurysmal dissection, which in turn resulted in esophageal rupture with aneurysmal disruption.

  5. Should a reimplantation valve sparing procedure be done systematically in type A aortic dissection?

    PubMed

    Farhat, Fadi; Durand, Marion; Boussel, Loïc; Sanchez, Ingrid; Villard, Jacques; Jegaden, Olivier

    2007-01-01

    To evaluate the risks and benefits of a systematic reimplantation valve sparing procedure in the surgical treatment of type A aortic dissection (TAAD). From February December 2005, 15 consecutive patients (mean age 61+/-12 years) who underwent surgery for TAAD were analyzed prospectively. Eleven had a preoperative CT-scan and all had an echography. Eight patients presented with a preoperative aortic insufficiency>2/4 and seven had an ascending aortic aneurysm over 50mm. In 11 cases, arterial cannulation was performed directly into the ascending aorta. Surgical technique included complete resection and replacement of the ascending aorta using a reimplantation valve sparing technique (David), associated in 12 patients with an arch replacement, under mild (29.7+/-3.0 degrees C) hypothermia and cerebral selective antegrade perfusion. Aortic clamping, cerebral perfusion and cardiopulmonary bypass (CPB) times were respectively 93+/-29, 18+/-9, and 131+/-38min. Mean bleeding at 24h was 1165+/-846ml. Troponin I level at 24h was 21+/-30 microg/l. One patient had a right coronary artery bypass for a chronically occluded coronary. Another had a triple arterial revascularisation for pre-existing coronary dissection. One patient presented with a postoperative regressive right hemiparesia (normal CT-scan). Two patients underwent revision for bleeding (one was undergoing treatment by clopidogrel). One patient had at day 7 an implantation of a covered stentgraft on the descending aorta for a concomitant penetrating aortic ulcer. One patient died suddenly on POD 7 during a tracheal aspiration. Intubation and ICU times were respectively 9.5+/-16.3 and 16.2+/-20.9 days. Four patients with severe preoperative co morbidities had long intubations. Echographic and CT-scan control, done in postoperative and after a mean follow up of 11.0+/-4.8 months, did not show any residual aortic insufficiency (actuarial survival rate at 2 years of 93.3%). A reimplantation valve sparing procedure in

  6. Innovative postmarket device evaluation using a quality registry to monitor thoracic endovascular aortic repair in the treatment of aortic dissection.

    PubMed

    Beck, Adam W; Lombardi, Joseph V; Abel, Dorothy B; Morales, J Pablo; Marinac-Dabic, Danica; Wang, Grace; Azizzadeh, Ali; Kern, John; Fillinger, Mark; White, Rodney; Cronenwett, Jack L; Cambria, Richard P

    2017-05-01

    United States Food and Drug Administration (FDA)-mandated postapproval studies have long been a mainstay of the continued evaluation of high-risk medical devices after initial marketing approval; however, these studies often present challenges related to patient/physician recruitment and retention. Retrospective single-center studies also do not fully represent the spectrum of real-world performance nor are they likely to have a sufficiently large enough sample size to detect important signals. In recent years, The FDA Center for Devices and Radiological Health has been promoting the development and use of patient registries to advance infrastructure and methodologies for medical device investigation. The FDA 2012 document, "Strengthening the National System for Medical Device Post-market Surveillance," highlighted registries as a core foundational infrastructure when linked to other complementary data sources, including embedded unique device identification. The Vascular Quality Initiative (VQI) thoracic endovascular aortic repair for type B aortic dissection project is an innovative method of using quality improvement registries to meet the needs of device evaluation after market approval. Here we report the organization and background of this project and highlight the innovation facilitated by collaboration of physicians, the FDA, and device manufacturers. This effort used an existing national network of VQI participants to capture patients undergoing thoracic endovascular aortic repair for acute type B aortic dissection within a registry that aligns with standard practice and existing quality efforts. The VQI captures detailed patient, device, and procedural data for consecutive eligible cases under the auspices of a Patient Safety Organization (PSO). Patients were divided into a 5-year follow-up group (200 acute; 200 chronic dissections) and a 1-year follow-up group (100 acute; 100 chronic). The 5-year cohort required additional imaging details, and the 1-year

  7. Shock complicating type A acute aortic dissection: Clinical correlates, management, and outcomes.

    PubMed

    Bossone, Eduardo; Pyeritz, Reed E; Braverman, Alan C; Peterson, Mark D; Ehrlich, Marek; O'Gara, Patrick; Suzuki, Toru; Trimarchi, Santi; Gilon, Dan; Greason, Kevin; Desai, Nimesh D; Montgomery, Daniel G; Isselbacher, Eric M; Nienaber, Christoph A; Eagle, Kim A

    2016-06-01

    Shock is among the most dreaded and common complications of type A acute aortic dissection (TAAAD). However, clinical correlates, management, and short- and long-term outcomes of TAAAD patients presenting with shock in real-world clinical practice are not known. We evaluated 2,704 patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection between January 1, 1996, and August 18, 2012. On admission, 407 (15.1%) TAAAD patients presented with shock. Most in-hospital complications (coma, myocardial or mesenteric ischemia or infarction, and cardiac tamponade) were more frequent in shock patients. In-hospital mortality was significantly higher in TAAAD patients with than without shock (30.2% vs 23.9%, P=.007), regardless of surgical or medical treatment. Most shock patients underwent surgical repair, with medically managed patients demonstrating older age and more complications at presentation. Estimates using Kaplan-Meier survival analysis indicated that most (89%) TAAAD patients with shock discharged alive from the hospital survived 5years, a rate similar to that of TAAAD patients without shock (82%, P=.609). Shock occurred in 1 of 7 TAAAD patients and was associated with higher rates of in-hospital adverse events and mortality. However, TAAAD survivors with or without shock showed similar long-term mortality. Successful early and aggressive management of shock in TAAAD patients has the potential for improving long-term survival in this patient population. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Midterm results after endovascular treatment of acute, complicated type B aortic dissection: the Talent Thoracic Registry.

    PubMed

    Ehrlich, Marek P; Rousseau, Herve; Heijmen, Robin; Piquet, Philippe; Beregi, Jean-Paul; Nienaber, Christoph A; Sodeck, Gottfried; Fattori, Rossella

    2013-01-01

    To assess the efficacy and midterm results of endovascular treatment of acute complicated type B dissection. From January 1998 to March 2004, 29 patients (7 women and 22 men) with acute complicated aortic type B dissection (mean age, 61 years; range, 22-78), defined as aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with the Medtronic Talent device. Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve. The mean aortic diameter at intervention was 48 ± 13 mm. Follow-up was 100% complete and averaged 53 ± 41 months. The technical feasibility and success with deployment proximal to the entry tear was 100%, requiring partial or total coverage of the left subclavian artery in only 1 patient (3%). Hospital mortality was 17% ± 7% (70% confidence limit) with 6 late deaths. The causes of hospital death included multiorgan failure in 2 patients, aortic rupture in 2, and retrograde dissection in 1 patient. Three patients (10%) who survived the procedure developed neurologic complications (2 strokes and 1 transient ischemic attack). One patient required early conversion to surgery because of retrograde type A dissection. Furthermore, 4 patients developed a type Ia endoleak. A postprocedural increase in the distal aortic diameter was observed in 3 patients. The actuarial survival at 1 and 5 years was 79% and 61%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 82% and 77%, respectively. Endovascular stent graft placement in acute complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, could further improve the prognosis of patients in this life-threatening situation

  9. Staged total exclusion of the aorta for chronic type B aortic dissection.

    PubMed

    Dias Perera, Anton; Willis, Alan K; Fernandez, Joss D; Garrett, H Edward; Wolf, Bradley A

    2010-11-01

    Hybrid techniques using extra-anatomic bypass of critical aortic branches to enable endovascular treatment of complex aortic pathology have been previously described. A staged endograft repair of a complex, chronic Stanford type B aortic dissection with aneurysmal degeneration is reported in a 50-year-old man. The aneurysmal portion of the dissection extended from the distal arch to both common iliac arteries and was covered with an endograft from the ascending aorta to both external iliac arteries. Aortic arch branches, visceral, and renal arteries were bypassed using open technique. The patient had no neurologic complications. This case report illustrates the feasibility of the hybrid technique in selected high-risk patients when confronted with complex aortic pathology.

  10. Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis.

    PubMed

    Sabzi, Feridoun; Faraji, Reza

    2016-02-01

    The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence.

  11. Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT.

    PubMed

    Buitrago, Guadalupe; Vasaturo, Sabina; Kroft, Lucia J M

    2014-01-01

    This case report shows the full spectrum evolution of type B intramural hematoma under conservative treatment, with initial progression into a true aortic dissection, followed by extremely rare near-complete healing of the dissection at followup.

  12. Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT

    PubMed Central

    Buitrago, Guadalupe; Vasaturo, Sabina; Kroft, Lucia J.M.

    2015-01-01

    This case report shows the full spectrum evolution of type B intramural hematoma under conservative treatment, with initial progression into a true aortic dissection, followed by extremely rare near-complete healing of the dissection at followup. PMID:27186244

  13. Endovascular creation of aortic dissection in a swine model with technical considerations.

    PubMed

    Okuno, Teruaki; Yamaguchi, Masato; Okada, Takuya; Takahashi, Takuya; Sakamoto, Noriaki; Ueshima, Eisuke; Sugimura, Kazuro; Sugimoto, Koji

    2012-05-01

    Creating an experimental model of a type B aortic dissection with a minimally invasive endovascular procedure in swine to help future evaluation of therapies for aortic dissection. Aortic dissection was created in 14 swine using endovascular procedures only. Under fluoroscopy, a modified 10F outer catheter with a 14 G stiffening inner metallic cannula was forced via the femoral artery into the aortic vessel wall to create an initial dissection. A .035-inch guidewire and a 4F straight catheter were advanced into the dissected space, and the dissection was extended in a retrograde direction using a technique including loop formation of the guidewire, which was placed carefully against the transmural penetration and extended as far as possible in the descending thoracic aorta up to the point where loop formation of the guidewire reached smoothly. An 8F introducer sheath was advanced with a Brockenbrough needle into the dissected space, and a proximal fenestration was created by puncturing the intima. If required, balloon dilatation was performed to enlarge the proximal and distal tears. Aortography and contrast-enhanced cone beam computed tomography (CBCT) were performed in addition to a detailed histologic evaluation of the dissected portion. Aortic dissection was successfully created in 11 of the 14 swine (78.6%). Among the 11 dissections, nine were located in the thoracoabdominal aorta and two in the abdominal aorta. The initial aortic diameter at the middle portion of the created dissection ranged from 7.4 to 16.8 mm (mean ± standard deviation, 10.9 ± 2.9), while after dissection, it ranged from 7.8 to 19.3 mm (12.9 ± 3.8 mm). The dissected length ranged from 4.4 to 17.7 cm (10.7 ± 4.6 cm). Aortography and CBCT revealed seven dissections (63.6%) with a smooth and patent false lumen. Histologic evaluation revealed that the outer one-third of the media was separated from the inner two-thirds. In the remaining four dissections (36.4%), imaging procedures revealed

  14. Role of the femorofemoral crossover graft in acute lower limb ischemia due to acute type B aortic dissection.

    PubMed

    Corfield, Lorraine; McCormack, David J; Bell, Rachel; Taylor, Peter; Reidy, John

    2014-04-01

    Acute limb ischemia due to type B aortic dissection is rare and continues to be a management challenge. A case series is presented here with the aim of assessing the outcomes of treatment with a femorofemoral crossover graft with or without thoracic stent graft insertion. This is a combined retrospective and prospective review of nine cases of acute lower limb ischemia secondary to acute type B aortic dissection. The presenting features, radiological findings, treatment and outcomes were reviewed. Five patients had a femorofemoral crossover graft (FFXO) alone, two an FFXO with a thoracic stent graft and the eighth a thoracic and iliac stent. The other case was initially treated conservatively but subsequently required an FFXO. The mean follow-up was 16 (3-51) months. A further two thoracic stents were placed during the follow-up period. Thus five out of nine patients (56%) required aortic stenting. This series suggests that an FFXO is a reliable treatment for acute limb ischemia due to type B aortic dissection. However, these patients are often complex with ischemia in other vascular beds and are at risk of subsequent aneurysmal dilation.

  15. Aortic dissection in pregnancy in England: an incidence study using linked national databases

    PubMed Central

    Banerjee, Amitava; Begaj, Irena; Thorne, Sara

    2015-01-01

    Objectives To conduct the first population-level incidence study of aortic dissection in pregnancy using linked hospital-based data in England. Setting Hospital-based data (Hospital Episode Statistics (HES) linked with mortality data from the Office of National Statistics), national enquiries (Confidential Enquiries into Maternal Mortality) and surveys (UK Obstetric Surveillance System; UKOSS) of aortic dissection in pregnancy from 2003 to 2011 in England. Participants Between 2003 and 2011, all female patients admitted with diagnoses of aortic dissection (not necessarily as the primary cause of admission) and of pregnancy, childbirth and puerperium, were included. Outcome measures Diagnosis of aortic dissection during pregnancy, operated or not operated, with outcome of death or live patient from 2003 to 2011 in England. Results There were significant differences in characteristics of databases with respect to study population, time of study, recorded event and follow-up of outcomes. On the basis of HES, annual incidence of aortic dissection was 1.23 (95% CI 1.22 to 1.24) per 100 000 maternities. Incidence of aortic dissection with death within 1 year was 0.30 (0.29 to 0.31) per 100 000 maternities. Incidence of aortic dissection increased from 0.74 (0.73 to 0.75) per 100 000 maternities in 2003–2005 to 1.52 (1.51 to 1.53) per 100 000 maternities in 2009–2011. In the Confidential Enquiries into Maternal Deaths, incidence of deaths was highest for 2003–2005 (0.43/100 000 maternities) and lowest for 1997–1999 (0.21/100 000 maternities). In the UK Obstetric Surveillance System, national incidence of aortic dissection was 0.80 (0.50 to 1.50) per 100 000 maternities between 2009 and 2011. Conclusions The case of aortic dissection in pregnancy illustrates data limitations regarding complications in pregnancy from different sources in the UK, even for a diagnosis with seemingly few alternative coding and diagnostic possibilities. These limitations should be

  16. Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection

    PubMed Central

    Zhang, Min-Hong; Du, Xin; Guo, Wei; Liu, Xiao-Ping; Jia, Xin; Ge, Yang-Yang

    2017-01-01

    Abstract Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection. Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months. The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen. TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity. PMID:28700467

  17. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis.

    PubMed

    Yan, Yan; Xu, Li; Zhang, Hao; Xu, Zhi-Yun; Ding, Xue-Yan; Wang, Shu-Wei; Xue, Xiang; Tan, Meng-Wei

    2016-05-01

    The optimal surgical strategy for acute type A aortic dissection (ATAAD) is still controversial because of the inconsistent or even conflicting results of proximal aortic repair (PR) versus extensive aortic repair (ER) on early and late prognostic outcomes. This meta-analysis pooled data from all available studies of PR versus ER to get a summarized conclusion. Studies were identified by searching the Medline, EMBASE and Cochrane databases. Early and late prognostic outcomes of interest were evaluated with meta-analysis. Fixed- or random-effect models were used according to the significance of heterogeneity. Robustness of pooled estimates and the source of heterogeneity were assessed via sensitivity analyses and meta-regression, respectively. Publication bias was evaluated by the funnel plot and Egger's test. Nine studies with a total of 1872 patients were included for the meta-analysis. Pooled results indicated that, when compared with the ER procedure, PR was associated with lower early mortality [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.54-0.90, P = 0.005] but higher incidence of postoperative aortic events including reoperation of the distal aorta (RR = 3.14, 95% CI 1.74-5.67, P < 0.001). PR and ER demonstrated analogous prognosis on long-term mortality (HR = 1.02, 95% CI 0.51-2.06, P = 0.96) and the incidences of early postoperative renal failure (RR = 0.75, 95% CI 0.49-1.14, P = 0.17) and stroke (RR = 0.73, 95% CI 0.30-1.78, P = 0.50). All the pooled results were robust to sensitivity analysis. Heterogeneity was insignificant except for the meta-analysis of late mortality. Performing a less aggressive initial surgical procedure of PR in ATAAD patients would have lower early mortality but elevated incidence rates of late aortic reintervention, when compared with ER. Other prognostic results of the two surgical strategies including long-term mortality were similar for both. © The Author 2015. Published by Oxford University Press on behalf of the

  18. Endovascular stent-graft repair of acute thoracic aortic dissection--early clinical experiences.

    PubMed

    Tiesenhausen, K; Amann, W; Koch, G; Hausegger, K A; Oberwalder, P; Rigler, B

    2001-02-01

    Standard treatment of acute thoracic aortic dissection type B is the medical therapy used for most patients, according to Stanford. Surgical therapy involves a high mortality rate and is reserved for patients with complicated dissections. We report from four patients with acute thoracic aortic dissection, treated endoluminally by stent-graft implantation. Four patients with complicated acute thoracic aortic dissections type B were treated endoluminally by transfemoral stent-graft implantation. Preoperative evaluation was performed with spiral-computed tomography and calibrated aortography. The Talent stent-graft system (Metronic) was used in all patients. The primary entry tear could be sealed successfully and complete thrombosis of the false thoracic aortic lumen was obtained in all cases. In one patient, transposition of the left subclavian artery was performed, in two patients the stent-grafts had to be placed across the origin of the left subclavian artery. No severe intra- or postoperative complications occurred. Endoluminal treatment of acute thoracic aortic dissection seems to be a less invasive and effective therapy. Long-term results for this method are necessary.

  19. The new indication of TEVAR for uncomplicated type B aortic dissection

    PubMed Central

    Song, Chao; Lu, Qingsheng; Zhou, Jian; Yu, Guanyu; Feng, Xiang; Zhao, Zhiqing; Bao, Junmin; Feng, Rui; Jing, Zaiping

    2016-01-01

    Abstract The classical therapeutic indication for type B aortic dissection is based on either medication or open surgery; medication therapy is recommended for relatively stable uncomplicated type B aortic dissection. With improvements in endovascular repair and the potential risk of disease progression, it is now necessary to evaluate the requirement for revision of the therapeutic choice of uncomplicated type B aortic dissection based on morphological features and time window. Data from 252 patients diagnosed as uncomplicated type B aortic dissection from 1992 to 2015 were analyzed retrospectively. Among these cases, 117 patients received medication therapy and 135 patients underwent endovascular repair. The 60-month survival rate in the endovascular group was higher than that in the medication group (92.3% vs 67.6%). According to the morphological evaluation, visceral artery involvement and false/true lumen ratios over 0.7 were strong risk factors for medical treatment alone. Increased surgical time and blood loss were found in patients treated in the chronic phase, compared with those who underwent endovascular repair within 14 days of the onset of symptoms. With improvements in aortic remodeling techniques, endovascular repair has been shown to improve long-term survival rates of patients with uncomplicated aortic dissection. Considering the potential risk of death, we recommend that patients with visceral artery involvement and a false/true lumen ratio over 0.7 should receive endovascular repair aggressively. Furthermore, delayed endovascular repair in the chronic phase does not improve the long-term outcome of uncomplicated type B aortic dissection. PMID:27336881

  20. Predicting flow in aortic dissection: comparison of computational model with PC-MRI velocity measurements.

    PubMed

    Cheng, Z; Juli, C; Wood, N B; Gibbs, R G J; Xu, X Y

    2014-09-01

    Aortic dissection is a life-threatening process in which the weakened wall develops a tear, causing separation of wall layers. The dissected layers separate the original true aortic lumen and a newly created false lumen. If untreated, the condition can be fatal. Flow rate in the false lumen is a key feature for false lumen patency, which has been regarded as one of the most important predictors of adverse early and later outcomes. Detailed flow analysis in the dissected aorta may assist vascular surgeons in making treatment decisions, but computational models to simulate flow in aortic dissections often involve several assumptions. The purpose of this study is to assess the computational models adopted in previous studies by comparison with in vivo velocity data obtained by means of phase-contrast magnetic resonance imaging (PC-MRI). Aortic dissection geometry was reconstructed from computed tomography (CT) images, while PC-MRI velocity data were used to define inflow conditions and to provide distal velocity components for comparison with the simulation results. The computational fluid dynamics (CFD) simulation incorporated a laminar-turbulent transition model, which is necessary for adequate flow simulation in aortic conditions. Velocity contours from PC-MRI and CFD in the two lumens at the distal plane were compared at four representative time points in the pulse cycle. The computational model successfully captured the complex regions of flow reversal and recirculation qualitatively, although quantitative differences exist. With a rigid wall assumption and exclusion of arch branches, the CFD model over-predicted the false lumen flow rate by 25% at peak systole. Nevertheless, an overall good agreement was achieved, confirming the physiological relevance and validity of the computational model for type B aortic dissection with a relatively stiff dissection flap.

  1. Outcomes of Patients With Acute Type B (DeBakey III) Aortic Dissection

    PubMed Central

    Afifi, Rana O.; Sandhu, Harleen K.; Leake, Samuel S.; Boutrous, Mina L.; Kumar, Varsha; Azizzadeh, Ali; Charlton-Ouw, Kristofer M.; Saqib, Naveed U.; Nguyen, Tom C.; Miller, Charles C.; Safi, Hazim J.

    2015-01-01

    Background— Aortic dissection remains the most common aortic catastrophe. In the endovascular era, the management of acute type B aortic dissection (ATBAD) is undergoing dramatic changes. The aim of this study is to evaluate the long-term outcomes of patients with ATBAD who were treated at our center over a 13-year period. Methods and Results— We reviewed patients with ATBAD between 2001 and 2014, analyzing variables based on status (complicated [c] versus uncomplicated [u]) and treatment modalities. We defined cATBAD as rupture, expansion of diameter on imaging during the admission, persistent pain, or clinical malperfusion leading to a deficit in cerebral, spinal, visceral, renal, or peripheral vascular territories at presentation or during initial hospitalization. Postoperative outcomes were defined as deficits not present before the intervention. Outcomes were compared between the groups by use of Kaplan-Meier and descriptive statistics. We treated 442 patients with ATBAD. Of those 442, 60.6% had uATBAD and were treated medically, and 39.4% had cATBAD, of whom 39.0% were treated medically to 30.0% with open repair, 21.3% with thoracic endovascular aortic repair, and 9.7% with other open peripheral procedures. Intervention-free survival at 1 and 5 years was 84.8% and 62.7% for uATBAD, 61.8% and 44.0% for cATBAD-medical, 69.2% and 47.2% for cATBAD-open, and 68.0% and 42.5% for cATBAD–thoracic endovascular aortic repair, respectively (P=0.001). Overall survival was significantly related primarily to complicated presentation. Conclusions— In our experience, early and late outcomes of ATBAD were dependent on the presence of complications, with cATBAD faring worse. Although uATBAD was associated with favorable early survival, late complications still occurred, mandating radiographic surveillance and open or endovascular interventions. Prospective trials are required to better determine the optimal therapy for uATBAD. PMID:26304666

  2. A Case of Acute Aortic Dissection Type B Associated with Cushing's Syndrome

    PubMed Central

    Petramala, Luigi; Cotesta, Dario; Sapienza, Paolo; Zinnamosca, Laura; Moroni, Enrico; di Marzio, Luca; De Toma, Giorgio; Letizia, Claudio

    2009-01-01

    We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Keywords Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B PMID:22505966

  3. Acute myocardial infarction with cardiogenic shock in a patient with acute aortic dissection.

    PubMed

    Camaro, Cyril; Wouters, Noëmi T A E; Gin, Melvyn Tjon Joe; Bosker, Hans A

    2009-09-01

    Diagnosing acute Stanford type A aortic dissection with the uncommon involvement of the left main coronary artery(LMCA) remains challenging for the emergency physician because it can resemble acute myocardial infarction with cardiogenic shock. The following case report illustrate this infrequent but critical situation. A 52-year-old woman with a history of hypertension awakened with acute retrosternal chest pain accompanied by nausea and vomiting. She was referred to our hospital for primary coronary intervention because of acute myocardial infarction with cardiogenic shock. Coronary angiography indeed revealed LMCA occlusion. Subsequently successful percutaneous coronary intervention with stent implantation was performed, followed by immediate clinical improvement of the patient. Soon after admission at the coronary care unit, severe chest pain, hypotension, and electrocardiographic signs of diffuse myocardial ischemia relapsed. Control coronary angiography,however, showed no in-stent thrombosis. Review of clinical examination revealed an aortic regurgitation murmur. Because of this dynamic pattern of (1) signs of acute myocardial ischemia, (2) relapse of hemodynamic collapse, and (3) unaltered control coronary angiography together with the confirmed aortic regurgitation at transthoracic echocardiography, the patient was suspected of having aortic dissection. Transesophageal echocardiography revealed Stanford type A aortic dissection with severe eccentric aortic regurgitation and no pericardial effusion. Emergent valve-sparing aortic replacement was performed. The patient recovered completely. In this case, the lifesaving element was primary coronary intervention with stenting of the LMCA preventing extensive myocardial damage followed by a surgical correction of the aorta.

  4. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review.

    PubMed

    Cifani, Noemi; Proietta, Maria; Tritapepe, Luigi; Di Gioia, Cira; Ferri, Livia; Taurino, Maurizio; Del Porto, Flavia

    2015-01-01

    Acute aortic dissection (AAD) is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. Depending on the site of rupture, AAD is classified as Stanford-A when the ascending aortic thoracic tract and/or the arch are involved, and Stanford-B when the descending thoracic aorta and/or aortic abdominal tract are targeted. It was recently shown that inflammatory pathways underlie aortic rupture in both type A and type B Stanford AAD. An immune infiltrate has been found within the middle and outer tunics of dissected aortic specimens. It has also been observed that the recall and activation of macrophages inside the middle tunic are key events in the early phases of AAD. Macrophages are able to release metalloproteinases (MMPs) and pro-inflammatory cytokines which, in turn, give rise to matrix degradation and neoangiogenesis. An imbalance between the production of MMPs and MMP tissue inhibitors is pivotal in the extracellular matrix degradation underlying aortic wall remodelling in dissections occurring both in inherited conditions and in atherosclerosis. Among MMPs, MMP-12 is considered a specific marker of aortic wall disease, whatever the genetic predisposition may be. The aim of this review is, therefore, to take a close look at the immune-inflammatory mechanisms underlying Stanford-A AAD.

  5. Elevated Wall Shear Stress in Aortic Type B Dissection May Relate to Retrograde Aortic Type A Dissection: A Computational Fluid Dynamics Pilot Study.

    PubMed

    Osswald, A; Karmonik, C; Anderson, J R; Rengier, F; Karck, M; Engelke, J; Kallenbach, K; Kotelis, D; Partovi, S; Böckler, D; Ruhparwar, A

    2017-09-01

    Retrograde aortic type A dissection (RTAD) is a known complication in patients with aortic type B dissection. The purpose of this computational fluid dynamics (CFD) study was to identify haemodynamic risk factors for the occurrence of RTAD. Computed tomographic angiography (CTA) images of 10 patients with type B dissections, who subsequently developed a RTAD, were retrospectively analysed together with patients constituting a control group (n = 10) where no further vascular events after the initial type B dissection occurred. CFD simulations were conducted based on 3D surface models of the aortic lumen derived from CTA datasets. For both groups, pressures, velocity magnitudes and wall shear stress (WSS) were compared at the site of the future RTAD entry tear and the surrounding aortic wall. WSS at the site of the future entry tear was significantly elevated compared with the surrounding wall (15.10 Pa vs. 5.15 Pa, p < .001) and was significantly higher in the RTAD group than in the control group (6.05 Pa, p < .002). Pressures and velocity magnitudes were not significantly elevated at the entry tear (3825.8 Pa, 0.63 m/s) compared with the aortic arch (3549.8 Pa, 0.50 m/s) or control group (3501.7 Pa, 0.62 m/s). Increased WSS accompanies the occurrence of RTAD. The results merit the design for a prospective study to confirm whether WSS is a risk factor for the occurrence of RTAD. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Recurrent Chromosome 16p13.1 Duplications Are a Risk Factor for Aortic Dissections

    PubMed Central

    McDonald, Merry-Lynn N.; Johnson, Ralph J.; Wang, Min; Regalado, Ellen S.; Russell, Ludivine; Cao, Jiu-Mei; Kwartler, Callie; Fraivillig, Kurt; Coselli, Joseph S.; Safi, Hazim J.; Estrera, Anthony L.; Leal, Suzanne M.; LeMaire, Scott A.; Belmont, John W.; Milewicz, Dianna M.

    2011-01-01

    Chromosomal deletions or reciprocal duplications of the 16p13.1 region have been implicated in a variety of neuropsychiatric disorders such as autism, schizophrenia, epilepsies, and attention-deficit hyperactivity disorder (ADHD). In this study, we investigated the association of recurrent genomic copy number variants (CNVs) with thoracic aortic aneurysms and dissections (TAAD). By using SNP arrays to screen and comparative genomic hybridization microarrays to validate, we identified 16p13.1 duplications in 8 out of 765 patients of European descent with adult-onset TAAD compared with 4 of 4,569 controls matched for ethnicity (P = 5.0×10−5, OR = 12.2). The findings were replicated in an independent cohort of 467 patients of European descent with TAAD (P = 0.005, OR = 14.7). Patients with 16p13.1 duplications were more likely to harbor a second rare CNV (P = 0.012) and to present with aortic dissections (P = 0.010) than patients without duplications. Duplications of 16p13.1 were identified in 2 of 130 patients with familial TAAD, but the duplications did not segregate with TAAD in the families. MYH11, a gene known to predispose to TAAD, lies in the duplicated region of 16p13.1, and increased MYH11 expression was found in aortic tissues from TAAD patients with 16p13.1 duplications compared with control aortas. These data suggest chromosome 16p13.1 duplications confer a risk for TAAD in addition to the established risk for neuropsychiatric disorders. It also indicates that recurrent CNVs may predispose to disorders involving more than one organ system, an observation critical to the understanding of the role of recurrent CNVs in human disease and a finding that may be common to other recurrent CNVs involving multiple genes. PMID:21698135

  7. Radiofrequency induction heating for the treatment of aortic dissection in an animal model.

    PubMed

    Fujii, H; Sawada, S; Tanigawa, N; Ito, E; Imamura, H

    2000-10-01

    In this study, radiofrequency (RF) induction heating therapy using a self-expanding Gianturco metallic stent (G-EMS) to treat acute aortic dissection was evaluated. We evaluated convergent RF induction heating of G-EMS in pigs. In group A (n=3), an aortic dissection was created to determine the natural course of this lesion. In group B (n=4), 0.40 mm stainless steel bare G-EMSs (2.5 cm, 10 bends) were placed in the aorta 5 to 7 days after dissection, and RF induction heating was performed for 30 (n=2) or 45 (n=2) minutes. In group C (n=6), G-EMSs with 0.10 mm ferro-chrome wire mounted on alternating stent legs were placed in the aorta 1 to 7 days after dissection, and RF induction heating was performed for 10 minutes. In group A, 2 pigs died from rupture of the false lumen. In group B, fusion of the dissection flap was confirmed histologically. However, all of the pigs died. In group C, all of the pigs tolerated the procedure, and fusion of the dissection flap was confirmed in all of the pigs. This experimental animal study suggested that RF induction heating combined with G-EMS, if properly applied, has a potential to treat acute aortic dissection.

  8. The role of branch vessels in aortic type B dissection: an in vitro study.

    PubMed

    Veger, H T C; Westenberg, J J M; Visser, M J T

    2015-04-01

    In acute type B aortic dissection (ABAD) a patent false lumen portends a poor outcome. Patent branch vessels originating from the false lumen in a type B aortic dissection are assumed to contribute to persistent blood flow and patent false lumen. Therefore, the morphologic changes of the false lumen generated by different outflow rates in an in vitro model were investigated. An artificial dissection was created in two ex vivo porcine aortas. A thin cannula was placed in the false lumen, simulating a branch vessel originating from it. The aorta was positioned in a validated in vitro circulatory system with physiological pulsatile flow (1,500-2,700 mL/minute) and pressure characteristics (130/70 mm Hg). The cannula was attached to a small silicone tube with an adjustable valve mechanism. Three different valve settings were used for creating outflow from the false lumen (fully closed, opened at 50%, and fully opened at 100%). Measurements of lumen areas and flow rates were assessed with time-resolved magnetic resonance imaging. In order to study reproducibility, the experiment was performed twice in two different porcine aortas with a similar morphology. Increasing antegrade outflow through the branch vessel of the false lumen resulted in a significant (p < .01) increase of the mean false lumen area at the proximal and distal location in both models. The distal false lumen expanded up to 107% in the case of high outflow via the false lumen through the branch vessel. Increasing antegrade outflow through a branch vessel originating from the false lumen when no distal re-entry tear is present results in an expansion of the cross sectional false lumen area. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Mathematical modeling of thrombus formation in idealized models of aortic dissection: initial findings and potential applications.

    PubMed

    Menichini, Claudia; Xu, Xiao Yun

    2016-11-01

    Aortic dissection is a major aortic catastrophe with a high morbidity and mortality risk caused by the formation of a tear in the aortic wall. The development of a second blood filled region defined as the "false lumen" causes highly disturbed flow patterns and creates local hemodynamic conditions likely to promote the formation of thrombus in the false lumen. Previous research has shown that patient prognosis is influenced by the level of thrombosis in the false lumen, with false lumen patency and partial thrombosis being associated with late complications and complete thrombosis of the false lumen having beneficial effects on patient outcomes. In this paper, a new hemodynamics-based model is proposed to predict the formation of thrombus in Type B dissection. Shear rates, fluid residence time, and platelet distribution are employed to evaluate the likelihood for thrombosis and to simulate the growth of thrombus and its effects on blood flow over time. The model is applied to different idealized aortic dissections to investigate the effect of geometric features on thrombus formation. Our results are in qualitative agreement with in-vivo observations, and show the potential applicability of such a modeling approach to predict the progression of aortic dissection in anatomically realistic geometries.

  10. Postmortem genetic testing should be recommended in sudden cardiac death cases due to thoracic aortic dissection.

    PubMed

    Gago-Díaz, Marina; Ramos-Luis, Eva; Zoppis, Silvia; Zorio, Esther; Molina, Pilar; Braza-Boïls, Aitana; Giner, Juan; Sobrino, Beatriz; Amigo, Jorge; Blanco-Verea, Alejandro; Carracedo, Ángel; Brion, María

    2017-04-08

    Acute thoracic aortic dissections and ruptures, the main life-threatening complications of the corresponding aneurysms, are an important cause of sudden cardiac death. Despite the usefulness of the molecular diagnosis of these conditions in the clinical setting, the corresponding forensic field remains largely unexplored. The main goal of this study was to explore and validate a new massive parallel sequencing candidate gene​ assay as a diagnostic tool for acute thoracic aortic dissection autopsy cases. Massive parallel sequencing of 22 thoracic aortic disease candidate genes performed in 17 cases of thoracic aortic dissection using AmpliSeq and Ion Proton technologies. Genetic variants were filtered by location, type, and frequency at the Exome Aggregation Consortium and an internal database and further classified based on the American College of Medical Genetics and Genomics (ACMG) recommendations published in 2015. All prioritized results were confirmed by traditional sequencing. From the total of 10 potentially pathogenic genetic variants identified in 7 out of the 17 initial samples, 2 of them were further classified as pathogenic, 2 as likely pathogenic, 1 as possibly benign, and the remaining 5 as variants of uncertain significance, reaching a molecular autopsy yield of 23%, approximately. This massive parallel sequencing candidate gene approach proved useful for the molecular autopsy of aortic dissection sudden cardiac death cases and should therefore be progressively incorporated into the forensic field, being especially beneficial for the anticipated diagnosis and risk stratification of any other family member at risk of developing the same condition.

  11. Guide Catheter-Induced Aortic Dissection Complicated by Pericardial Effusion with Pulsus Paradoxus: A Case Report of Successful Medical Management

    PubMed Central

    Avadhani, Sriya A.; Marmur, Jonathan D.

    2015-01-01

    Aortic dissection is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Management strategies of PCI induced dissection are not clearly identified in literature; such occurrences often mandate surgical repair of the aortic root with reimplantation of the coronary arteries. Another trend seen in case reports is the use of coronary-aortic stenting if such lesions permit. Several factors impact the management decision including the hemodynamic stability of the patient; mechanism of aortic injury; size, severity, and direction of propagation of the dissection; presence of an intimal flap; and preexisting atherosclerotic disease. We describe a case of a 65-year-old woman who underwent PCI for a chronic right coronary artery (RCA) occlusion, which was complicated by aortic dissection and pericardial effusion. Our case report suggests that nonsurgical management may also be appropriate for PCI induced dissections, and potentially even those associated with new pericardial effusion. PMID:25685153

  12. The imaging assessment and specific endograft design for the endovascular repair of ascending aortic dissection

    PubMed Central

    Zhang, Yepeng; Tang, Hanfei; Zhou, JianPing; Liu, Zhao; Liu, Changjian; Qiao, Tong; Zhou, Min

    2016-01-01

    Background Endovascular option has been proposed for a very limited and selected number of Stanford type A aortic dissection (TAAD) patients. We have performed a computed tomography (CT)-based TAAD study to explore appropriate endograft configurations for the ascending aortic pathology. Methods TAAD patients treated with optimal CT scans were retrospectively reviewed, and their entry tears (ETs) were identified using three-dimensional and multiplanar reconstructions in an EndoSize workstation. After generating a centerline of flow, measurements, including numerous morphologic characteristics of anatomy, were evaluated and a selected subset of patients were determined to be suitable for endovascular treatments. Proximal diameter and distal diameter of endograft were selected based on diameters measured at the ET level and at the innominate artery (IA) level, with 10% oversizing with respect to the true lumen, but not exceeding the original aortic diameter. The length of the endograft was determined by the distance from the sinotubular junction to IA. Results This study covered 126 TAAD patients with primary ET in ascending aorta, among which, according to the assumed criteria, 48 (38.1%) patients were deemed to be suitable for endovascular treatment. The diameters of ascending aorta from the sinotubular junction to the IA level presented a downward trend, and the proximal diameters differed significantly from distal diameters of the endograft for TAAD (39.9 versus 36.2 mm, P<0.01), implying that the conical endograft might be compatible with the ascending pathology. In the ascending aorta, lengths of the endograft should be 50, 60, 70, 80, and 90 mm in five (10.4%), 22 (45.9%), 13 (27.1%), six (12.5%), and two (4.2%) patients, respectively. Conclusion In this selected number of Chinese patients, the suitability of endovascular repair has been demonstrated based on the CT imaging. Shorter, larger, and bare spring-free conical endografts were preferred in the

  13. Open triple-branched stent graft applied to patient of acute type a aortic dissection with Aberrant Right Subclavian Artery

    PubMed Central

    2013-01-01

    A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was sutured to mono–branched vascular prosthesis. Follow-up computed tomography angiography showed false lumen of the dissection disappeared with satisfactory position of the triple-branched stent graft. PMID:23587108

  14. Abdominal aortic aneurysm presenting as meralgia paraesthetica.

    PubMed Central

    Brett, A; Hodgetts, T

    1997-01-01

    A case of abdominal aortic aneurysm is reported in a patient with long standing low back pain, presenting as meralgia paraesthetica and an increase in the severity of back pain. The case highlights the need for objective assessment of new symptoms arising in a chronic condition, and for a systematic approach to the assessment of radiographs performed in the accident and emergency department. Images p50-a PMID:9147718

  15. Arch-first technique via clamshell incision: successful surgical reoperation for aortic arch dissection.

    PubMed

    Ozkara, Ahmet; Cetin, Gurkan; Mert, Murat; Akinci, Okan; Erdem, Can Caglar; Suzer, Kaya

    2005-01-01

    We report a case of successful reoperation for aortic arch dissection with use of the "arch-first" technique in a patient who had Marfan syndrome. Extracorporeal circulation was initiated via right subclavian artery cannulation, and the chest was entered through a clamshell incision for the best exposure. When the patient was cooled to 18 degrees C, the perfusion was stopped. After the 1st aortic arch anastomosis to a 30-mm Dacron graft, cerebral perfusion was reestablished via the right subclavian artery. The aortic repair was then completed. The cerebral ischemic time was 18 minutes, the aortic cross-clamp time was 69 minutes, and the total extracorporeal circulation time was 334 minutes. The patient was discharged from the hospital on postoperative day 10 with no neurologic impairment. The arch-first technique shortens the duration of brain ischemia. When combined with a clamshell incision, the technique is particularly helpful for reoperation of the aortic arch and thoracic aorta.

  16. GenTAC Registry Report: Gender Differences Among Individuals with Genetically-Triggered Thoracic Aortic Aneurysm and Dissection

    PubMed Central

    Holmes, Kathryn W.; Maslen, Cheryl L.; Kindem, Mark; Kroner, Barbara L.; Song, Howard K.; Ravekes, William; Dietz, H.C.; Weinsaft, Jonathan W.; Roman, Mary J.; Devereux, Richard B.; Pyeritz, Reed E.; Bavaria, Joseph; Milewski, Karianna; Milewicz, Dianna; LeMaire, Scott A.; Hendershot, Tabitha; Eagle, Kim A.; Tolunay, H. Eser; Desvigne-Nickens, Patrice; Silberbach, Michael

    2013-01-01

    Previous data suggest women are at increased risk of death from aortic dissection. Therefore, we analyzed data from the GenTAC registry, the NIH-sponsored program that collects information about individuals with genetically-triggered thoracic aortic aneurysms and cardiovascular conditions. We performed cross-sectional analyses in adults with Marfan syndrome (MFS), familial thoracic aortic aneurysm or dissection (FTAAD), bicuspid aortic valve (BAV) with thoracic aortic aneurysm or dissection, and subjects under 50 years of age with thoracic aortic aneurysm or dissection (TAAD<50y). Women comprised 32% of 1449 subjects and were 21% of subjects with BAV, 34% with FTAAD, 22% with TAAD <50y, and 47% with MFS. Thoracic aortic dissections occurred with equal gender frequency yet women with BAV had more extensive dissections. Aortic size was smaller in women but was similar after controlling for BSA. Age at operation for aortic valve dysfunction, aneurysm or dissection did not differ by gender. Multivariate analysis (adjusting for age, BSA, hypertension, study site, diabetes, and subgroup diagnoses) showed that women had fewer total aortic surgeries (OR= 0.65, p < 0.01) and were less likely to receive angiotensin converting enzyme inhibitors (ACEi) (OR=0.68, p < 0.05). As in BAV, other genetically-triggered aortic diseases such as FTAAD and TAAD<50 are more common in males. In women, decreased prevalence of aortic operations and less treatment with ACEi may be due to their smaller absolute aortic diameters. Longitudinal studies are needed to determine if women are at higher risk for adverse events. PMID:23444191

  17. Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?†.

    PubMed

    Shrestha, Malakh; Fleissner, Felix; Ius, Fabio; Koigeldiyev, Nurbol; Kaufeld, Tim; Beckmann, Erik; Martens, Andreas; Haverich, Axel

    2015-02-01

    Acute type A aortic dissection (AADA) is a surgical emergency. In patients with aortic arch and descending aorta (DeBakey type I) involvement, performing a total aortic arch replacement with frozen elephant trunk (FET) for supposedly better long-term results is controversial. We hereby present our results. From February 2004 to August 2013, 52 patients with acute aortic dissection DeBakey type I received a FET procedure at our centre (43 males, age 59.21 ± 11.67 years). All patients had an intimal tear in the aortic arch and/or proximal descending aorta. Concomitant procedures were Bentall (n = 15) and aortic valve repair (n = 30). Cardiopulmonary bypass (CPB), X-clamp and cardiac arrest times were 262 ± 64, 159 ± 45 and 55 ± 24 min, respectively. The 30-day mortality rate was 13% (n = 7). Stroke and re-thoracotomy for bleeding were 12% (n = 6) and 23% (n = 12), respectively. Postoperative recurrent nerve palsy and spinal cord injury rates were 10% (5 of 52) and 4% (2 of 52), respectively. Follow-up was 40 ± 24 months. During follow-up, no patient died and no patient required a reoperation for the aortic arch. Our results with FET in AADA show acceptable results. Total aortic arch replacement with an FET in AADA patients does demand high technical skills. In spite of this, we believe FET improves long-term outcomes in cases of AADA with intima tear or re-entry in the aortic arch or the descending aorta (DeBakey type I). Modern grafts with four side branches as well as sewing collars for the distal anastomosis have helped to further 'simplify' the FET implantation. However, such a strategy is not appropriate in all AADA cases; it should be implemented only in experienced centres and only if absolutely necessary. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair

    PubMed Central

    Galvin, Sean D.; Perera, Nisal K.

    2016-01-01

    Acute type A dissection (ATAAD) remains a morbid condition with reported surgical mortality as high as 25%. We describe our surgical approach to ATAAD and discuss the indications for adjunct techniques such as the frozen elephant trunk or complete aortic repair with endovascular methods. Arch replacement using the “branch-first technique” allows for complete root, ascending aorta, and arch replacement. A long landing zone is created for proximal endografting with a covered stent. Balloon-assisted intimal disruption and bare metal stenting of all residual dissected aorta to the level of the aortic bifurcation is then performed to obliterate the false lumen (FL) and achieve single true lumen (TL) flow. Additional branch vessel stenting is performed as required. PMID:27386413

  19. Endovascular treatment of type B dissection in patients with Marfan syndrome: mid-term outcomes and aortic remodeling.

    PubMed

    Eid-Lidt, Guering; Gaspar, Jorge; Meléndez-Ramírez, Gabriela; Cervantes S, Jorge; González-Pacheco, Hector; Dámas de Los Santos, Félix; Meave-González, Aloha; Ramírez Marroquín, Samuel

    2013-12-01

    To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair. Copyright © 2013 Wiley Periodicals, Inc.

  20. The Expanding Clinical Spectrum of Extracardiovascular and Cardiovascular Manifestations of Heritable Thoracic Aortic Aneurysm and Dissection.

    PubMed

    Bradley, Timothy J; Bowdin, Sarah C; Morel, Chantal F J; Pyeritz, Reed E

    2016-01-01

    More than 30 heritable conditions are associated with thoracic aortic aneurysm and dissection (TAAD). Heritable syndromic conditions, such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome, have somewhat overlapping systemic features, but careful clinical assessment usually enables a diagnosis that can be validated with genetic testing. Nonsyndromic FTAAD can also occur and in 20%-25% of these probands mutations exist in genes that encode elements of the extracellular matrix, signalling pathways (especially involving transforming growth factor-β), and vascular smooth muscle cytoskeletal and contractile processes. Affected individuals with either a syndromic presentation or isolated TAAD can have mutations in the same gene. In this review we focus on the genes currently known to have causal mutations for syndromic and isolated FTAAD and outline the range of associated extracardiovascular and cardiovascular manifestations with each. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Early Coronary Thrombosis without ST-Segment Elevation Following Repair of Acute Aortic Dissection

    PubMed Central

    Carino, Davide; Nicolini, Francesco; Romano, Giorgio; Ricci, Matteo; Gherli, Tiziano

    2016-01-01

    Acute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting. PMID:28097197

  2. Percutaneous fenestration of aortic dissection: Salvage of an ischemic solitary left kidney

    SciTech Connect

    Park, Jae Hyung; Chung, Jin Wook; Cho, Yoon Koo; Kim, Sun Ho; Ahn, Hyuk; Oh, Byung Hee

    1997-03-15

    The false channel of a type III aortic dissection caused acute renal ischemia by compression of the origin of the left renal artery in a patient with status post-right nephrectomy. To relieve the ischemia and restore renal function, percutaneous balloon fenestration was performed successfully.

  3. Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations.

    PubMed

    Colli, Andrea; Carrozzini, Massimiliano; Galuppo, Marco; Comisso, Marina; Toto, Francesca; Gregori, Dario; Gerosa, Gino

    2016-10-01

    To evaluate predictors of early and long-term outcomes of surgical repair of acute Type A aortic dissection. Retrospective single-centre study evaluating patients surgically treated between 1998 and 2013. Clinical follow-up was performed. Complications were classified according to the International Aortic Arch Surgery Study Group recommendations. Statistical analysis included univariate and multivariate analysis of preoperative and operative data. One hundred eighty-five patients were evaluated. The follow-up was complete for 180 patients (97 %). Mean age was 63 years, 82 % had a DeBakey type I aortic dissection, 18 % a type II. Eleven patients (6 %) died intraoperatively, 119 of the remaining (68 %) had postoperative complications. Thirty-day mortality was 21 % (38 patients). Average ICU and hospital stay were 6 and 14 days, respectively. During a mean follow-up time of 6 ± 4 years we observed 44 deaths (31 %). Twenty patients (14 %) needed late thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with abdominal pain at presentation (p < 0.01). The incidence of postoperative complications was related to older age at intervention (p < 0.01) and longer cross-clamp time (p < 0.01). Mortality at follow-up was significantly increased by older age at intervention (p < 0.01), with a logarithmic growth after 60 years, female sex (p < 0.01), preoperative limb ischemia (p = 0.02) and DHCA (p < 0.01). The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years.

  4. MRI in Chronic Aortic Dissection: A Systematic Review and Future Directions

    PubMed Central

    Sherrah, Andrew G.; Grieve, Stuart M.; Jeremy, Richmond W.; Bannon, Paul G.; Vallely, Michael P.; Puranik, Rajesh

    2015-01-01

    The acute event of thoracic aortic dissection carries with it high mortality and morbidity. Despite optimal initial surgical or medical management strategies, the risk of further complications in the long-term, including aneurysmal dilatation and false lumen (FL) expansion, are not insignificant. Adequate follow-up of such conditions requires dedicated imaging where relevant prognostic indicators are accurately assessed. We perform a systematic review of the literature and report the current evidence for the use of magnetic resonance imaging (MRI) in assessment of chronic aortic dissection. We then make a comparison with traditional imaging modalities including computed tomography and echocardiography. We discuss new ways in which MRI may extend existing aortic assessment, including identification of blood-flow dynamics within the TL and FL using phase-contrast imaging. PMID:26664877

  5. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) associated with acute aortic dissection: a study of two cases

    PubMed Central

    Strecker, Thomas; Bertz, Simone; Wachter, David Lukas; Weyand, Michael; Agaimy, Abbas

    2015-01-01

    Acute aortic dissection is a life-threatening condition mainly caused by hypertension, atherosclerotic disease and other degenerative diseases of the connective tissue of the aortic wall. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) is a rare benign reactive tumor-like lesion composed of admixture of histiocytes, mesothelial cells, and inflammatory cells set within a fibrinous meshwork without a vascular network or supporting stroma. Cardiac MICE occurring in association with aortic dissection is exceptionally rare (only one such case reported to date). We herein report on the surgical repair of two Stanford type A aortic dissections caused by idiopathic giant cell aortitis in a 66-year-old-woman and by atherosclerotic disease in a 58-year-old-man, respectively. In both cases, the dissections could be visualized via computed tomography. Histopathology showed cardiac incidental MICE within the external aortic wall near the pericardial surface which was confirmed by immunohistochemistry. PMID:26097568

  6. Independent risk factors for hypoxemia after surgery for acute aortic dissection

    PubMed Central

    Sheng, Wei; Yang, Hai-Qin; Chi, Yi-Fan; Niu, Zhao-Zhuo; Lin, Ming-Shan; Long, Sun

    2015-01-01

    Objectives: To determine risk factors associated with postoperative hypoxemia after surgery for acute type A aortic dissection. Methods: We retrospectively analyzed the clinical data of 192 patients with acute type A aortic dissection who underwent surgery in Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, China between January 2007 and December 2013. Patients were divided into hypoxemia group (n=55) [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤200 mm Hg] and non-hypoxemia group (n=137) [PaO2/FiO2 >200 mm Hg]. Perioperative clinical data were analyzed and compared between the 2 groups. Results: The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.6% (55/192). Perioperative death occurred in 13 patients (6.8%). Multivariate regression identified body mass index (BMI) >25 kg/m2 (OR=21.929, p=0.000), deep hypothermic circulatory arrest (DHCA) (OR=11.551, p=0.000), preoperative PaO2/FiO2 ≤300 mm Hg (OR=7.830, p=0.000) and blood transfusion >6U in 24 hours postoperatively (OR=12.037, p=0.000) as independent predictors of postoperative hypoxemia for patients undergoing Stanford A aortic dissection surgery. Conclusion: Our study demonstrated that BMI >25 kg/m2, DHCA, preoperative PaO2/FiO2 ≤300 mm Hg, and blood transfusion in 24 hours postoperatively >6U were independent risk factors of the hypoxemia after acute type A aortic dissection aneurysm surgery. PMID:26219444

  7. Treatment of a Chronic Aneurysmal Aortic Dissection in a Patient with Marfan Syndrome Using a Staged Hybrid Procedure and a Fenestrated Endograft

    SciTech Connect

    Walkden, R. Miles Morgan, Rob A.; Loftus, Ian; Thompson, Matt

    2008-07-15

    Patients with aneurysmal dissections involving both the thoracic and the abdominal aorta are particularly challenging to treat with endovascular techniques because of the natural communications at the level of the visceral arteries. We present the case of a patient with Marfan syndrome with an aneurysmal aortic dissection involving the thoracic and abdominal aorta who was treated by a combination of endografts, surgical bypass, and a fenestrated tube graft.

  8. Role of Microvascular Tone and Extracellular Matrix Contraction in the Regulation of Interstitial Fluid: Implications for Aortic Dissection.

    PubMed

    Mallat, Ziad; Tedgui, Alain; Henrion, Daniel

    2016-09-01

    The pathophysiology of aortic dissection is poorly understood, and its risk is resistant to medical treatment. Most studies have focused on a proposed pathogenic role of transforming growth factor-β in Marfan disease and related thoracic aortic aneurysms and aortic dissections. However, clinical testing of this concept using angiotensin II type 1 receptor antagonists to block transforming growth factor-β signaling fell short of promise. Genetic mutations that predispose to thoracic aortic aneurysms and aortic dissections affect components of the extracellular matrix and proteins involved in cellular force generation. Thus, a role for dysfunctional mechanosensing in abnormal aortic wall remodeling is emerging. However, how abnormal mechanosensing leads to aortic dissection remains a mystery. Here, we review current knowledge about the regulation of interstitial fluid dynamics and myogenic tone and propose that alteration in contractile force reduces vascular tone in the microcirculation (here, aortic vasa vasorum) and leads to elevations of blood flow, transmural pressure, and fluid flux into the surrounding aortic media. Furthermore, reduced contractile force in medial smooth muscle cells coupled with alteration of structural components of the extracellular matrix limits extracellular matrix contraction, further promoting the formation of intramural edema, a critical step in the initiation of aortic dissection. The concept is supported by several pathophysiological and clinical observations. A direct implication of this concept is that drugs that lower blood pressure and limit interstitial fluid accumulation while preserving or increasing microvascular tone would limit the risk of dissection. In contrast, drugs that substantially lower microvascular tone would be ineffective or may accelerate the disease and precipitate aortic dissection.

  9. Risk factors for prolonged mechanical ventilation after total aortic arch replacement for acute DeBakey type I aortic dissection.

    PubMed

    Li, Cheng-Nan; Chen, Lei; Ge, Yi-Peng; Zhu, Jun-Ming; Liu, Yong-Min; Zheng, Jun; Liu, Wei; Ma, Wei-Guo; Sun, Li-Zhong

    2014-09-01

    EuroSCORE II is an objective risk scoring model. The aim of this study was to assess the performance of EuroSCORE II in the prediction of prolonged mechanical ventilation following total aortic arch replacement for acute DeBakey type I aortic dissection and evaluate the risk factors for prolonged mechanical ventilation. Between February 2009 to February 2012, data from 240 patients who underwent total aortic arch replacement for acute DeBakey type I aortic dissection were collected retrospectively. Mechanical ventilation after the surgery longer than 48 hours was defined as postoperative prolonged mechanical ventilation. EuroSCORE II was applied to predict prolonged mechanical ventilation. A C statistic (receiver operating characteristic curve) was used to test discrimination of the model. Calibration was assessed with a Hosmer-Lemeshow goodness-of-fit statistic. Multiple logistic regression analysis was used to identify the final risk factors of prolonged mechanical ventilation. The overall mortality was 10%. The mean length of mechanical ventilation after total aortic arch replacement was 42.72 ± 51.45 hours. Total 74 patients needed prolonged mechanical ventilation. EuroSCORE II showed poor discriminatory ability (C statistic 0.52) and calibration (Hosmer-Lemeshow, p<0.05) in predicting prolonged mechanical ventilation. On multivariate analysis, independent risk factors for postoperative prolonged mechanical ventilation were age ≥ 48.5 years (p<0.001, OR=3.85), preoperative leukocyte count ≥ 13.5 × 10⁹/L (p<0.001, OR=4.05) and symptom onset before the surgery less than one week (p=0.002, OR=3.75). EuroSCORE II could not predict prolonged mechanical ventilation following total aortic arch replacement for acute DeBakey type I aortic dissection. Preoperative high level of leukocyte, age and surgical period from symptom onset are risk factors for prolonged mechanical ventilation. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic

  10. Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

    PubMed Central

    Huang, Fang; Chen, Qiang; Lai, Qing-quan; Huang, Wen-han; Wu, Hong; Li, Wei-cheng

    2016-01-01

    Abstract The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD). From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy. In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation. MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information. PMID:27684852

  11. Altered Smooth Muscle Cell Force Generation as a Driver of Thoracic Aortic Aneurysms and Dissections.

    PubMed

    Milewicz, Dianna M; Trybus, Kathleen M; Guo, Dong-Chuan; Sweeney, H Lee; Regalado, Ellen; Kamm, Kristine; Stull, James T

    2017-01-01

    The importance of maintaining contractile function in aortic smooth muscle cells (SMCs) is evident by the fact that heterozygous mutations in the major structural proteins or kinases controlling contraction lead to the formation of aneurysms of the ascending thoracic aorta that predispose to life-threatening aortic dissections. Force generation by SMC requires ATP-dependent cyclic interactions between filaments composed of SMC-specific isoforms of α-actin (encoded by ACTA2) and myosin heavy chain (MYH11). ACTA2 and MYH11 mutations are predicted or have been shown to disrupt this cyclic interaction predispose to thoracic aortic disease. Movement of the myosin motor domain is controlled by phosphorylation of the regulatory light chain on the myosin filament, and loss-of-function mutations in the dedicated kinase for this phosphorylation, myosin light chain kinase (MYLK) also predispose to thoracic aortic disease. Finally, a mutation in the cGMP-activated protein kinase (PRKG1) results in constitutive activation of the kinase in the absence of cGMP, thus driving SMC relaxation in part through increased dephosphorylation of the regulatory light chain and predisposes to thoracic aortic disease. Furthermore, SMCs cannot generate force without connections to the extracellular matrix through focal adhesions, and mutations in the major protein in the extracellular matrix, fibrillin-1, linking SMCs to the matrix also cause thoracic aortic disease in individuals with Marfan syndrome. Thus, disruption of the ability of the aortic SMC to generate force through the elastin-contractile units in response to pulsatile blood flow may be a primary driver for thoracic aortic aneurysms and dissections.

  12. Role of Mechanotransduction in Vascular Biology: Focus on Thoracic Aortic Aneurysms and Dissections

    PubMed Central

    Humphrey, J.D.; Schwartz, M.A.; Tellides, G.; Milewicz, D.M.

    2015-01-01

    Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the wall. We have only limited understanding, however, of the mechanobiological processes that lead to these potentially lethal conditions. Homeostasis requires that intramural cells sense their local chemo-mechanical environment and establish, maintain, remodel, or repair the extracellular matrix to provide suitable compliance and yet sufficient strength. Proper sensing, in turn, necessitates both receptors that connect the extracellular matrix to intracellular actomyosin filaments and signaling molecules that transmit the related information to the nucleus. Thoracic aortic aneurysms and dissections are associated with poorly controlled hypertension and mutations in genes for extracellular matrix constituents, membrane receptors, contractile proteins, and associated signaling molecules. This grouping of factors suggests that these thoracic diseases result, in part, from dysfunctional mechanosensing and mechanoregulation of the extracellular matrix by the intramural cells, which leads to a compromised structural integrity of the wall. Thus, improved understanding of the mechanobiology of aortic cells could lead to new therapeutic strategies for thoracic aortic aneurysms and dissections. PMID:25858068

  13. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections.

    PubMed

    Humphrey, Jay D; Schwartz, Martin A; Tellides, George; Milewicz, Dianna M

    2015-04-10

    Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the wall. We have only limited understanding, however, of the mechanobiological processes that lead to these potentially lethal conditions. Homeostasis requires that intramural cells sense their local chemomechanical environment and establish, maintain, remodel, or repair the extracellular matrix to provide suitable compliance and yet sufficient strength. Proper sensing, in turn, necessitates both receptors that connect the extracellular matrix to intracellular actomyosin filaments and signaling molecules that transmit the related information to the nucleus. Thoracic aortic aneurysms and dissections are associated with poorly controlled hypertension and mutations in genes for extracellular matrix constituents, membrane receptors, contractile proteins, and associated signaling molecules. This grouping of factors suggests that these thoracic diseases result, in part, from dysfunctional mechanosensing and mechanoregulation of the extracellular matrix by the intramural cells, which leads to a compromised structural integrity of the wall. Thus, improved understanding of the mechanobiology of aortic cells could lead to new therapeutic strategies for thoracic aortic aneurysms and dissections.

  14. Simulations of blood flow in patient-specific aortic dissections with a deformable wall model

    NASA Astrophysics Data System (ADS)

    Baeumler, Kathrin; Vedula, Vijay; Sailer Karmann, Anna; Marsden, Alison; Fleischmann, Dominik

    2016-11-01

    Aortic dissection is a life-threatening condition in which blood penetrates into the vessel wall, creating a second flow channel, often requiring emergency surgical repair. Up to 50% of patients who survive the acute event face late complications like aortic dilatation and eventual rupture. Prediction of late complications, however, remains challenging. We therefore aim to perform accurate and reliable patient-specific simulations of blood flow in aortic dissections, validated by 4D-Flow MRI. Among other factors, this is a computational challenge due to the compliance of the vessel walls and the large degree of membrane deformation between the two flow channels. We construct an anatomic patient-specific model from CT data including both flow channels and the membrane between them. We then run fluid structure interaction simulations using an arbitrary Lagrangian-Eulerian (ALE) formulation within a multiscale variational framework, employing stabilized finite element methods. We compare hemodynamics between a rigid and a deformable wall model and examine membrane dynamics and pressure differences between the two flow channels. The study focuses on the computational and modeling challenges emphasizing the importance of employing a deformable wall model for aortic dissections.

  15. The genetic message of a sudden, unexpected death due to thoracic aortic dissection.

    PubMed

    Ripperger, Tim; Tröger, Hans Dieter; Schmidtke, Jörg

    2009-05-30

    Thoracic aortic aneurysms are associated with sudden, unexpected death due to dissection and/or rupture. In such cases, the latent, preceding state of aortic dilatation has often gone undiagnosed. As a consequence of the sudden unresolved death, medico-legal autopsy requested by a public prosecutor will be the consequence to establish the cause and manner of death. Usually, autopsy records do not include relevant information for differential diagnosis of heritable syndromic and non-syndromic diseases associated with thoracic aortic aneurysms/dissections (TAAD), including e.g. Marfan syndrome, Loeys-Dietz syndrome, and isolated thoracic aortic aneurysms/dissection. However, for at-risk relatives of the deceased, it could be of great benefit to be alerted to the potential heritable aetiology, because early diagnosis of the latent stage of the disease would allow preventive management. Such attempts, including recommendations to seek genetic counselling, are nevertheless rarely made in the context of medico-legal autopsies, in which primarily the legal aspects are considered. We report here on three cases to underline the practical relevance of (i) documentation of relevant information for differential diagnosis of TAAD-associated disorders, (ii) storage of unfixed tissue samples for subsequent molecular genetic testing, and most importantly (iii) the information of relatives at risk. In view of the general ethical principal of nonmaleficience, direct or indirect contact with family members of victims of possible heritable forms of TAAD should be established as a standard of care, also in the medico-legal setting.

  16. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection

    SciTech Connect

    Liu Jincheng; Zhang Jinzhou Yang Jian; Zuo Jian; Zhang Jinbao; Yu Shiqiang; Chen Tao; Xu Xuezeng; Wei Xufeng; Yi Dinghua

    2008-07-15

    Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neurological complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks, or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.

  17. Marfan Syndrome and Related Heritable Thoracic Aortic Aneurysms and Dissections.

    PubMed

    De Backer, Julie; Renard, Marjolijn; Campens, Laurence; Mosquera, Laura Muino; De Paepe, Anne; Coucke, Paul; Callewaert, Bert; Kodolitsch, Yskert von

    2015-01-01

    In this overview we aim to address a number of recent insights and developments regarding clinical aspects, etiology, and treatment of Heritable Thoracic Aortic Disease (H-TAD). We will focus on monogenetic disorders related to aortic aneurysms. H-TADs are rare but they provide a unique basis for the study of underlying pathogenetic pathways in the complex disease process of aneurysm formation. The understanding of pathomechanisms may help us to identify medical treatment targets to improve prognosis. Among the monogenetic aneurysm disorders, Marfan syndrome is considered as a paradigm entity and many insights are derived from the study of clinical, genetic and animal models for Marfan syndrome. We will therefore first provide a detailed overview of the various aspects of Marfan syndrome after which we will give an overview of related H-TAD entities.

  18. Intensive blood pressure control in patients with acute type B aortic dissection (RAID): study protocol for randomized controlled trial.

    PubMed

    Zhou, Jian-Cang; Zhang, Nan; Zhang, Zhong-Heng; Wang, Ting-Ting; Zhu, Yue-Feng; Kang, Hui; Zhang, Wei-Min; Li, Dong-Lin; Li, Wei-Dong; Liu, Zhen-Jie; Qian, Xi-Min; Zhang, Ming-You; Wang, Jue; Zhou, Mi; Yang, Zhi-Tao; Yu, Yun-Xian; Li, Hang-Yang; Zhang, Jian; Wang, Yong-Gang; Gao, Jian-Ping; Ling, Lin; Pan, Kong-Han

    2017-05-01

    Blood pressure control is an essential therapy for patients with acute type B aortic dissection (ABAD) and should be maintained throughout the entire treatment. Thus, vast majority current guidelines recommend control the blood pressure to lower than 140/90 mmHg. Theoretically, a much lower target may further decrease the risk of propagation of dissection. However, some argued that too lower blood pressure would compromise the organ perfusion. Thus, there is no unanimous optimal target for blood pressure in patients with ABAD so far. The present study aimed to investigate the optimal blood pressure target for patients with ABAD, in the hope that the result would optimize the treatment of aortic dissection (AD). The study is a multi-center randomized controlled clinical trial. Study population will include patients with new diagnosed ABAD and hypertension. Blocked randomization was performed where intensive blood pressure control (<120 mmHg) with conventional blood pressure control (<140 mmHg) were allocated at random in a ratio of 1:1 in blocks of sizes 4, 6, 8, and 10 to 360 subjects. Interim analysis will be performed. The primary outcome is a composite in-hospital adverse outcome, including death, permanent paraplegia or semi- paralysis during the hospitalization, and renal failure requiring hemodialysis at discharge. While the secondary outcomes include the aortic size, lower extremity or visceral ischemia, retrograde propagation into aortic arch or ascending aorta, mortality in 6 months and 1 year, intensive care unit (ICU) length of stay, total length of hospital stay, creatinine level, and surgical or endovascular intervention. The study was approved by the institutional review board of Sir Run Run Shaw Hospital (approval number: 20160920-9). Informed consent will be obtained from participants or their next-of-kin. The results will be published in a peer-reviewed journal and shared with the worldwide medical community. NCT03001739 (https://register.clinicaltrials.gov/).

  19. Chronobiology of Acute Aortic Dissection in the Marfan Syndrome (from the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions and the International Registry of Acute Aortic Dissection).

    PubMed

    Siddiqi, Hasan K; Luminais, Steven N; Montgomery, Dan; Bossone, Eduardo; Dietz, Harry; Evangelista, Arturo; Isselbacher, Eric; LeMaire, Scott; Manfredini, Roberto; Milewicz, Dianna; Nienaber, Christoph A; Roman, Mary; Sechtem, Udo; Silberbach, Michael; Eagle, Kim A; Pyeritz, Reed E

    2017-03-01

    Marfan syndrome (MFS) is an autosomal dominant connective tissue disease associated with acute aortic dissection (AAD). We used 2 large registries that include patients with MFS to investigate possible trends in the chronobiology of AAD in MFS. We queried the International Registry of Acute Aortic Dissection (IRAD) and the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) registry to extract data on all patients with MFS who had suffered an AAD. The group included 257 patients with MFS who suffered an AAD from 1980 to 2012. The chi-square tests were used for statistical testing. Mean subject age at time of AAD was 38 years, and 61% of subjects were men. AAD was more likely in the winter/spring season (November to April) than the other half of the year (57% vs 43%, p = 0.05). Dissections were significantly more likely to occur during the daytime hours, with 65% of dissections occurring from 6 a.m. to 6 p.m. (p = 0.001). Men were more likely to dissect during the daytime hours (6 a.m. to 6 p.m.) than women (74% vs 51%, p = 0.01). These insights offer a glimpse of the times of greatest vulnerability for patients with MFS who suffer from this catastrophic event. In conclusion, the chronobiology of AAD in MFS reflects that of AAD in the general population.

  20. Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities.

    PubMed

    Delsart, Pascal; Maldonado-Kauffmann, Pauline; Bic, Mathieu; Boudghene-Stambouli, Fanny; Sobocinski, Jonathan; Juthier, Francis; Domanski, Olivia; Coisne, Augustin; Azzaoui, Richard; Rousse, Natacha; Fayad, George; Modine, Thomas; Haulon, Stephan; Vincentelli, Andre; Mounier-Vehier, Claire; Montaigne, David

    2016-09-15

    Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these patients are unexplored yet. We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. The population was composed of 76% of male, with a mean age of 57.9±12.4years. There were an equal distribution between the two type of dissection (47% of type A and 53% of type B aortic dissection). No cardiac event occurred during or after CPX. One third of patients have normal aerobic exercise capacity defined as peak oxygen uptake upper than 85% of their predicted capacity. Mean oxygen uptake peak was quite low 19.2±5.2ml/kg/min (5.5±1.5 metabolic equivalents). Aerobic capacity was limited by cardiac chronotropic incompetence in 42% or peripheral deconditioning in 45%. Blood pressure remained in an acceptable range during the exercise. Systolic and diastolic blood pressures were respectively 151±20 and 77±13mmHg at first ventilatory threshold. CPX is a safe exploration in patients with post aortic dissection syndrome. Given the fact that most of these patients are faced with significant alteration of aerobic capacities, the recommended daily practice of moderate exercise at 3-5 METS should be adapted and personalized to each patient thanks to CPX. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Presence of simple renal cysts is associated with increased risk of aortic dissection: a common manifestation of connective tissue degeneration?

    PubMed

    Kim, Eun Kyoung; Choi, E Ryoung; Song, Bong Gun; Jang, Shin Yi; Ko, Sung Min; Choi, Seung-Hyuk; Sung, Jidong; Sung, Kiick; Choe, Yeon Hyeon; Oh, Jae K; Kim, Duk-Kyung

    2011-01-01

    Aortic dissection is a multifactorial disease whose primary pathology is connective tissue degeneration of the aorta's medial layer. It was hypothesised that the presence of renal cysts, another possible manifestation of connective tissue weakness, would be associated with increased risk of aortic dissection. The incidence of simple renal cysts on CT angiography in 518 patients with aortic dissection (AD group) and 1366 healthy subjects (control group) who underwent CT for routine health screening was compared. To reduce the effects of selection bias and confounding variables, data were adjusted by propensity score matching. The prevalence of simple renal cysts was 37.8% in the AD group and 22.0% in the control group, a statistically significant difference (p<0.0001). The prevalence of renal cysts was even greater in patients with the following characteristics: intramural haematoma, type B dissection, normal blood pressure or advanced age. In the 311 matched cohorts after propensity score matching, the prevalence of simple renal cysts was still significantly higher in the AD group than in the control group (33.8% vs 25.7%, p = 0.023). Multivariate analysis confirmed that the presence of renal cysts (OR 1.49, p = 0.0245) could be a marker of having a common underlying mechanism with aortic dissection. Patients with aortic dissection have an increased burden of renal cysts compared with healthy controls. This finding suggests that the connective tissue weakness that predisposes patients to renal cysts may be associated with aortic dissection.

  2. Granulocyte macrophage colony-stimulating factor is required for aortic dissection/intramural haematoma.

    PubMed

    Son, Bo-Kyung; Sawaki, Daigo; Tomida, Shota; Fujita, Daishi; Aizawa, Kenichi; Aoki, Hiroki; Akishita, Masahiro; Manabe, Ichiro; Komuro, Issei; Friedman, Scott L; Nagai, Ryozo; Suzuki, Toru

    2015-04-29

    Aortic dissection and intramural haematoma comprise an aortopathy involving separation of the aortic wall. Underlying mechanisms of the condition remain unclear. Here we show that granulocyte macrophage colony-stimulating factor (GM-CSF) is a triggering molecule for this condition. Transcription factor Krüppel-like factor 6 (KLF6)-myeloid-specific conditional deficient mice exhibit this aortic phenotype when subjected to aortic inflammation. Mechanistically, KLF6 downregulates expression and secretion of GM-CSF. Administration of neutralizing antibody against GM-CSF prevents the condition in these mice. Conversely, administration of GM-CSF in combination with aortic inflammation to wild-type mice is sufficient to induce the phenotype, suggesting the general nature of effects. Moreover, patients with this condition show highly increased circulating levels of GM-CSF, which is also locally expressed in the dissected aorta. GM-CSF is therefore a key regulatory molecule causative of this aortopathy, and modulation of this cytokine might be an exploitable treatment strategy for the condition.

  3. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    PubMed Central

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  4. The impact of surgical strategy on survival after repair of type A aortic dissection.

    PubMed

    Lawton, Jennifer S; Liu, Jingxia; Kulshrestha, Kevin; Moon, Marc R; Damiano, Ralph J; Maniar, Hersh; Pasque, Michael K

    2015-08-01

    A diverse group of operative strategies are utilized for treatment of acute Stanford type A aortic dissection. We hypothesized that a surgical strategy to prevent cross-clamp injury or false lumen pressurization would be associated with reduced morbidity, mortality, persistent false lumen patency, and improved survival. This study was designed to determine the differences in outcomes between operative techniques. Outcomes and postoperative imaging were compared in patients who underwent surgery for acute type A aortic dissection. Two groups were compared, based on operative strategy. The surgical strategy for group 1 consisted of no aortic cross-clamp use, use of deep hypothermic circulatory arrest, and use of only antegrade perfusion after aortic replacement. The surgical strategy for group 2 consisted of any other combination that lacked 1 of these 3 technical steps. Between January 1, 1996, and December 31, 2012, a total of 196 patients underwent surgery for acute type A aortic dissection. Operative mortality and postoperative morbidity were not statistically different between groups. Mean follow-up time was 3.95 (range: 0-15.4) years. Persistence of a false lumen was not statistically different between groups (P = .78). Overall survival was significantly better in group 1, versus group 2 (P = .0020). Multivariate Cox regression identified preoperative renal failure, chronic lung disease, greater number of packed red blood cells transfused, and being in group 2 as risk factors for poor long-term survival. The operative strategy of group 1 (no cross-clamp, use of DHCA and antegrade perfusion) was associated with a highly significant improvement in survival, despite a lack of statistical difference in the incidence of persistent false aortic lumen between groups. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. Technical Aspects of Open Repair for Degenerative Aneurysmal Evolution Despite Early Thoracic Endovascular Repair of Type B Aortic Dissection.

    PubMed

    Aguir, Sonia; El Batti, Salma; Achouh, Paul; Julia, Pierre; Bel, Alain; Fabiani, Jean-Noël; Alsac, Jean-Marc

    2017-04-01

    Closure of the proximal tear by thoracic endovascular aortic repair (TEVAR) at the acute phase appears to be a safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoracoabdominal aneurysm despite early closure proximal tear by TEVAR. During a period of 5 years, 96 patients presenting acute type B aortic dissections were treated by TEVAR and followed-up in our institution. Among them, 5 patients experienced an evolution to a dissecting thoracoabdominal aortic aneurysm. Their demographic data and initial medical conditions, delay to reintervention, operative technical details, perioperative and mid-term outcomes were collected and analyzed. All 5 patients (4 male, mean age 58 ± 9) were operated under peripheral normothermic bypass without deep circulatory arrest using the thoracic stent graft as an elephant trunk for completion of the proximal anastomosis. In cases of patency, the false lumen was reapproximated in the anastomosis, 6 visceral arteries were revascularized selectively. One patient died at day 1 of perioperative ventricular fibrillation due to an acute myocardial infarction. The 4 others are alive without complication after a median of 30 months, range (13-22). In our experience, TEVAR was not only efficient at the acute phase to deal with complications, but in cases of subsequent aneurysmal evolution, it made open repair even easier by avoiding very proximal cross-clamping/anastomosis and circulatory arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Coronary Reconnection in Emergency “Conduit Operation” for Acute Type-A Aortic Dissection with Aortic Insufficiency: Experience with 24 Cases

    PubMed Central

    Massimo, Carlo G.; Presenti, Luigi F.; Favi, Piero P.; Duranti, Alberto; Poma, Alberto G.; Marranci, Pierluigi; Modiano, Claudio

    1987-01-01

    Twenty-four cases of acute type-A aortic dissection with aortic valvular insufficiency were treated in our institution by means of an emergency operation in which the aortic valve, ascending aorta, and aortic arch were resected and replaced with a valved conduit that had been lengthened with a tubular Dacron graft. The procedure included the use of deep hypothermia for cerebral protection, as well as extracorporeal circulation. Aortic resection was performed from the aortic valve to the origin of the descending thoracic aorta; the aortic graft was anastomosed proximally to the valve annulus and distally to the descending aorta. The carotid orifices were connected to the side of the graft in a single tissue button. The coronary arteries were then reconnected by means of double venous bypass grafts to the innominate artery, to allow for inclusion of the graft. Within 1 month after operation, four patients died of the consequences of dissection. Six months postoperatively, one patient succumbed to an infarction. Six months to 5 years after operation, the remaining 19 patients are still alive. On the basis of this experience, we believe that acute type-A aortic dissection with aortic valvular insufficiency should be treated during the first hours after the onset of symptoms. The above-described procedure proved effective in the control of bleeding, which is the major risk in emergency operations of this type. (Texas Heart Institute Journal 1987; 14:418-421) Images PMID:15227299

  7. An Unusual Complication of Surgery for Type A Dissection Treated by Thoracic Endovascular Aortic Repair

    PubMed Central

    Petrilli, Giuseppe; Puppini, Giovanni; Torre, Salvo; Calzaferri, Daniele; Bugana, Antonella; Faggian, Giuseppe

    2013-01-01

    A 58-year-old man was admitted to our hospital for massive swelling in an anterior cervical location. Nine years earlier, he underwent surgical repair of a complex type A aortic dissection. This procedure was complicated by a fistula between the anastomosis of the graft and the descending aorta, resulting in massive presternal swelling. Therefore, we performed thoracic endovascular repair with successful sealing of the prosthetic leak, achieving progressive reduction in the collection of fluid. We propose thoracic endovascular aortic repair as an alternative to open surgical repair for the treatment of complicated cases. PMID:26798686

  8. Gene expression profiling of acute type A aortic dissection combined with in vitroassessment†.

    PubMed

    Kimura, Naoyuki; Futamura, Kyoko; Arakawa, Mamoru; Okada, Naoko; Emrich, Fabian; Okamura, Homare; Sato, Tetsuya; Shudo, Yasuhiro; Koyano, Tiffany K; Yamaguchi, Atsushi; Adachi, Hideo; Matsuda, Akio; Kawahito, Koji; Matsumoto, Kenji; Fischbein, Michael P

    2017-04-11

    The mechanisms underlying aortic dissection remain to be fully elucidated. We aimed to identify key molecules driving dissection through gene expression profiling achieved by microarray analysis and subsequent in vitro experiments using human aortic endothelial cells (HAECs) and aortic vascular smooth muscle cells (AoSMCs). Total RNA, including microRNA (miRNA), was isolated from the intima-media layer of dissected ascending aorta obtained intraoperatively from acute type A aortic dissection (ATAAD) patients without familial thoracic aortic disease ( n  = 8) and that of non-dissected ascending aorta obtained from transplant donors ( n  = 9). Gene expression profiling was performed with mRNA and miRNA microarrays, and results were confirmed by quantitative polymerase chain reaction (qPCR). Target genes and miRNA were identified by gene ontology analysis and a literature search. To reproduce the in silico results, HAECs and AoSMCs were stimulated in vitro by upstream cytokines, and expression of target genes was assessed by qPCR. Microarray analysis revealed 1536 genes (3.6%, 1536/42 545 probes) and 41 miRNAs (3.0%, 41/1368 probes) that were differentially expressed in the ATAAD group (versus donor group). The top 15 related pathways included regulation of inflammatory response, growth factor activity and extracellular matrix. Gene ontology analysis identified JAK2 (regulation of inflammatory response), PDGFA, TGFB1, VEGFA (growth factor activity) and TIMP3 , TIMP4, SERPINE1 (extracellular matrix) as the target genes and miR-21-5p, a TIMP3 repressor, as target miRNA that interacts with the target genes. Validation qPCR confirmed the altered expression of all 7 target genes and miR-21-5p in dissected aorta specimens (all genes, P  < 0.05). Ingenuity pathway analysis showed TNF-α and TGF-β to be upstream cytokines for the target genes. In vitro experiments showed these cytokines inhibit TIMP3 expression ( P  < 0.05) and enhance VEGFA expression ( P

  9. Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. Report of 26 cases.

    PubMed

    Bachet, J; Teodori, G; Goudot, B; Diaz, F; el Kerdany, A; Dubois, C; Brodaty, D; de Lentdecker, P; Guilmet, D

    1988-12-01

    In type A aortic dissection, the intimal disruption is located on or extends to the transverse arch in about 20% of patients. Replacement of the arch may then be necessary to avoid leaving an unresected, acutely dissected aorta and to prevent bleeding, progression of aneurysm, rupture, and ultimately reoperation or death. From 1970 to September 1987, 119 patients were operated on for type A acute dissection. Starting in January 1977, gelatin-resorcin-formaldehyde biologic glue was used in 91 patients to reinforce the dissected tissues at the suture sites. Among these 119 patients, 26 (ages 32 to 76 years) underwent replacement of the transverse aortic arch in addition to replacement of the ascending aorta. In 20 patients cerebral protection was achieved by profound hypothermia (16 degrees to 20 degrees C) associated with circulatory arrest (15 to 40 minutes, mean 27 minutes) during the distal anastomosis. In six patients the carotid arteries were selectively perfused with cold blood (6 degrees C) during moderate core hypothermia (28 degrees C) while cardiopulmonary bypass was discontinued (19 to 34 minutes, mean 25 minutes) to allow the prosthesis to be sutured without the distal aorta being cross-clamped. Moderate hypothermia avoided the long rewarming time necessitated by profound hypothermia. The hospital mortality rate was 34% (9/26). Two of the 20 patients subjected to profound hypothermia and circulatory arrest died during the operation and seven patients died of postoperative complications. No deaths or major complication were observed in the other six patients. Follow-up of the 17 survivors ranges from 3 to 90 months (mean 39). One patient died 6 months after the operation of cerebral hemorrhage. One patient is disabled by neurologic sequelae. Fifteen patients are in good clinical condition (New York Heart Association class I or II). Postoperative aortograms in 12 patients, and computed tomographic scans in all, have shown a stable repair of the transverse

  10. The Chronobiology of Stanford Type A Aortic Dissections

    PubMed Central

    DeAnda, Abe; Grossi, Eugene A.; Balsam, Leora B.; Moon, Marc R.; Barlow, Clifford W.; Navia, Daniel O.; Ursomanno, Patricia; Ziganshin, Bulat A.; Rabinovich, Annette E.; Elefteriades, John A.; Smith, Julian A.

    2015-01-01

    Background Seasonal variations of Stanford Type A dissections (STADs) have been previously described in the Northern Hemisphere (NH). This study sought to determine if these variation are mirrored in the Southern Hemisphere (SH). Methods Data from patients treated surgically for STADs were retrospectively obtained from existing administrative and clinical databases from NH and SH sites. Data points of interest included age, sex, date of dissection, and 30-day mortality. The dates of dissections (independent of year) were then organized by season. Results A total of 1418 patients were identified (729 NH and 689 SH) with complete data available for 1415; 896 patients were male with a mean age was 61 ± 14 years, and the overall 30-day mortality was 17.3%. Comparison of NH and SH on a month-to-month basis demonstrated a 6-month phase shift and a significant difference by season, with STADs occurring predominantly in the winter and least in the summer. Decomposition of the monthly incidence using Fourier analysis revealed the phase shift of the primary harmonic to be –21.9 and 169.8 degrees (days), respectively, for NH and SH. The resultant 191.7 day difference did not exactly correspond to the anticipated 6-month difference but was compatible with the original hypothesis. Conclusion Chronobiology plays a role in the occurrence of STADs with the highest occurrence in the winter months independent of the hemisphere. Season is not the predominant reason why aortas dissect, but for patients at risk, the increase in systemic vascular resistance during the winter months may account for the seasonal variations seen. PMID:27390746

  11. Novel Endovascular Management of Proximal Type A (DeBakey II) Aortic Dissection With a Patent Foramen Ovale Occluder.

    PubMed

    Yuan, Xun; Mitsis, Andreas; Mozalbat, David; Nienaber, Christoph A

    2017-08-01

    To present a novel endovascular management option that avoids open surgery in selected patients with subacute type A aortic dissection (DeBakey II). A 75-year-old woman with previous infrarenal abdominal aortic aneurysm repaired in 2006 and multiple comorbidities (EURO score II 20.5%) was admitted with chest pain; computed tomography angiography (CTA) showed a new dissection in the ascending aorta just above the right coronary ostium. As the patient was considered unfit to undergo surgery, an endovascular solution was suggested after multidisciplinary team discussion. With a single entry identified, coils were deployed in the false lumen followed by a patent foramen ovale (PFO) occluder placed across the entry tear to seal the cavity. Intraprocedural digital subtraction angiography and transesophageal echocardiography, as well as CTA 3 days postprocedure, confirmed an entirely thrombosed false lumen. The 6-month follow-up CTA demonstrated the PFO occluder firmly in place, shrinkage of the false lumen, and remodeling of the ascending aorta. Interventional management of the false lumen in proximal (type A) dissection is feasible and sustainable. The use of coils and closure devices may present a new, efficient, minimalistic strategy to avoid open surgery in selected cases.

  12. Dexmedetomidine Use in the Setting of Cocaine-Induced Hypertensive Emergency and Aortic Dissection: A Novel Indication

    PubMed Central

    Javed, Fahad; Benjo, Alexandre Miguel; Reddy, Kiran; Shoaib Akram, Muhammad; Khan, Shahzeb Afsar; Sabharwal, Manpreet Singh; Nadkarni, Girish; Aziz, Emad F.; Herzog, Eyal

    2011-01-01

    Aortic dissection is a potentially fatal but rare disease characterized by an aortic intimal tear with blood passing into the media creating a false lumen and with resultant high mortality depending on the location of dissection if not aggressively treated. Cocaine users are known to have a higher incidence of aortic dissection. We report here aortic dissection in a patient with cocaine abuse which did not respond to traditional medication regimes used currently in this setting. Worth mentioning is the use of an alpha-2 receptor selective agonist named Dexmedetomidine as a treatment modality to control hypertension in this patient, which is approved only for sedation of intubated and mechanically ventilated patients in the intensive care settings and for sedation during invasive procedures. This paper illustrates the practical beneficial role of Dexmedetomidine in controling blood pressure in the settings of cocaine-induced sympathetic surge when other treatment modalities fail. PMID:21961011

  13. Vascular Smooth Muscle Sirtuin-1 Protects Against Aortic Dissection During Angiotensin II–Induced Hypertension

    PubMed Central

    Fry, Jessica L; Shiraishi, Yasunaga; Turcotte, Raphaël; Yu, Xunjie; Gao, Yuan Z; Akiki, Rachid; Bachschmid, Markus; Zhang, Yanhang; Morgan, Kathleen G; Cohen, Richard A; Seta, Francesca

    2015-01-01

    Background Sirtuin-1 (SirT1), a nicotinamide adenine dinucleotide+–dependent deacetylase, is a key enzyme in the cellular response to metabolic, inflammatory, and oxidative stresses; however, the role of endogenous SirT1 in the vasculature has not been fully elucidated. Our goal was to evaluate the role of vascular smooth muscle SirT1 in the physiological response of the aortic wall to angiotensin II, a potent hypertrophic, oxidant, and inflammatory stimulus. Methods and Results Mice lacking SirT1 in vascular smooth muscle (ie, smooth muscle SirT1 knockout) had drastically high mortality (70%) caused by aortic dissection after angiotensin II infusion (1 mg/kg per day) but not after an equipotent dose of norepinephrine, despite comparable blood pressure increases. Smooth muscle SirT1 knockout mice did not show any abnormal aortic morphology or blood pressure compared with wild-type littermates. Nonetheless, in response to angiotensin II, aortas from smooth muscle SirT1 knockout mice had severely disorganized elastic lamellae with frequent elastin breaks, increased oxidant production, and aortic stiffness compared with angiotensin II–treated wild-type mice. Matrix metalloproteinase expression and activity were increased in the aortas of angiotensin II–treated smooth muscle SirT1 knockout mice and were prevented in mice overexpressing SirT1 in vascular smooth muscle or with use of the oxidant scavenger tempol. Conclusions Endogenous SirT1 in aortic smooth muscle is required to maintain the structural integrity of the aortic wall in response to oxidant and inflammatory stimuli, at least in part, by suppressing oxidant-induced matrix metalloproteinase activity. SirT1 activators could potentially be a novel therapeutic approach to prevent aortic dissection and rupture in patients at risk, such as those with hypertension or genetic disorders, such as Marfan’s syndrome. PMID:26376991

  14. Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection

    SciTech Connect

    Haesemeyer, Scott W.; Vedantham, Suresh Braverman, Alan

    2005-01-15

    Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.

  15. Extensive Iatrogenic Aortic Dissection During Renal Angioplasty: Successful Treatment with a Covered Stent-Graft

    SciTech Connect

    Rasmus, M.; Huegli, R.; Jacob, A.L.; Aschwanden, M.; Bilecen, D.

    2007-06-15

    An extensive iatrogenic aortic type B dissection during percutaneous transluminal renal angioplasty (PTRA) for bilateral renal artery stenosis was treated with a covered stent placed in the right renal artery. Control angiography confirmed closure of the entry. Postprocedural CT demonstrated a thick intramural hematoma (IMH) up to the left subclavian artery. CT follow-up at 8 months showed an almost complete resorption of the IMH. While medical treatment is the standard therapy for type B dissections, closure of the intimal tear with a covered stent may be an additional option in extensive cases during PTRA.

  16. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database.

    PubMed

    Kamman, Arnoud V; Brunkwall, Jan; Verhoeven, Eric L; Heijmen, Robin H; Trimarchi, Santi

    2017-04-01

    The high-risk patient cohort of uncomplicated type B aortic dissections (uTBADs) needs to be clarified. We compared uTBAD patients treated with best medical treatment (BMT), with and without aortic growth, from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial database. Furthermore, we looked for trends in outcome for aortic growth and remodeling after BMT and thoracic endovascular aortic repair (TEVAR) and BMT (TEVAR+BMT). BMT patients with available baseline and a 1-year follow-up arterial computed tomography scan were identified. True lumen and false lumen diameter was assessed at baseline and at follow-up. Patients with false lumen growth (group I) and without false lumen growth (group II) were compared. Predictors of false lumen and total lumen (aortic) growth were identified. Lastly, BMT outcomes were compared with BMT+TEVAR for false lumen thrombosis and change in false lumen and total aortic diameter in four sections: 0 to 10 cm (A), 10 to 20 cm (B), 20 to 30 cm (C), and 30 to 40 cm (D) from the left subclavian artery. The dissection was significantly longer in group I than in group II (43.2 ± 4.9 cm vs 30.4 ± 8.8 cm; P = .002). The number of vessels originating from the false lumen at baseline was identified as an independent predictor of false lumen growth (odds ratio, 22.1; 95% confidence interval, 1.01-481.5; P = .049). Increasing age was a negative predictor of total aortic diameter growth (odds ratio, 0.902; 95% confidence interval, 0.813-1.00; P = .0502). The proximal sections A and B showed complete thrombosis in 80.6% in the BMT+TEVAR group compared with 9.5% in the BMT group. In these sections, changes from patent to partial or partial to complete thrombosis were observed in 90.3% of the TEVAR+BMT group vs 31.0% in the BMT group. In sections C and D, the change in thrombosis was 74.1% for the TEVAR+BMT group vs 20.6% for the BMT group. The false lumen diameter increase at section C was larger in the BMT

  17. Iatrogenic subtle acute aortic dissection during coronary angioplasty for in-stent restenosis. Value of intravascular ultrasound for diagnosis and management.

    PubMed

    Alfonso, Fernando; Alvarez, Lucia; Almeria, Carlos

    2004-09-01

    A patient with a subtle, iatrogenic, type A aortic dissection following a coronary angioplasty is described. Intravascular ultrasound was useful to confirm the diagnosis of the confined aortic dissection and also to guide adequate stent coverage of its coronary entry door. Both transesophageal echocardiography and magnetic resonance imaging failed to detect any significant aortic wall abnormality.

  18. Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management.

    PubMed

    Pujara, Akshat C; Roselli, Eric E; Hernandez, Adrian V; Vargas Abello, Lina M; Burke, Jacob M; Svensson, Lars G; Greenberg, Roy K

    2012-10-01

    Controversy surrounds the treatment of chronic aortic dissection. Open surgical and endovascular experiences include mixed populations treated with evolving strategies and limited follow-up. We establish a standard against which endovascular repair can be compared by assessing outcomes after open repair of chronic distal aortic dissections anatomically suitable to stent-grafting. From 2000 to 2008, 169 patients underwent open repair of the descending thoracic artery only (n = 88) or thoracoabdominal (n = 81) chronic aortic dissection (elective in 98, urgent/emergency in 71). Chart review and 3-dimensional assessment of computed tomography were performed. Poor outcome included all-cause mortality or vascular reintervention. Thirty-day mortality was 8% (n = 14). Serious complications included neurologic (n = 12 [spinal cord n = 4, 2.4%]), respiratory (n = 32), and renal failure (n = 1 descending thoracic artery only vs 17 thoracoabdominal, P < .001). Chronic obstructive pulmonary disease predicted early mortality (hazard ratio 8.0, P = .005). Survival at 1, 2, and 5 years was 76%, 69%, and 55%, respectively; 23 patients (14%) required reintervention. Event-free survival at 5 years was 51% and 47% after descending thoracic artery only or thoracoabdominal repair, respectively. Greater maximum aortic diameter (hazard ratio 1.9, P = .03) and greater diameter at the diaphragm (hazard ratio 3.7, P = .01) or renal segment (hazard ratio 4.3, P = .03) predicted poor outcome. Early outcomes are good and late outcomes are less than desirable after open repair of chronic distal aortic dissection, regardless of the extent of repair. High-risk and late-stage patients with larger and more extensive aneurysmal degeneration warrant further investigation, including the use of newer, less-invasive techniques. Select patients at risk for aneurysmal degeneration should undergo a more aggressive initial approach with aortic dissection repair. Copyright © 2012 The

  19. Candy-Plug Technique Using an Excluder Aortic Extender for Distal Occlusion of a Large False Lumen Aneurysm in Chronic Aortic Dissection.

    PubMed

    Ogawa, Yukihisa; Nishimaki, Hiroshi; Chiba, Kiyoshi; Murakami, Kenji; Sakurai, Yuka; Fujiwara, Keishi; Miyairi, Takeshi; Nakajima, Yasuo

    2016-06-01

    To describe the candy-plug technique using an Excluder aortic extender for distal occlusion of a large false lumen aneurysm in chronic aortic dissection. A 60-year-old female patient with a history of chronic type B aortic dissection and high-dose steroid use for Churg-Strauss syndrome developed a large 6.2 cm maximum diameter false lumen aneurysm. She underwent thoracic endovascular aortic repair from the left common carotid artery to the descending aorta to cover the proximal entry at the level of distal arch, with coil embolization of the left subclavian artery. To occlude the large false lumen from the reentry just below the level of the left renal artery ostium, a modified 32×45-mm Excluder aortic extender was deployed in the false lumen through the reentry, and a 16-mm Amplatzer Vascular Plug I was deployed in the waist of the modified Excluder aortic extender for complete occlusion. No obvious technical complication was seen. Contrast-enhanced computed tomography at 1 and 14 months revealed no endoleaks and showed complete false lumen thrombosis. The candy-plug technique using the Excluder aortic extender is feasible for occlusion of a large false lumen aneurysm in chronic aortic dissection. © The Author(s) 2016.

  20. Treatment of Acute Aortic Type B Dissection with Stent-Grafts

    SciTech Connect

    Hausegger, K.A.; Tiesenhausen, K.; Schedlbauer, P.; Oberwalder, P.; Tauss, J.; Rigler, B.

    2001-09-15

    Purpose: To evaluate the feasibility of endoluminal stent-grafts in the treatment of acute type B aortic dissections.Methods: In five patients with acute aortic type B dissections, sealing of the primary intimal tear with an endoluminal stent-graft was attempted. Indication for treatment was aneurysm formation in two patients and persistent pain in three patients. One of the latter also had an unstable dissection flap compromising the ostium of the superior mesenteric artery. The distance from the intimal tear to the left subclavian artery was <0.5 cm in four patients, who had typical type B dissections. In one patient with an atypical dissection the distance from the primary tear to the left subclavian artery was 4 cm. This patient had no re-entry tear. Talent tube grafts (World Medical Manufacturing Cooperation, Sunrise, FL, USA) were used in all patients.Results: Stent-graft insertion with sealing of the primary tear was successful in all patients. The proximal covered portion of the stent-graft was placed across the left subclavian artery in four patients (1x transposition of the left subclavian artery). Left arm perfusion was preserved via a subclavian steal phenomenon in the patients in whom the stent-graft covered the orifice of the left subclavian artery. The only procedural complication we observed was an asymptomatic segmental renal infarction in one patient. In the thoracic aorta thrombosis of the false aortic lumen occurred in all patients. In one patient the false lumen of the abdominal aorta thrombosed after 4 weeks; in the other three patients the status of the abdominal aorta remained unchanged compared with the situation prior to stent-graft insertion. As a late complication formation of a secondary aneurysm of the thoracic aorta was observed at the distal end of the stent-graft 3 months after the primary intervention. This aneurysm was treated by coaxial insertion of an additional stent-graft without complications.Conclusion: Endoluminal treatment

  1. Wrapping procedure for stanford type a acute aortic dissection: is there an indication for surgery without a cardiopulmonary bypass?

    PubMed

    Lopez, Stéphane; Roux, Daniel; Cazavet, Alexandre; Tapia, Michel; Teboul, Jacques; Leobon, Bertrand; Glock, Yves

    2012-09-01

    A wrapping procedure for acute type A aortic dissection was performed on six elderly patients at high risk for conventional surgery. Aortic valve insufficiency was mild, with no malperfusion syndrome. A Teflon plaque or Dacron vascular prosthesis was passed around the aorta and tightened from the coronary ostia to the innominate artery. No severe neurologic complications or deaths occurred in the postoperative period. Computed tomography and magnetic resonance imaging imaging during follow-up showed aortic diameters had stabilized in all patients.

  2. A meta-analysis of weekend admission and surgery for aortic rupture and dissection.

    PubMed

    Takagi, Hisato; Ando, Tomo; Umemoto, Takuya

    2017-10-01

    We performed a meta-analysis to determine whether weekend admission and surgery for ruptured abdominal/thoracic aortic aneurysm (RAAA/RTAA) and acute aortic dissection (AAD) is associated with increased mortality. MEDLINE and EMBASE were searched from January 1946 to December 2016 using PubMed and OVID. Eligible studies were prospective or retrospective, comparative or cohort studies enrolling patients admitting or undergoing surgery for RAAA/RTAA/AAD and reporting mortality after weekend (including holiday) versus weekday admission/surgery. Our search identified 11 studies including a total of 166,195 patients. A pooled analysis of 13 adjusted odds ratios (ORs), one adjusted hazard ratio, and one unadjusted OR from all 11 studies demonstrated a statistically significant 32% increase in mortality with weekend admission/surgery (OR, 1.32; 95% confidence interval (CI), 1.20 to 1.45; p < 0.00001). Despite possible publication bias disadvantageous to weekend admission/surgery based on funnel plot asymmetry, adjustment for the asymmetry using the trim-and-fill method did not alter the significant association of weekend admission/surgery with increased mortality (OR, 1.21; 95% CI, 1.09 to 1.34; p = 0.0006). In conclusion, weekend admission/surgery for ruptured abdominal/thoracic aortic aneurysm and acute aortic dissection (AAD) may be associated with increased mortality.

  3. Successful reversal of immediate paraplegia associated with repair of acute Type A aortic dissection using cerebrospinal fluid drainage.

    PubMed

    Shimura, Shinichiro; Cho, Yasunori; Aki, Akira; Ueda, Toshihiko

    2013-12-01

    We present a case of a 49-year old man who suffered from immediate paraplegia upon awakening from anaesthesia after surgery for acute aortic dissection Type A. A catheter was promptly inserted into the spinal canal for cerebrospinal fluid drainage, and the cerebrospinal fluid pressure was maintained <10 cmH2O. Although magnetic resonance imaging showed extensive spinal cord ischaemia, the patient gradually recovered from the paraplegia and was able to walk by himself after rehabilitation. In some cases, cerebrospinal fluid drainage can be effective for the treatment of immediate postoperative spinal cord damage.

  4. Successful reversal of immediate paraplegia associated with repair of acute Type A aortic dissection using cerebrospinal fluid drainage

    PubMed Central

    Shimura, Shinichiro; Cho, Yasunori; Aki, Akira; Ueda, Toshihiko

    2013-01-01

    We present a case of a 49-year old man who suffered from immediate paraplegia upon awakening from anaesthesia after surgery for acute aortic dissection Type A. A catheter was promptly inserted into the spinal canal for cerebrospinal fluid drainage, and the cerebrospinal fluid pressure was maintained <10 cmH2O. Although magnetic resonance imaging showed extensive spinal cord ischaemia, the patient gradually recovered from the paraplegia and was able to walk by himself after rehabilitation. In some cases, cerebrospinal fluid drainage can be effective for the treatment of immediate postoperative spinal cord damage. PMID:24014618

  5. Crisis resource management of the airway in a patient with Klippel-Feil syndrome, congenital deafness, and aortic dissection.

    PubMed

    Khawaja, Omar M; Reed, J Taylor; Shaefi, Shahzad; Chitilian, Hovig V; Sandberg, Warren S

    2009-04-01

    Klippel-Feil syndrome is a visually arresting deformity wherein severe restriction of cervical motion predicts a difficult airway. Even minor distraction of the neck risks cervical spine or neurologic injury, so regional techniques, awake fiberoptic intubation, or awake tracheostomy are recommended anesthetic approaches. We present a case of aortic dissection in a Klippel-Feil syndrome patient for whom congenital bilateral deafness, coupled with the urgency of the surgery, mitigated against the recommended first-choice techniques. Using anesthesia crisis resource management methods, a multi-member team rehearsed predefined roles and then managed the airway via inhaled induction of anesthesia, followed by flexible fiberoptic intubation.

  6. Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

    PubMed Central

    Ma, Wei-Guo; Zheng, Jun; Liu, Yong-Min; Zhu, Jun-Ming; Sun, Li-Zhong

    2013-01-01

    Sun's procedure is a modified elephant trunk technique that integrates the advantages of open surgical and endovascular repairs as a treatment of type A aortic dissection. It is named after Dr. Li-Zhong Sun and refers to total arch replacement using a four-branched graft with implantation of a special stented endovascular graft. Since its introduction, it has produced excellent early and late clinical outcomes. We present a video of this procedure and make an overview regarding the technical aspects, surgical indications, and clinical outcomes of Sun's procedure. PMID:26798674

  7. Acute aortic dissection occurring during the butterfly stroke in a 12-year-old boy.

    PubMed

    Uchida, Keiji; Imoto, Kiyotaka; Yanagi, Hiromasa; Date, Koichiro

    2009-08-01

    A 12-year-old boy had severe chest and back pain of sudden onset while practicing the butterfly stroke in a swimming class. Computed tomography revealed an intimal flap in the descending thoracic aorta with massive right hemothorax. A ruptured type B acute aortic dissection was diagnosed, and then he collapsed. We totally replaced the descending aorta with a woven polyester prosthetic graft during deep hypothermic circulatory arrest. Hemostasis was achieved, but consciousness was not regained after operation, and multiple organ failure occurred. He died on the fifth postoperative day. He and his family had no history of cardiovascular disease. It seems that the swimming provoked a severe Valsalva maneuver, raising blood pressure acutely and thereby leading to dissection. This is then analogous to the propensity for dissection during intense isometic exercise such as weightlifting.

  8. Acute Aortic Dissection Occurring “Behind The Wheel”, Report of 11 Cases

    PubMed Central

    Yoshizaki, Takamichi; Hirano, Tomoyasu; Yamaguchi, Atsushi; Adachi, Hideo

    2016-01-01

    We investigated the clinical picture of non-traumatic acute aortic dissection (AAD) occurring behind the wheel. Between 1990 and 2014, AAD had occurred in 11 patients while driving (nine men, mean age; 58.3 years, seven commercial drivers). The symptoms included chest and/or back pain (n = 9) and syncope (n = 2). One patient with syncope caused a traffic accident. Ten patients had type A dissection (DeBakey type I) and 1 type B dissection. In-hospital mortality was 9.9% (1/11). Our data showed if affected drivers are transported to a hospital in a timely fashion, a good surgical outcome can be expected. PMID:27738463

  9. Development of a patient-specific simulation tool to analyse aortic dissections: assessment of mixed patient-specific flow and pressure boundary conditions.

    PubMed

    Alimohammadi, Mona; Agu, Obiekezie; Balabani, Stavroula; Díaz-Zuccarini, Vanessa

    2014-03-01

    Aortic dissection has high morbidity and mortality rates and guidelines regarding surgical intervention are not clearly defined. The treatment of aortic dissection varies with each patient and detailed knowledge of haemodynamic and mechanical forces would be advantageous in the process of choosing a course of treatment. In this study, a patient-specific dissected aorta geometry is constructed from computed tomography scans. Dynamic boundary conditions are implemented by coupling a three element Windkessel model to the 3D domain at each outlet, in order to capture the essential behaviour of the downstream vasculature. The Windkessel model parameters are defined based on clinical data. The predicted minimum and maximum pressures are close to those measured invasively. Malperfusion is indicated and complex flow patterns are observed. Pressure, flow and wall shear stress distributions are analysed. The methodology presented here provides insight into the haemodynamics in a patient-specific dissected aorta and represents a development towards the use of CFD simulations as a diagnostic tool for aortic dissection. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

  10. Loss of STAT1 is Associated with Increased Aortic Rupture in an Experimental Model of Aortic Dissection and Aneurysm Formation

    PubMed Central

    Eagleton, Matthew J.; Xu, Jun; Liao, Mingfang; Parine, Brittney; Chisolm, Guy M.; Graham, Linda M.

    2009-01-01

    Background Transcription factor signal transducer and activator of transcription (STAT) 1 has been linked to a variety of pathologic states involved with matrix remodeling, but its role in aortic pathology has not been previously described. The current study hypothesizes that STAT1 regulates aneurysmal degeneration and its role will be evaluated in human aortic aneurysms and in a mouse model of aortic dissection. Methods Apolipoprotein E knockout mice (ApoE−/−) or ApoE/STAT1 double knockout mice (ApoE/STAT1−/−) were infused with 1000 ng/kg/min of angiotensin II (Ang II). Systolic blood pressure (SBP) was measured in the rodent tail. At sacrifice, aortic diameters and extent of aneurysm formation were measured by digital microscopy. STAT1 and phosphorylated-STAT1 protein levels were assessed in ApoE−/− mice at 0, 7, 14, and 28 days (n=8/time point) by ELISA. Histology was performed using H&E and Movat stains. Statistical analyses included chi-square test, T-test, and ANOVA. Results STAT1 mRNA and total protein were greater in human AAA compared to non-aneurysmal controls. In addition, aneurysms occurred in 8%, 50%, and 80% of apoE−/− mice at 7, 14, and 28 days respectively. Total STAT1 levels were not altered during the course of Ang II infusion, but phosphorylated STAT1 levels peaked at 7 days with a 1.4-fold increase over baseline (P<0.05). Aneurysms occurred in 0%, 100%, and 100% of apoE/STAT1−/− mice at 3, 5, and 28 days. In mice infused with Ang II for more than 3 days, aortic rupture occurred more frequently in apoE/STAT−/− mice (53% v. 19%, P<0.05) and at earlier time points (4.0±0.5 v. 9.2±0.77 days, P<0.05) compared with apoE−/− mice. SBP did not differ between the groups during Ang II infusion. By 28 days, aneurysms were larger in apoE/STAT1−/− mice compared to apoE−/− mice (2.7±0.4 v. 1.9±0.1 mm, P<0.05), and were more extensive arising at the level of the left subclavian artery and extending to the infrarenal aorta

  11. Refractory ascites - a rare presentation of severe aortic regurgitation.

    PubMed

    Jenkinson, Charles; Rajaratnam, Shanker; Joshi, Pragnesh; Passage, Jurgen

    2014-01-01

    A 47 year-old male with a history of refractory ascites presented to our centre complaining of dyspnoea, abdominal distention, and weight gain. He was admitted under a medical team for investigation and management. Work-up excluded all common aetiologies of ascites. Echocardiography revealed severe aortic regurgitation (AR) with a dilated left ventricle but no right heart pathology or pulmonary hypertension. He underwent mechanical aortic valve replacement. Intra-operatively, a prolapsing left coronary leaflet of the aortic valve with frayed edges raised suspicion of resolved infective endocarditis. Postoperative course was uneventful. Following replacement of the aortic valve, the patient was completely free of ascites. This case demonstrates that ascites can be an unusual clinical presentation of severe aortic regurgitation, which may respond to aortic valve replacement. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  12. Effect of Intravascular Ultrasound-assisted Thoracic Endovascular Aortic Repair for “Complicated” Type B Aortic Dissection

    PubMed Central

    Guo, Bao-Lei; Shi, Zhen-Yu; Guo, Da-Qiao; Wang, Li-Xin; Tang, Xiao; Li, Wei-Miao; Fu, Wei-Guo

    2015-01-01

    Background: Intravascular ultrasound (IVUS) examination can provide useful information during endovascular stent graft repair. However, its actual clinical utility in thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (type B-AD) remains unclear, especially in complicated aortic dissection. We evaluated the effect of IVUS as a complementary tool during TEVAR. Methods: From September 2011 to April 2012, we conducted a prospective cohort study of 47 consecutive patients with “complicated” type B-AD diagnosed. We divided the patients into two groups: IVUS-assisted TEVAR group and TEVAR using angiography alone group. The general procedure of TEVAR was performed. We evaluated the perioperative and follow-up events. Patient demographics, comorbidities, preoperative images, dissection morphology, details of operative strategy, intraoperative events, and postoperative course were recorded. Results: A total of 47 patients receiving TEVAR were enrolled. Among them (females, 8.51%; mean age, 57.38 ± 13.02 years), 13 cases (27.66%) were selected in the IVUS-assisted TEVAR group, and 34 were selected in the TEVAR group. All patients were symptomatic. The average diameter values of IVUS measurements in the landing zone were greater than those estimated by computed tomography angiography (31.82 ± 4.21 mm vs. 30.64 ± 4.13 mm, P < 0.001). The technique success rate was 100%. Among the postoperative outcomes, statistical differences were only observed between the IVUS-assisted TEVAR group and TEVAR group for total operative time and the amount of contrast used (P = 0.013 and P < 0.001, respectively). The follow-up ranged from 15 to 36 months for the IVUS-assisted TEVAR group and from 10 to 35 months for the TEVAR group (P = 0.646). The primary endpoints were no statistical difference in the two groups. Conclusions: Intraoperative IVUS-assisted TEVAR is clinically feasible and safe. For the endovascular repair of “complicated” type B-AD, IVUS may be

  13. Chronic Thoracic Aortic Aneurysm Presenting 29 Years following Trauma

    PubMed Central

    Miller, Sarah; Kumar, Prashant; Van den Bosch, Rene; Khanafer, Adib

    2015-01-01

    Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour. Aortic injury is missed in 1-2% of patients that survive to hospital, and a chronic thoracic aortic aneurysm may subsequently form. We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident. We discuss the epidemiology, presentation, and management of this uncommon consequence of blunt, nonpenetrating aortic injury. Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment. PMID:26351610

  14. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair

    PubMed Central

    Zhu, Kai; Guo, Changfa; Li, Jun

    2014-01-01

    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation. PMID:25590002

  15. Aortic root abscess presenting as alternating bundle branch block: Infective endocarditis of bicuspid aortic valve

    PubMed Central

    Jain, Rakesh; Kader, Muneer; Sajeev, C.G.; Krishnan, M.N.

    2015-01-01

    Bicuspid aortic valve is the most common congenital cardiac malformation, affecting 1%–2% of the population. Among various complications, incidence of infective endocarditis (IE) in the bicuspid aortic valve population is high with higher rate of periannular extension resulting in conduction disturbances. Here we are reporting a rare case of infective endocarditis of bicuspid aortic valve presented with alternating bundle branch block. PMID:26138186

  16. Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes. Traumatic aortic rupture, aortic aneurysm, aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer.

    PubMed

    Ledbetter, S; Stuk, J L; Kaufman, J A

    1999-05-01

    For the near future, CT will play the critical and dominant role in the evaluation of patients presenting with emergent aortic syndromes. Its convenience, accuracy, and utility in the rapid evaluation of not just the aorta, but the entire thorax, make it ideally suited for use in emergency settings. Further benefits are likely to be realized in speed and resolution with multislice CT, although it is as yet not widely available.

  17. Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

    PubMed

    Platon, Alexandra; Bernard, Stephane; Perrin, Nils; Murith, Nicolas; John, Gregor; Perneger, Thomas; Rutschmann, Olivier T; Poletti, Pierre-Alexandre

    2016-11-01

    To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29-80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (inmm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p=0.02) of aortic valve involvement. Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type A aortic dissection.

    PubMed Central

    Hatzidakis, A; Krokidis, M; Androulakakis, Z; Rossi, M

    2015-01-01

    Background/Aim We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. Conclusion This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissection. Hippokratia 2015; 19 (3): 270-273. PMID:27418791

  19. The Candy-Plug Technique: Technical Aspects and Early Results of a New Endovascular Method for False Lumen Occlusion in Chronic Aortic Dissection.

    PubMed

    Rohlffs, Fiona; Tsilimparis, Nikolaos; Fiorucci, Beatrice; Heidemann, Franziska; Debus, Eike Sebastian; Kölbel, Tilo

    2017-08-01

    To describe the technical aspects and early results of the Candy-Plug technique for endovascular false lumen occlusion in chronic aortic dissection. A retrospective single-center study analyzing 18 consecutive patients (mean age 63 years, range 44-76; 16 men) with thoracic false lumen aneurysm in chronic aortic dissection. All patients underwent thoracic endovascular aortic repair with false lumen occlusion using the Candy-Plug technique. Primary endpoints consisted of technical success (successful deployment) and clinical success (no false lumen backflow). Secondary endpoints included 30-day mortality and morbidity as well as aortic remodeling during follow-up. Technical success was 100%. Additional intraprocedural false lumen embolization at the Candy-Plug level was needed in 1 patient due to persisting false lumen backflow on the final angiogram (clinical success 94%). There were no intraprocedural complications. In the perioperative period, there were 3 minor complications: transient mild spinal cord ischemia, cervical hematoma after carotid-subclavian bypass, and a common femoral artery pseudoaneurysm. No deaths or reinterventions occurred. Complete distal false lumen occlusion was present on postoperative computed tomography in 15 patients, while 3 had minor contrast enhancement in the distal false lumen. Over a mean 9-month follow-up (range 0-26), 1 patient died due to rupture. Follow-up >6 months was available in 10 patients (mean 14.7 months, range 7-26): 7 patients showed aortic remodeling, while aneurysm size was stable in 3 patients. The Candy-Plug technique is a feasible endovascular method to achieve false lumen occlusion and aortic remodeling in chronic aortic dissection. It is associated with low morbidity and mortality due to its minimal invasiveness.

  20. Recurrent Rare Genomic Copy Number Variants and Bicuspid Aortic Valve Are Enriched in Early Onset Thoracic Aortic Aneurysms and Dissections.

    PubMed

    Prakash, Siddharth; Kuang, Shao-Qing; Regalado, Ellen; Guo, Dongchuan; Milewicz, Dianna

    2016-01-01

    Thoracic Aortic Aneurysms and Dissections (TAAD) are a major cause of death in the United States. The spectrum of TAAD ranges from genetic disorders, such as Marfan syndrome, to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to early onset TAAD (ETAAD). We conducted a genome-wide SNP array analysis of ETAAD patients of European descent who were enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). Genotyping was performed on the Illumina Omni-Express platform, using PennCNV, Nexus and CNVPartition for CNV detection. ETAAD patients (n = 108, 100% European American, 28% female, average age 20 years, 55% with bicuspid aortic valves) were compared to 7013 dbGAP controls without a history of vascular disease using downsampled Omni 2.5 data. For comparison, 805 sporadic TAAD patients with late onset aortic disease (STAAD cohort) and 192 affected probands from families with at least two affected relatives (FTAAD cohort) from our institution were screened for additional CNVs at these loci with SNP arrays. We identified 47 recurrent CNV regions in the ETAAD, FTAAD and STAAD groups that were absent or extremely rare in controls. Nine rare CNVs that were either very large (>1 Mb) or shared by ETAAD and STAAD or FTAAD patients were also identified. Four rare CNVs involved genes that cause arterial aneurysms when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (two duplications and two deletions) and 17q25.1 (three duplications). The percentage of individuals harboring rare CNVs was significantly greater in the ETAAD cohort (32%) than in the FTAAD (23%) or STAAD (17%) cohorts. We identified multiple loci affected by rare CNVs in one-third of ETAAD patients, confirming the genetic heterogeneity of TAAD. Alterations of candidate genes at these loci may contribute to the pathogenesis of TAAD.

  1. Recurrent Rare Genomic Copy Number Variants and Bicuspid Aortic Valve Are Enriched in Early Onset Thoracic Aortic Aneurysms and Dissections

    PubMed Central

    Prakash, Siddharth; Kuang, Shao-Qing; Regalado, Ellen; Guo, Dongchuan; Milewicz, Dianna

    2016-01-01

    Thoracic Aortic Aneurysms and Dissections (TAAD) are a major cause of death in the United States. The spectrum of TAAD ranges from genetic disorders, such as Marfan syndrome, to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to early onset TAAD (ETAAD). We conducted a genome-wide SNP array analysis of ETAAD patients of European descent who were enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). Genotyping was performed on the Illumina Omni-Express platform, using PennCNV, Nexus and CNVPartition for CNV detection. ETAAD patients (n = 108, 100% European American, 28% female, average age 20 years, 55% with bicuspid aortic valves) were compared to 7013 dbGAP controls without a history of vascular disease using downsampled Omni 2.5 data. For comparison, 805 sporadic TAAD patients with late onset aortic disease (STAAD cohort) and 192 affected probands from families with at least two affected relatives (FTAAD cohort) from our institution were screened for additional CNVs at these loci with SNP arrays. We identified 47 recurrent CNV regions in the ETAAD, FTAAD and STAAD groups that were absent or extremely rare in controls. Nine rare CNVs that were either very large (>1 Mb) or shared by ETAAD and STAAD or FTAAD patients were also identified. Four rare CNVs involved genes that cause arterial aneurysms when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (two duplications and two deletions) and 17q25.1 (three duplications). The percentage of individuals harboring rare CNVs was significantly greater in the ETAAD cohort (32%) than in the FTAAD (23%) or STAAD (17%) cohorts. We identified multiple loci affected by rare CNVs in one-third of ETAAD patients, confirming the genetic heterogeneity of TAAD. Alterations of candidate genes at these loci may contribute to the pathogenesis of TAAD. PMID:27092555

  2. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  3. 3D segmentation of the true and false lumens on CT aortic dissection images

    NASA Astrophysics Data System (ADS)

    Fetnaci, Nawel; Łubniewski, Paweł; Miguel, Bruno; Lohou, Christophe

    2013-03-01

    Our works are related to aortic dissections which are a medical emergency and can quickly lead to death. In this paper, we want to retrieve in CT images the false and the true lumens which are aortic dissection features. Our aim is to provide a 3D view of the lumens that we can difficultly obtain either by volume rendering or by another visualization tool which only directly gives the outer contour of the aorta; or by other segmentation methods because they mainly directly segment either only the outer contour of the aorta or other connected arteries and organs both. In our work, we need to segment the two lumens separately; this segmentation will allow us to: distinguish them automatically, facilitate the landing of the aortic prosthesis, propose a virtual 3d navigation and do quantitative analysis. We chose to segment these data by using a deformable model based on the fast marching method. In the classical fast marching approach, a speed function is used to control the front propagation of a deforming curve. The speed function is only based on the image gradient. In our CT images, due to the low resolution, with the fast marching the front propagates from a lumen to the other; therefore, the gradient data is insufficient to have accurate segmentation results. In the paper, we have adapted the fast marching method more particularly by modifying the speed function and we succeed in segmenting the two lumens separately.

  4. Chronic dissecting aneurysm of the ascending aorta developed in a patient who had rejected surgical treatment for type II acute ascending aortic dissection three years earlier.

    PubMed

    Erkut, Bilgehan; Dag, Ozgur; Kaygïn, Mehmet Ali; Lïmandal, Husnu Kamïl; Aydïn, Ahmet; Calïk, Eyup Serhat

    2014-02-23

    A 66-year-old male patient was admitted to our clinic because of shortness of breath and chest pain. A grade 4/6 diastolic murmur was heard on auscultation. Physical examination revealed signs of congestive heart failure and poor peripheral perfusion. There was a diagnosis of type II ascending aortic dissection in the history of the patient. He had refused emergency surgical intervention three years earlier. Computed tomography revealed that the ascending aorta was dilated to about 10 cm in diameter, and there was a chronic aortic type II dissection. The patient had second- to third-degree aortic insufficiency and he had a calcified bicuspid aortic valve on echocardiography. Two-vessel disease and a 90-mmHg aortic gradient were detected on angiography. Graft replacement of the ascending aorta, serape aortic valve replacement with a mechanical valve, and coronary arterial bypass grafting were performed successfully under cardiopulmonary bypass with an open aortic technique. The patient was discharged on the 10th postoperative day with no problems.

  5. Adult presentation with vascular ring due to double aortic arch.

    PubMed

    Kafka, Henryk; Uebing, Anselm; Mohiaddin, Raad

    2006-11-01

    This is a case report on the use of cardiovascular magnetic resonance imaging to diagnose vascular ring due to double aortic arch in an adult presenting with an abnormal chest X-ray. The experience in this case and the literature review identify the benefits of using cardiovascular magnetic resonance imaging to clarify complex aortic arch anatomy.

  6. Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

    PubMed Central

    Hako, René; Fedačko, Ján; Morochovič, Radoslav; Kristian, Pavol; Pekárová, Tímea; Tuomainen, Petri; Pella, Daniel

    2017-01-01

    Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension. PMID:28154579

  7. Evolution of surgical therapy for Stanford acute type A aortic dissection.

    PubMed

    Chiu, Peter; Miller, D Craig

    2016-07-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

  8. Evolution of surgical therapy for Stanford acute type A aortic dissection

    PubMed Central

    Chiu, Peter

    2016-01-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

  9. Exacerbation of intracranial aneurysm and aortic dissection in hypertensive rat treated with the prostaglandin F-receptor antagonist AS604872.

    PubMed

    Fukuda, Miyuki; Aoki, Tomohiro; Manabe, Toshiaki; Maekawa, Akiko; Shirakawa, Takayuki; Kataoka, Hiroharu; Takagi, Yasushi; Miyamoto, Susumu; Narumiya, Shuh

    2014-01-01

    Intracranial aneurysm (IA) and aortic dissection are both complications of hypertension and characterized by degeneration of the media. Given the involvement of prostaglandin F2α and its receptor, FP, in extracellular matrix remodeling in a mouse model of pulmonary fibrosis, here we induced hypertension and IA in rats by salt loading and hemi-lateral ligation of renal and carotid arteries and examined effects of a selective FP antagonist, AS604872, on these vascular events. AS604872 significantly accelerated degeneration of the media in both cerebral artery and aorta as evidenced by thinning of the media and disruption of the elastic lamina and promoted IA and aortic dissection. Notably, AS604872 induced expression of pro-inflammatory genes such as E-selectin in lesions and significantly enhanced macrophage infiltration. Suppression of surface expression of E-selectin with cimetidine prevented macrophage infiltration and aortic dissection. Thus, AS604872 exacerbates vascular inflammation in hypertensive rats and facilitates IA and aortic dissection. These results demonstrate that both IA and aortic dissection are caused by chronic inflammation of the arterial wall, which is worsened by AS604872, cautioning that other FP antagonists may share such deleterious actions in vascular homeostasis and suggesting that AS604872 can be used to make models of these vascular diseases with extensive degeneration.

  10. Pathogenic FBN1 variants in familial thoracic aortic aneurysms and dissections.

    PubMed

    Regalado, E S; Guo, D C; Santos-Cortez, R L P; Hostetler, E; Bensend, T A; Pannu, H; Estrera, A; Safi, H; Mitchell, A L; Evans, J P; Leal, S M; Bamshad, M; Shendure, J; Nickerson, D A; Milewicz, D M

    2016-06-01

    Marfan syndrome (MFS) due to mutations in FBN1 is a known cause of thoracic aortic aneurysms and acute aortic dissections (TAAD) associated with pleiotropic manifestations. Genetic predisposition to TAAD can also be inherited in families in the absence of syndromic features, termed familial TAAD (FTAAD), and several causative genes have been identified to date. FBN1 mutations can also be identified in FTAAD families, but the frequency of these mutations has not been established. We performed exome sequencing of 183 FTAAD families and identified pathogenic FBN1 variants in five (2.7%) of these families. We also identified eight additional FBN1 rare variants that could not be unequivocally classified as disease-causing in six families. FBN1 sequencing should be considered in individuals with FTAAD even without significant systemic features of MFS.

  11. Diabetes and Reduced Risk for Thoracic Aortic Aneurysms and Dissections: A Nationwide Case-Control Study

    PubMed Central

    Prakash, Siddharth K.; Pedroza, Claudia; Khalil, Yameen A.; Milewicz, Dianna M.

    2012-01-01

    Background Vascular diseases are the principal causes of death and disability in people with diabetes. At the same time, studies suggest a protective role of diabetes in the development of abdominal aortic aneurysms. We sought to determine whether diabetes is associated with decreased hospitalization due to thoracic aortic aneurysms and dissections (TAAD). Methods and Results We used the 2006 and 2007 Nationwide Inpatient Sample (NIS) to determine TAAD discharge rates. Control subjects were randomly selected to achieve three controls per case. Predictor variables in multilevel logistic regression included age, race, median income, diabetes, and hypertension. We estimated that the average rate of hospital discharge for TAAD among individuals diagnosed with diabetes was 9.7 per 10 000, compared to 15.6 per 10 000 among all discharges. The prevalence of diabetes was substantially lower in TAAD (13%) than in control (22%) records. After adjustment for demographic characteristics, the negative association between diabetes and TAAD remained highly significant in both NIS datasets. Compared to discharges without diabetes, those with chronic complications of diabetes were least likely to be diagnosed with TAAD (OR [odds ratio] 0.17, 95% CI, 0.12–0.23). A significant association remained between uncomplicated diabetes and TAAD. We replicated these findings in an independent group of patients who were hospitalized with acute thoracic aortic dissections. Conclusions The principal implication of our findings is that diabetes is independently associated with a decreased rate of hospitalization due to TAAD in proportion to the severity of diabetic complications. Future studies should consider diabetes in predictive models of aneurysm expansion or dissection. (J Am Heart Assoc. 2012;1:jah3-e000323 doi: 10.1161/JAHA.111.000323.) PMID:23130125

  12. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

    PubMed Central

    Stamou, Sotiris C.; Gartner, Derek; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles. PMID:28097193

  13. Atmospheric Pressure Changes Are Associated with Type A Acute Aortic Dissections and Spontaneous Abdominal Aortic Aneurysm Rupture in Tuzla Canton

    PubMed Central

    Krdzalic, Alisa; Rifatbegovic, Zijah; Krdzalic, Goran; Jahic, Elmir; Adam, Visnja Nesek; Golic, Darko

    2014-01-01

    Aim: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. Patients and methods: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). Results: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found. PMID:25568523

  14. Bilateral Leg Ischemia due to Descending Aortic Dissection: Combined Treatment with Femoro-femoral Cross-over Bypass and Unilateral Aorto-iliac stenting

    SciTech Connect

    Frahm, Christian; Widmer, Matthias K.; Do, Dai-Do

    2002-10-15

    We report a case of aorto-iliac occlusion due to descending aortic dissection treated initially with femoro-femoral cross-over bypass and secondarily with unilateral aorto-iliac stenting because of progression of the dissection. A 75-year-old man presented with acute ischemia of the right leg. CT revealed occlusion of the right iliac artery due to descending aortic dissection with a clotted false lumen. Three days after femoro-femoral cross-over bypass,ischemia of both legs developed and angiography demonstrated occlusion of the infrarenal aorta and left common iliac artery. Two overlapping stents were deployed in these vessel segments. Completion angiography confirmed successful recanalization with adequate distal flow and good patency of the cross-over bypass. Peripheral pulses were restored and the patient's symptoms were alleviated. Combined treatment with cross-over bypass and endovascular recanalization may be considered as a viable alternative to open aortic surgery in selected cases of complicated aorto-iliac dissection with bilateral leg ischemia.

  15. An aortic dissection in a young weightlifter with non-Marfan fibrillinopathy.

    PubMed

    Hogan, C J

    2005-04-01

    Aortic dissection (AD) is an uncommon condition that occurs mainly in the older patient population (>40 years). It is rare in younger people and is usually associated with trauma, Marfan's syndrome, or pregnancy. We report a case of a young weightlifter who died from an AD, and upon autopsy, was diagnosed as having non-Marfan's fibrillinopathy. We recommend that AD should be considered in symptomatic patients with any family history of early cardiac deaths, a history suggestive of a connective tissue disorder (that is, multiple joint surgeries) or who practise weightlifting.

  16. A Case of Sudden Death in Decameron IV.6: Aortic Dissection or Atrial Myxoma?

    PubMed

    Toscano, Fabrizio; Spani, Giovanni; Papio, Michael; Rühli, Frank J; Galassi, Francesco M

    2016-07-08

    Giovanni Boccaccio's Decameron contains a novella that details the sudden death of a young man called Gabriotto, including a portrayal of the discomfort that the protagonist experienced and a rudimentary autopsy performed by local physicians. The intriguing description of symptoms and pathologies has made it possible to read a 7-century-old case through the modern clinical lens. Thanks to the medical and philological analysis of the text-despite the vast difference between modern and medieval medicine-2 hypothetical diagnoses have emerged: either an aortic dissection or an atrial myxoma. © 2016 American Heart Association, Inc.

  17. [Dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery due to localized dissection of the aortic arch; report of a case].

    PubMed

    Higashi, Shigeki; Yoshida, Y; Mitsuoka, H

    2007-07-01

    A 43-year-old male lost consciousness immediately after archery practice, and was brought to our hospital by ambulance. Angiography showed dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery, causing compression of these arteries. Under cardiopulmonary bypass with selective cerebral perfusion, the blood supply to these arteries was restored with a bifurcated graft. Surgical specimen showed localized dissection of the aortic arch at the bifurcation to the brachiocephalic artery and the left common carotid artery, with the formation of dissecting aneurysms at the bases of both arteries. The aneurysms were filled with thrombi. In addition to these dissecting aneurysms, there were arterial dissections involving the brachiocephalic artery and the bilateral common carotid arteries. Histopathological examination of the vessel wall showed no evidence of atherosclerosis or vasculitis, and no abnormalities in the arrangement of elastic fibers.

  18. An adventitial IL-6/MCP1 amplification loop accelerates macrophage-mediated vascular inflammation leading to aortic dissection in mice

    PubMed Central

    Tieu, Brian C.; Lee, Chang; Sun, Hong; LeJeune, Wanda; Recinos, Adrian; Ju, Xiaoxi; Spratt, Heidi; Guo, Dong-Chuan; Milewicz, Dianna; Tilton, Ronald G.; Brasier, Allan R.

    2009-01-01

    Vascular inflammation contributes to cardiovascular diseases such as aortic aneurysm and dissection. However, the precise inflammatory pathways involved have not been clearly defined. We have shown here that subcutaneous infusion of Ang II, a vasopressor known to promote vascular inflammation, into older C57BL/6J mice induced aortic production of the proinflammatory cytokine IL-6 and the monocyte chemoattractant MCP-1. Production of these factors occurred predominantly in the tunica adventitia, along with macrophage recruitment, adventitial expansion, and development of thoracic and suprarenal aortic dissections. In contrast, a reduced incidence of dissections was observed after Ang II infusion into mice lacking either IL-6 or the MCP-1 receptor CCR2. Further analysis revealed that Ang II induced CCR2+CD14hiCD11bhiF4/80– macrophage accumulation selectively in aortic dissections and not in aortas from Il6–/– mice. Adoptive transfer of Ccr2+/+ monocytes into Ccr2–/– mice resulted in selective monocyte uptake into the ascending and suprarenal aorta in regions of enhanced ROS stress, with restoration of IL-6 secretion and increased incidence of dissection. In vitro, coculture of monocytes and aortic adventitial fibroblasts produced MCP-1– and IL-6–enriched conditioned medium that promoted differentiation of monocytes into macrophages, induced CD14 and CD11b upregulation, and induced MCP-1 and MMP-9 expression. These results suggest that leukocyte-fibroblast interactions in the aortic adventitia potentiate IL-6 production, inducing local monocyte recruitment and activation, thereby promoting MCP-1 secretion, vascular inflammation, ECM remodeling, and aortic destabilization. PMID:19920349

  19. Ruptured Pancreaticoduodenal Artery Aneurysm Associated with Median Arcuate Ligament Compression and Aortic Dissection Successfully Treated with Embolotherapy

    PubMed Central

    Terada, Takuro; Tamaki, Masato

    2015-01-01

    A 51-year-old man with a ruptured pancreaticoduodenal artery (PDA) aneurysm caused by compression of the celiac artery by the median arcuate ligament and aortic dissection involving the celiac axis was transferred to our hospital for endovascular treatment. A 4-F catheter was advanced into the superior mesenteric artery through the narrow true lumen via the left brachial artery, and coil embolization of the aneurysm was successfully performed. In this case, rapid increase of blood flow in the superior mesenteric artery, which compensated for the decreased celiac blood flow by aortic dissection, increased hemodynamic stress on the PDA, leading to aneurysmal rupture. PMID:25848431

  20. Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases.

    PubMed

    Li, Yang; Li, Ling; Mu, Hong-Shu; Fan, Shuan-Liang; He, Fang-Gang; Wang, Zhen-Yuan

    2015-09-01

    Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female=6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.

  1. [Hiatal hernia incarceration during cardiopulmonary bypass in patient with acute aortic dissection--a case report].

    PubMed

    Hasegawa, Y; Saito, T; Horimi, H; Kato, M; Kawashima, T; Fuse, K

    1995-09-01

    A 67-year-old woman was admitted to our hospital under diagnosis of Stanford type A acute aortic dissection. Chest CT showed aortic dissection from the ascending to descending aorta, and large hiatal hernia. Operation was undergone under cardiopulmonary bypass and circulatory arrest with retrograde cerebral perfusion. A graft replacement was carried out from the ascending to transverse arch aorta. After the release of the cross-clamping of aorta, the heart was gradually oppressed anteriorly by extrapericardial mass, so that the patient could not be weaned from the cardiopulmonary bypass. The mass was revealed incarcerated hiatal hernia by ultrasonography. After laparotomy, diaphragm and hiatus were incised, the incarceration was relieved and the diaphgragm was repaired with a Goretex sheet. Then the patient could be weaned from cardiopulmonary bypass. Her postoperative course was uneventful except for acute renal failure, and she was discharged 60 days after the operation. The incarceration of hiatal hernia was thought to be caused by tissue edema and small bleeding during cardiopulmonary bypass. This is the first reported case with the incarceration of hiatal hernia which occurred during cardiopulmonary bypass.

  2. Usefulness of cervical magnetic resonance imaging for detecting type A acute aortic dissection with acute stroke symptoms.

    PubMed

    Matsumoto, Hiroaki; Yoshida, Yasuhisa; Hirata, Yutaka

    2016-09-01

    Type A acute aortic dissection (TAAAD) sometimes presents with acute stroke-like symptoms. When intravenous tissue plasminogen activator (IV-tPA) therapy is considered for acute ischemic stroke, TAAAD must be excluded. Painless TAAAD presenting with acute stroke may be easily missed. Two cases of painless TAAAD presenting with acute stroke in which IV-tPA therapy was considered are reported. In these cases, cervical magnetic resonance angiography (MRA) was useful for detecting TAAAD, and IV-tPA therapy was canceled. The mottled high signal ("snowstorm") in the common carotid artery on cervical MRA is specific for TAAAD. We have thus named this phenomenon the "snowstorm sign" and believe it can help diagnose TAAAD. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Dissection Dissected.

    ERIC Educational Resources Information Center

    Berman, William

    1984-01-01

    Discusses the role of dissection in science courses, examining essential lessons students can learn (such as developing an abiding respect for all forms of life, including the animal being dissected). Also presents a list of tips related to classroom dissection and comments on formaldehyde and formalin substitutes. (JN)

  4. Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg.

    PubMed

    Kurz, S D; Falk, V; Kempfert, J; Gieb, M; Ruschinski, T M; Kukucka, M; Tsokos, M; Grubitzsch, H; Herbst, H; Semmler, J; Buschmann, C

    2017-08-15

    Stanford acute type A aortic dissection (ATAAD) is a potentially lethal condition. Epidemiology studies show a statistical incidence in Europe of approximately 2-16 cases/100,000 inhabitants/year. In Germany, the estimated incidence (here subsumed under "thoracic aortic dissection" with 4.63 cases/100,000 inhabitants/year) is mainly extracted from medical death certificates by the German Federal Statistical Office. The prehospital incidence of ATAAD deaths is largely unknown. Since patients often die in the pre-hospital setting, the incidence of ATAAD is therefore likely to be higher than current estimates. For the period from 2010 to 2014, we retrospectively analyzed all in-hospital ATAAD data from two of the largest cardiac surgical centers that treat ATAAD in the Berlin-Brandenburg region. In addition, autopsy reports of all forensic medicine institutes and of one large pathological provider in the region were analyzed to identify additional non-hospitalized ATAAD patients. Based on these findings, the regional incidence of ATAAD was calculated. In addition to in-hospital ATAAD patients (n=405), we identified additional 145 lethal ATAAD cases among 14,201 autopsy reports. The total of 550 ATAAD cases led to an estimated incidence of 11.9 cases/100,000 inhabitants/year for the whole Berlin-Brandenburg region. Arterial hypertension, pre-existing aortic dilatation, and hereditary connective tissue disorder were found in, respectively, 62.7%, 10%, and 1.8% of patients. ATAAD is more frequent than previously reported. Our results show that when patients who die outside of cardiac surgery centers are included, the incidence of ATAAD significantly exceeds the rate reported by the Federal Statistical Office. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. IL-6-STAT3 signaling mediates aortic dissections induced by angiotensin II via the Th17 lymphocyte-IL17 axis in C57BL/6 Mice

    PubMed Central

    Ju, Xiaoxi; Ijaz, Talha; Sun, Hong; Ray, Sutapa; Lejeune, Wanda; Lee, Chang; Recinos, Adrian; Guo, Dong-Chuan; Milewicz, Dianna M.; Tilton, Ronald G.; Brasier, Allan R.

    2013-01-01

    Objective Dysregulated angiotensin II (Ang II) signaling induces local vascular interleukin-6 (IL-6) secretion, producing leukocyte infiltration and life-threatening aortic dissections. Precise mechanism(s) by which IL-6 signaling induces leukocyte recruitment remain(s) unknown. T-helper 17lymphocytes (Th17) have been implicated in vascular pathology, but their role in the development of aortic dissections is poorly understood. Here, we tested the relationship of IL-6-STAT3 signaling with Th17-induced inflammation in the formation of Ang II-induced dissections in C57BL/6 mice. Methods and Results Ang II infusion induced aortic dissections and CD4+-interleukin 17A (IL-17A)-expressing, Th17 cell accumulation in C57BL/6 mice. A blunted local Th17 activation, macrophage recruitment, and reduced incidence of aortic dissections were seen in IL-6−/− mice. To determine pathological roles of Th17 lymphocytes, we treated Ang II infused mice with IL-17A neutralizing antibody (IL17A NAb), or infused Ang II in genetically deficientIL-17A mice, and found decreased aortic chemokine MCP-1 production and macrophage recruitment, leading to a reduction in aortic dissections. This effect was independent of blood pressure in IL17ANAb experiment. Application of a cell-permeable STAT3 inhibitor to downregulate the IL-6 pathway decreased aortic dilation and Th17 cell recruitment. We also observed increased aortic Th17 infiltration and IL-17 mRNA expression in patients with thoracic aortic dissections. Lastly, we found that Ang II mediated aortic dissections occurred independent of blood pressure changes. Conclusions Our results indicate that the IL-6-STAT3 signaling pathway converges on Th17 recruitment and IL-17A signaling upstream of macrophage recruitment, mediating aortic dissections. PMID:23685554

  6. Rapid diagnosis and management of thoracic aortic dissection and intramural haematoma: a prospective study of advantages of multiplane vs. biplane transoesophageal echocardiography.

    PubMed

    Pepi, M; Campodonico, J; Galli, C; Tamborini, G; Barbier, P; Doria, E; Maltagliati, A; Alimento, M; Spirito, R

    2000-03-01

    The purposes of this study were to compare the accuracy of multiplane vs. biplane transoesophageal echocardiography (TEE) in the diagnosis of aortic dissection and aortic intramural haematoma, and to test whether these techniques provide all the diagnostic information required to make management decisions. Fifty-eight consecutive patients with clinically suspected aortic dissection were studied with multiplane TEE; all cases who required surgery underwent intraoperative monitoring with multiplane TEE. The following multiplane TEE data were analysed: the angle between current and 0 degrees plane at which each view was obtained; the success rate in the evaluation of true and false lumen, entry tear, coronary artery involvement, aortic regurgitation, pericardial effusion. Advantages of multiplane over biplane TEE have been evaluated by the demonstration of usefulness of views obtained in planes other than 0 degrees-20 degrees or 70 degrees-110 degrees, assuming that with manipulation of a biplane probe a 20 degrees arc could be added to the conventional horizontal and vertical planes. On the basis of TEE findings, aortic dissection was confirmed in 36 cases (18 type A, 12 type B, six intramural haematoma). The specificity and sensitivity of TEE in terms of the presence or absence of aortic dissection or intramural haematoma were 100%. An additional clinical value of multiplane over biplane TEE in the evaluation of ascending aorta, aortic arch, entry tears and coronary artery involvement was demonstrated. All cases with type A aortic dissection or intramural haematoma involving the ascending aorta had an operation that was performed immediately after the diagnosis (hospital mortality, 13%). Patients with type B aortic dissection were treated medically; 25% of these cases were operated later (hospital mortality, 0%). Multiplane and biplane TEE have excellent and similar accuracies in the evaluation of aortic dissection and intramural haematoma. Multiplane TEE improves

  7. The regulatory role of smooth muscle 22 on the proliferation of aortic smooth muscle cells participates in the development of aortic dissection.

    PubMed

    Sun, Yudong; Zhao, Zhiqing; Hou, Lewei; Xiao, Yu; Qin, Feng; Yan, Junyi; Zhou, Jian; Jing, Zaiping

    2017-09-01

    The aim of this study was to determine the role of smooth muscle 22 (SM22) in aortic dissection (AD) vascular remodeling and its regulatory mechanism on vascular smooth muscle cell function. Seven patients who underwent surgery for AD with no genetic predisposition and seven organ donors who died from nonvascular diseases were selected. In each aorta sample, the levels of SM22 were detected using immunohistochemistry and Western blot analysis. We inhibited the expression of SM22 with the application of RNA interference in human aortic smooth muscle cells (HASMCs). Cell-counting Kit-8 (Dojindo, Kumamoto, Japan) analyses were used to detect HASMC proliferation. Furthermore, the intracellular calcium concentration was detected using Rhod-2/AM (Dojindo) staining. SM22 was significantly downregulated in the media of AD samples compared with controls (P < .05). In an in vitro study, downregulation of SM22 can significantly promote HASMC proliferation. Our research further revealed that cells treated with nifedipine can inhibit the promoter activity of SM22 downregulation on HASMC proliferation. Intracellular calcium concentration was a significantly varied during the process. SM22 regulates HASMC function activity through intracellular calcium. It presents a downregulation in AD, which might play a potential role in vascular remodeling of AD. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  8. Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

    PubMed Central

    Nicolò, Francesca; Bovio, Emanuele; Serrao, Andrea; Zeitani, Jacob; Scafuri, Antonio; Chiariello, Luigi; Ruvolo, Giovanni

    2016-01-01

    We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement. The operative mortality rate was 22%. Total arch replacement was associated with a 33% risk of operative death, versus 15% for hemiarch (P=0.044). Multivariable analysis found these independent predictors of operative death: age (odds ratio [OR]=1.13/yr; 95% confidence interval [CI], 1.04–1.23; P=0.002), body mass index >30 kg/m2 (OR=9.9; 95% CI, 1.28–19; P=0.028), postoperative low cardiac output (OR=10.6; 95% CI, 1.18–25; P=0.035), and total arch replacement (OR=8.8; 95% CI, 1.39–15; P=0.021) The mean overall 5-year survival rate was 59.3% ± 5.5%, and mean 5-year freedom from distal reintervention was 95.4% ± 3.2% (P=NS). In type A AAD, aortic arch surgery is still associated with high operative mortality rates; hemiarch replacement can be performed more safely than total arch replacement. Rates of distal aortic reoperation were not different between the 2 surgical strategies. PMID:28100966

  9. Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection.

    PubMed

    Gao, Feng; Zeng, Qian; Lin, Fangming; Ge, Xiaohu

    2017-07-01

    To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

  10. Clinical outcomes of valve-sparing root replacement in acute type A aortic dissection.

    PubMed

    Lee, Heemoon; Cho, Yang Hyun; Sung, Kiick; Kim, Wook Sung; Park, Kay-Hyun; Park, Pyo Won; Lee, Young Tak

    2015-01-01

    The early and late outcomes of valve-sparing root replacement (VSR) in type A aortic dissection (AAD) are unknown. The aim of this study was to review the outcomes of VSR in AAD. We also compared the outcomes of VSR with the Bentall operation, which served as a standard reference technique. We retrospectively reviewed 52 patients who underwent surgery for AAD and concomitant root replacement between 1998 and 2013 at Samsung Medical Center. Patients were divided into two groups: Bentall (n = 34) and VSR (n = 18). Two out of six surgeons performed VSR. The mean follow-up duration was 62.3 ± 46.5 months. Preoperative characteristics were similar between the two groups except age (Bentall, 48 ± 11 years; VSR, 37 ± 11 years, p = 0.011). The aortic cross-clamping time was longer in the VSR group (Bentall, 185.8 ± 63.8; VSR, 241.4 ± 44.3 min, p = 0.002). There was no early death in the VSR group, but there was one in the Bentall group (p = 1.000). Despite the higher reoperation rate for aortic valve in the VSR group (Three reoperations) than in the Bentall group (no reoperation), major valve-related events and overall mortality did not differ between the two groups(p = 0.876 and 0.119, respectively). In multivariable analysis, the root replacement technique was not a risk factor for major valve-related events. VSR seems to be equivalent to the Bentall procedure for AAD in terms of early and late outcomes. VSR can be considered as a viable option, particularly for young patients with favorable aortic valve leaflets undergoing surgery at an experienced center.

  11. Malignant hypertension and acute aortic dissection associated with caffeine-based ephedra-free dietary supplements: a case report.

    PubMed

    Ahmed, Imdad

    2009-04-03

    The use of weight loss dietary supplements is prevalent in the United States, and over the past decade, there has been tremendous growth of the use of these products. It is well documented that ephedra-based products are associated with various cardiovascular adverse effects. With new restrictions placed on such products, companies are now manufacturing caffeine-based ephedra-free herbal supplements. We present the case of 36-year old, previously healthy female who developed malignant hypertension and aortic dissection while taking various caffeine-based dietary supplements. Given the lack of research studies in regards to their safety and efficacy, judicious care should be taken with the use of dietary supplements, including those designated as ephedra-free.

  12. The Potential of Computational Fluid Dynamics Simulation on Serial Monitoring of Hemodynamic Change in Type B Aortic Dissection.

    PubMed

    Yu, Simon C H; Liu, Wen; Wong, Randolph H L; Underwood, Malcolm; Wang, Defeng

    2016-08-01

    We aimed to assess the potential of computational fluid dynamics simulation (CFD) in detecting changes in pressure and flow velocity in response to morphological changes in type B aortic dissection. Pressure and velocity in four morphological models of type B aortic dissection before and after closure of the entry tear were calculated with CFD and analyzed for changes among the different scenarios. The control model (Model 1) was patient specific and built from the DICOM data of CTA, which bore one entry tear and three re-entry tears. Models 2-4 were modifications of Model 1, with two re-entry tears less in Model 2, one re-entry tear more in Model 3, and a larger entry tear in Model 4. The pressure and velocity pertaining to each of the morphological models were unique. Changes in pressure and velocity findings were accountable by the changes in morphological features of the different models. There was no blood flow in the false lumen across the entry tear after its closure, the blood flow direction across the re-entry tears was reversed after closure of the entry tear. CFD simulation is probably useful to detect hemodynamic changes in the true and false lumens of type B aortic dissection in response to morphological changes, it may potentially be developed into a non-invasive and patient-specific tool for serial monitoring of hemodynamic changes of type B aortic dissection before and after treatment.

  13. Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.

    PubMed

    Núñez-Gil, Iván J; Bautista, Daniel; Cerrato, Enrico; Salinas, Pablo; Varbella, Ferdinando; Omedè, Pierluigi; Ugo, Fabrizio; Ielasi, Alfonso; Giammaria, Massimo; Moreno, Raúl; Pérez-Vizcayno, María José; Escaned, Javier; De Agustin, José Alberto; Feltes, Gisela; Macaya, Carlos; Fernández-Ortiz, Antonio

    2015-06-16

    Aortic dissection type A is a disease with high mortality. Iatrogenic aortic dissection after interventional procedures is infrequent, and prognostic data are scarce. Our objective was to analyze its incidence, patient profile, and long-term prognosis. Between 2000 and 2014, we retrospectively analyzed 74 patients with dissection of the ascending aorta. Clinical and procedural data were reviewed, and later, we performed a prospective clinical follow-up by telephone or in the office. The incidence of aortic dissection was 0.06%. Our patients, predominantly male (67.6%), had a mean age of 66.9±10.8 years. With multiple cardiovascular risk factors, the main reason for cardiac catheterization was an acute coronary syndrome (n=54). The complication was detected acutely in all, trying to engage the right coronary artery in 47 and the left main artery in 30 and after other maneuvers in 2, mostly complex therapeutic procedures (78.4%). A coronary artery was involved in 45 patients (60.8%). Thirty-five patients underwent an angioplasty and stent implantation; 3 had cardiac surgery; and 36 were managed conservatively. Two patients died of cardiogenic shock after the dissection. After a median follow-up of 51.2 months (range, 16.4-104.8 months), none of the remaining patients developed complications as a result of the dissection, progression, ischemia, pain, or dissection recurrence. Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short- and long-term prognosis with the adoption of a conservative approach. When a coronary artery is involved as an entry point, it usually can be safely sealed with a stent with good long-term outcomes. © 2015 American Heart Association, Inc.

  14. Traumatic vertebral artery dissection presenting with incomplete congruous homonymous quadrantanopia

    PubMed Central

    2010-01-01

    Background To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis. Case presentation A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect. Conclusions We describe an atypical case of VAD presenting with a small congruous quadrantanopia. This is a rare but significant condition that predisposes to multiple thromboembolic infarction that may be easily misdiagnosed and a high index of suspicion is required to make the diagnosis. PMID:20482837

  15. Intracranial versus extracranial artery dissection cases presenting with ischemic stroke.

    PubMed

    Chen, Hongbing; Hong, Hua; Xing, Shihui; Liu, Gang; Zhang, Aiwu; Tan, Shuangquan; Zhang, Jian; Zeng, Jinsheng

    2015-04-01

    To compare the clinical and radiologic characteristics, possible stroke mechanisms, and prognosis of intracranial artery dissections (IADs) with those of extracranial artery dissections (EADs) presenting with cerebral infarction. Among 3250 adult patients with acute ischemic stroke (cerebral infarction), we prospectively recruited and categorized patients with cerebral infarction secondary to spontaneous cerebral artery dissection into IAD or EAD groups. The clinical and radiologic characteristics, possible stroke mechanisms according to the distributions of the infarctions based on diffusion-weighted imaging, and prognosis were analyzed for both groups. There were 48 and 50 patients experiencing IAD and EAD, accounting for 1.5% and 1.5% of all ischemic stroke patients, respectively. Compression of the perforating artery was the most common possible stroke mechanism (33.3%) in IADs; thromboembolism was more common in EADs than that in IADs (36 of 50 versus 12 of 48; P < .001). Magnetic resonance imaging and angiography were used to investigate the arterial dissections in all IAD patients and 46 EAD patients. Based on magnetic resonance imaging and angiography, the IADs more frequently displayed dissecting aneurysm (6 of 48 versus 0 of 46; P = .027) and intimal flap or double lumen (21 of 48 versus 4 of 46; P < .001) than EADs. For the clinical characteristics and prognosis, there was no significant difference between the 2 groups. These results indicate that IAD is an important cause of ischemic stroke, and it displays unique radiologic characteristics and specific stroke mechanisms compared with EAD. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Influence of False Lumen Status on the Prognosis of Acute Type A Aortic Dissection without Urgent Surgical Treatment

    PubMed Central

    Ishii, Hideki; Suzuki, Susumu; Ota, Tomoyuki; Oshima, Hideki; Usui, Akihiko; Komori, Kimihiro; Murohara, Toyoaki

    2017-01-01

    Aim: Recently, much attention has been focused on partial thrombosis of the false lumen in patients with acute aortic dissection. However, its effect on clinical outcomes in these patients, especially in case of acute type A aortic dissection, has not been clearly elucidated. This study evaluated the influence of the false lumen status, including partial thrombosis, on short-term clinical outcomes in acute type A aortic dissection patients without urgent surgical treatment. Methods: Sixty-two patients (29 males, mean age 73 ± 13 years) with acute type A aortic dissection who did not receive urgent surgical treatment at four hospitals were enrolled. Patients were divided into three groups based on the false lumen status on enhanced computed tomography image (complete thrombosis, n = 28; partial thrombosis, n = 27; patent, n = 7). Patients with partial thrombosis were further divided into two groups (thrombus-dominant, n = 15; flow-dominant, n = 12). Results: The short-term mortality rate (in-hospital and 30-day) was significantly higher in patients with a patent false lumen, while no significant difference was seen between the other two groups. Patients with flow-dominant partial thrombosis had significantly higher short-term mortality rate than those with thrombus-dominant partial thrombosis (in-hospital, p = 0.001 and 30-day, p < 0.001). Conclusions: The short-term mortality rate in acute type A aortic dissection patients without urgent surgical treatment was lower in patients with partial thrombosis of the false lumen than in those with a patent false lumen. Furthermore, patients with flow-dominant partial thrombosis had higher mortality rate than those with thrombus-dominant partial thrombosis. PMID:27466158

  17. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection.

    PubMed

    Aizawa, Kei; Kawahito, Koji; Misawa, Yoshio

    2016-07-01

    Extended arch repair for acute type A aortic dissection remains controversial. Our strategy for acute type A aortic dissection was primary entry resection and tear-oriented ascending/hemiarch replacement for patients with the intimal tear in the ascending aorta or is not found in the ascending/aortic arch. Extended total/partial arch replacement was performed for patients with the tear located in the aortic arch. Here, we investigated the validity of our strategy from the viewpoints of long-term survival and reoperation. Between 2003 and 2014, 267 acute type A aortic dissection patients (mean age; 65.2 ± 12.9 years, 134 men and 133 women) underwent emergent surgical repair. Ascending/hemiarch replacements were performed in 225 patients (ascending/hemiarch group) and total/partial arch replacements in 42 patients (arch group). Early and late outcomes of both groups were compared. The hospital mortality rates in the ascending/hemiarch and the arch groups were 4.4 and 9.5 %, respectively (p = 0.25). For ascending/hemiarch and arch groups, the actuarial survival rates were 80.7 vs. 84.3 % after 5 years, and 66.4 vs. 74.6 %, respectively, after 10 years (p = 0.94). For ascending/hemiarch and arch groups, reoperation-free survival rates were 72.1 vs. 77.1 % after 5 years, and 62.0 vs. 67.1 %, respectively, after 10 years (p = 0.85). We observed no significant differences in the actuarial survival or reoperation-free survival rates between the groups. These findings suggest that tear-oriented ascending/hemiarch replacement for acute type A aortic dissection does not increase the risk of long-term mortality or reoperation.

  18. A Case Based Approach to Clinical Genetics of Thoracic Aortic Aneurysm/Dissection

    PubMed Central

    Giusti, Betti; Nistri, Stefano; Sticchi, Elena; De Cario, Rosina; Abbate, Rosanna; Gensini, Gian Franco; Pepe, Guglielmina

    2016-01-01

    Thoracic aortic aneurysm/dissection (TAAD) is a potential lethal condition with a rising incidence. This condition may occur sporadically; nevertheless, it displays familial clustering in >20% of the cases. Family history confers a six- to twentyfold increased risk of TAAD and has to be considered in the identification and evaluation of patients needing an adequate clinical follow-up. Familial TAAD recognizes a number of potential etiologies with a significant genetic heterogeneity, in either syndromic or nonsyndromic forms of the manifestation. The clinical impact and the management of patients with TAAD differ according to the syndromic and nonsyndromic forms of the manifestation. The clinical management of TAAD patients varies, depending on the different forms. Starting from the description of patient history, in this paper, we summarized the state of the art concerning assessment of clinical/genetic profile and therapeutic management of TAAD patients. PMID:27314043

  19. The interactions between bloodstream and vascular structure on aortic dissecting aneurysmal model: A numerical study

    NASA Astrophysics Data System (ADS)

    Chen, Zeng-Sheng; Fan, Zhan-Ming; Zhang, Xi-Wen

    2013-06-01

    Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm (ADA). However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to occlude ADA will result in a decreased chance of rupture.

  20. 320-row CT renal perfusion imaging in patients with aortic dissection: A preliminary study

    PubMed Central

    Liu, Dongting; Liu, Jiayi; Wen, Zhaoying; Li, Yu; Sun, Zhonghua; Xu, Qin; Fan, Zhanming

    2017-01-01

    Objective To investigate the clinical value of renal perfusion imaging in patients with aortic dissection (AD) using 320-row computed tomography (CT), and to determine the relationship between renal CT perfusion imaging and various factors of aortic dissection. Methods Forty-three patients with AD who underwent 320-row CT renal perfusion before operation were prospectively enrolled in this study. Diagnosis of AD was confirmed by transthoracic echocardiography. Blood flow (BF) of bilateral renal perfusion was measured and analyzed. CT perfusion imaging signs of AD in relation to the type of AD, number of entry tears and the false lumen thrombus were observed and compared. Results The BF values of patients with type A AD were significantly lower than those of patients with type B AD (P = 0.004). No significant difference was found in the BF between different numbers of intimal tears (P = 0.288), but BF values were significantly higher in cases with a false lumen without thrombus and renal arteries arising from the true lumen than in those with thrombus (P = 0.036). The BF values measured between the true lumen, false lumen and overriding groups were different (P = 0.02), with the true lumen group having the highest. Also, the difference in BF values between true lumen and false lumen groups was statistically significant (P = 0.016), while no statistical significance was found in the other two groups (P > 0.05). The larger the size of intimal entry tears, the greater the BF values (P = 0.044). Conclusions This study shows a direct correlation between renal CT perfusion changes and AD, with the size, number of intimal tears, different types of AD, different renal artery origins and false lumen thrombosis, significantly affecting the perfusion values. PMID:28182709

  1. Mechanical stretch-induced endoplasmic reticulum stress, apoptosis and inflammation contribute to thoracic aortic aneurysm and dissection.

    PubMed

    Jia, Li-Xin; Zhang, Wen-Mei; Zhang, Hong-Jia; Li, Tao-Tao; Wang, Yue-Li; Qin, Yan-Wen; Gu, Hong; Du, Jie

    2015-07-01

    Thoracic aortic aneurysm/dissection (TAAD) is characterized by excessive smooth muscle cell (SMC) loss, extracellular matrix (ECM) degradation and inflammation. In response to certain stimuli, endoplasmic reticulum (ER) stress is activated and regulates apoptosis and inflammation. Excessive apoptosis promotes aortic inflammation and degeneration, leading to TAAD. Therefore, we studied the role of ER stress in TAAD formation. A lysyl oxidase inhibitor, 3-aminopropionitrile fumarate (BAPN), was administrated to induce TAAD formation in mice, which showed significant SMC loss (α-SMA level). Excessive apoptosis (TUNEL staining) and ER stress (ATF4 and CHOP), along with inflammation, were present in TAAD samples from both mouse and human. Transcriptional profiling of SMCs after mechanical stress demonstrated the expression of genes for ER stress and inflammation. To explore the causal role of ER stress in initiating degenerative signalling events and TAAD, we treated wild-type (CHOP(+/+)) or CHOP(-/-) mice with BAPN and found that CHOP deficiency protected against TAAD formation and rupture, as well as reduction in α-SMA level. Both SMC apoptosis and inflammation were significantly reduced in CHOP(-/-) mice. Moreover, SMCs isolated from CHOP(-/-) mice were resistant to mechanical stress-induced apoptosis. Taken together, our results demonstrated that mechanical stress-induced ER stress promotes SMCs apoptosis, inflammation and degeneration, providing insight into TAAD formation and progression. © 2015 Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

  2. TGFBR2 mutations alter smooth muscle cell phenotype and predispose to thoracic aortic aneurysms and dissections

    PubMed Central

    Inamoto, Sakiko; Kwartler, Callie S.; Lafont, Andrea L.; Liang, Yao Yun; Fadulu, Van Tran; Duraisamy, Senthil; Willing, Marcia; Estrera, Anthony; Safi, Hazim; Hannibal, Mark C.; Carey, John; Wiktorowicz, John; Tan, Filemon K.; Feng, Xin-Hua; Pannu, Hariyadarshi; Milewicz, Dianna M.

    2010-01-01

    Aims Transforming growth factor-β (TGF-β) signaling is critical for the differentiation of smooth muscle cells (SMCs) into quiescent cells expressing a full repertoire of contractile proteins. Heterozygous mutations in TGF-β receptor type II (TGFBR2) disrupt TGF-β signaling and lead to genetic conditions that predispose to thoracic aortic aneurysms and dissections (TAADs). The aim of this study is to determine the molecular mechanism by which TGFBR2 mutations cause TAADs. Methods and results Using aortic SMCs explanted from patients with TGFBR2 mutations, we show decreased expression of SMC contractile proteins compared with controls. Exposure to TGF-β1 fails to increase expression of contractile genes in mutant SMCs, whereas control cells further increase expression of these genes. Analysis of fixed and frozen aortas from patients with TGFBR2 mutations confirms decreased in vivo expression of contractile proteins relative to unaffected aortas. Fibroblasts explanted from patients with TGFBR2 mutations fail to transform into mature myofibroblasts with TGF-β1 stimulation as assessed by expression of contractile proteins. Conclusions These data support the conclusion that heterozygous TGFBR2 mutations lead to decreased expression of SMC contractile protein in both SMCs and myofibroblasts. The failure of TGFBR2-mutant SMCs to fully express SMC contractile proteins predicts defective contractile function in these cells and aligns with a hypothesis that defective SMC contractile function contributes to the pathogenesis of TAAD. PMID:20628007

  3. Immersed boundary peridynamics (IB/PD) method to simulate aortic dissection

    NASA Astrophysics Data System (ADS)

    Bhalla, Amneet Pal Singh; Griffith, Boyce

    2016-11-01

    Aortic dissection occurs when an intimal tear in the aortic wall propagates into the media to form a false lumen within the vessel wall. Rupture of the false lumen and collapse of the true lumen both carry a high risk of morbidity and mortality. Surgical treatment consists of either replacement of a portion of the aorta, or stent implantation to cover the affected segment. Both approaches carry significant risks: open surgical intervention is highly invasive, whereas stents can be challenging to implant and offer unclear long-term patient outcomes. It is also difficult to time optimally the intervention to ensure that the benefits of treatment outweigh its risks. In this work we develop innovative fluid-structure interaction (FSI) model combining elements from immersed boundary (IB) and peridynamics (PD) methods to simulate tears in membranes. The new approach is termed as IB/PD method. We use non-ordinary state based PD to represent material hyperelasticity. Several test problems are taken to validate peridynamics approach to model structural dynamics, with and without accounting for failure in the structures. FSI simulations using IB/PD method are compared with immersed finite element method (IB/FE) to validate the new hybrid approach. NIH Award R01HL117163 NSF Award ACI 1450327.

  4. A Case of Acute Myocardial Infarction due to Left Main Trunk Occlusion Complicated With Aortic Dissection as Diagnosed by Intravascular Ultrasound

    PubMed Central

    Okamoto, Masashi; Amano, Tomonori; Matsuoka, Shunzo; Hirai, Hideki; Masuda, Kazunori; Nakajima, Kanta; Sueyoshi, Atsushi

    2012-01-01

    A 52-year-old man was transferred to our hospital with a sudden onset of severe chest pains. His electrocardiogram revealed ST-segment elevation suggestive of acute myocardial infarction. Emergency coronary angiography showed subtotal occlusion of left main trunk (LMT) with delayed coronary flow. Because intravascular ultrasound revealed a large intimal flap, we diagnosed aortic dissection involving the LMT. After stenting of the LMT, the patient underwent surgical repair of the aortic dissection. Although it is difficult to obtain a correct diagnosis of aortic dissection complicated with myocardial ischemia, we succeeded in diagnosing this rare condition by use of a intravascular ultrasound.

  5. TGFB2 loss of function mutations cause familial thoracic aortic aneurysms and acute aortic dissections associated with mild systemic features of the Marfan syndrome

    PubMed Central

    Boileau, Catherine; Guo, Dong-Chuan; Hanna, Nadine; Regalado, Ellen S.; Detaint, Delphine; Gong, Limin; Varret, Mathilde; Prakash, Siddharth; Li, Alexander H.; d’Indy, Hyacintha; Braverman, Alan C.; Grandchamp, Bernard; Kwartler, Callie S.; Gouya, Laurent; Santos-Cortez, Regie Lyn P.; Abifadel, Marianne; Leal, Suzanne M.; Muti, Christine; Shendure, Jay; Gross, Marie-Sylvie; Rieder, Mark J.; Vahanian, Alec; Nickerson, Deborah A.; Michel, Jean Baptiste; Jondeau, Guillaume; Milewicz, Dianna M.

    2014-01-01

    A predisposition for thoracic aortic aneurysms leading to acute aortic dissections can be inherited in families in an autosomal dominant manner. Genome-wide linkage analysis of two large unrelated families with thoracic aortic disease, followed by whole exome sequencing of affected relatives, identified causative mutations in TGFB2. These mutations, a frameshift mutation in exon 6 and a nonsense mutation in exon 4, segregated with disease with a combined LOD score of 7.7. Sanger sequencing of 276 probands from families with inherited thoracic aortic disease identified two additional TGFB2 mutations. TGFB2 encodes the transforming growth factor beta-2 (TGF-β2) and the mutations are predicted to cause haploinsufficiency for TGFB2, but aortic tissue from cases paradoxically shows increased TGF-β2 expression and immunostaining. Thus, haploinsufficiency of TGFB2 predisposes to thoracic aortic disease, suggesting the initial pathway driving disease is decreased cellular TGF-β2 levels leading to a secondary increase in TGF-β2 production in the diseased aorta. PMID:22772371

  6. The utility of the aortic dissection team: outcomes and insights after a decade of experience

    PubMed Central

    Andersen, Nicholas D.; Benrashid, Ehsan; Ross, Adia K.; Pickett, Lisa C.; Smith, Peter K.; Daneshmand, Mani A.; Schroder, Jacob N.; Gaca, Jeffrey G.

    2016-01-01

    Background Mortality rates following acute type A aortic dissection (ATAAD) repair are reduced when operations are performed by a high-volume acute aortic dissection (AAD) team, leading to efforts to centralize ATAAD care. Here, we describe our experience with ATAAD repair by our AAD team over the last 10 years, with a focus on patient selection, transfer protocols, operative approach, and volume trends over time. Methods An AAD team was implemented at our institution in 2005, with dedicated high-volume AAD surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair. Further process improvements were made in 2013 to facilitate the rapid transfer of ATAAD patients to our institution using stream-lined triage, diagnostic, and transfer protocols for patients with suspected ATAAD (RACE-AD protocol). Volume trends and outcomes were assessed longitudinally over this period. Results Institutional ATAAD repair volume remained constant at 12±2 cases per year from 2005–2013, but increased nearly two-fold to 22±6 cases per year (P=0.004) from 2013–2015 following implementation of the RACE-AD protocol. To accommodate this increased volume, two additional surgeons were added to the AAD team. Surgeon ATAAD repair volume was unchanged over the 10-year interval (7.9±3.9 cases per year from 2005–2013 versus 5.5±1.5 cases per year from 2013–2015; P=0.36), and all AAD team surgeons consistently met or exceeded the high-volume surgeon threshold of 5 ATAAD repairs per year. Thirty-day/in-hospital mortality rates of less than 10% were maintained over the study period. Conclusions Centralization of ATAAD care has begun to occur at our center, with maintenance of low mortality rates for ATAAD repair. These data confirm a net positive impact on regional ATAAD outcomes through transfer of patients to a high-volume center with dedicated AAD surgeons. PMID:27386406

  7. [Surgical Procedure Using the Elephant Trunk Technique at All Anastomotic Sites for Acute Type A Aortic Dissection].

    PubMed

    Hashizume, Koji; Sumi, Mizuki; Tanigawa, Kazuyoshi; Miura, Takashi; Matsukuma, Seiji; Matsumaru, Ichiro; Eishi, Kiyoyuki

    2016-04-01

    We report the use of the elephant trunk technique at all anastomotic sites in acute type A aortic dissection surgery. Artificial graft carrying a 2-mm short elephant trunk were prepared for both distal and proximal anastomotic sites. Subjects were 82 patients with acute type A aortic dissection who underwent surgery using this procedure between March 2009 and August 2015. The mean age was 69.6 ±10.7 years( range, 43~89 years). Seventeen patients( 20.7%) had cardiac tamponade or shock, while 8 cases( 9.8%) had organ ischemia due to malperfusion. Total aortic arch replacement was performed in 22 patients (26.8%), while replacement of the ascending aorta was performed in 60( 73.2%). The mean durations of surgery, extracorporeal circulation, and cardiac ischemia were 352 ± 64, 199 ± 37, and 123 ± 26 min, respectively. Five in-hospital deaths( 6.1%) occurred. With respect to early complications, 5 patients( 6.1%) had permanent encephalopathy. Nine (11.0%) had respiratory failure, and 4 (4.9%) required tracheotomy. None of the patients had bleeding requiring additional thoracotomy for hemostasis and none had complications attributed to preparation of the artificial vessels. Artificial graft were prepared using the elephant trunk technique for use at all anastomotic sites in acute type A aortic dissection surgery. This procedure, involving stepwise proximal anastomosis, is highly effective for hemostasis and safe.

  8. [Distal anastomosis using parachute technique with 4 stay-sutures for Stanford type A acute aortic dissection].

    PubMed

    Suezawa, Takanori; Aoki, Atsushi; Kotani, Mitsuhisa; Tago, Mamoru

    2012-08-01

    Distal anastomosis in total arch repair for type A acute aortic dissection is difficult because of fragile aortic wall and time-limiting procedure. Until 2008, distal anastomosis was performed with continuous suture technique at 20 ℃, and parachute technique with 4-stay sutures at 26 ℃ was introduced in our institution. This new technique was compared with previous distal anastomosis with continuous suture technique. From May 1997 to December 2010, 40 patients underwent emergent arch repair for type A acute aortic dissection. Continuous suture technique was used in 23 patients (group C) and parachute technique with 4 stay-sutures was used in 17 patients( group P). Patient's demographics did not differ between the 2 groups and there was no difference in perioperative or hospital death in the 2 groups. Lower limb ischemic time, cardiac ischemic time, cardiopulmonary bypass time and operation time were significantly shorter in group P. Distal anastomosis using parachute technique with 4-stay sutures in arch repair for type A acute aortic dissection seems to be useful compared with continuous suture technique.

  9. Undiagnosed aortic dissection in patient with intra-aortic balloon pump.

    PubMed

    Raut, Monish S; Maheshwari, Arun; Sharma, Manish

    2016-01-01

    60 years old lady presented with chest pain and was admitted in local hospital. Electrocardiogram was suggestive of anterior myocardial ischemia. Patient underwent coronary angiography which revealed severe triple vessles coronary artery disease. As patient was hemodynamically unstable and in cardiogenic shock, intraaortic balloon pump was inserted .IABP augmented diastolic blood pressure was less than unassisted systolic blood pressure despite setting maximum augmentation on IABP machine.

  10. Undiagnosed aortic dissection in patient with intra-aortic balloon pump

    PubMed Central

    Raut, Monish S.; Maheshwari, Arun; Sharma, Manish

    2016-01-01

    60 years old lady presented with chest pain and was admitted in local hospital. Electrocardiogram was suggestive of anterior myocardial ischemia. Patient underwent coronary angiography which revealed severe triple vessles coronary artery disease. As patient was hemodynamically unstable and in cardiogenic shock, intraaortic balloon pump was inserted .IABP augmented diastolic blood pressure was less than unassisted systolic blood pressure despite setting maximum augmentation on IABP machine. PMID:27397468

  11. The influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair.

    PubMed

    Shuhaiber, Jeffrey H; Fava, Joseph L; Shin, Tai; Dobrilovic, Nikola; Ehsan, Afshin; Bert, Arthur; Sellke, Frank

    2013-11-01

    The effect of the lunar cycle and seasonal variation on ascending aortic dissection surgery outcomes is unknown. We investigated these temporal effects on risk-adjusted hospital mortality and then on the length of stay (LOS) following surgery for survivors. We examined prospectively collected data from cardiac operations at two major centres within a single state between January 1996 and December 2011. We first examined the relationship between the lunar cycle and seasonal variation, along with demographic and risk profile covariates, with mortality using univariate analyses, followed by multiple logistic regression modelling that controlled for demographic and patient risk variables including age, gender, risk profile (diabetes, hypertension, dyslipidaemia and renal failure), and two surgical groups: Group A, consisting of patients having repair of ascending aorta dissection repair only, and Group B, with those having ascending aorta repair plus aortic valve surgery or coronary bypass surgery or both. We further examined the relationship with LOS using both univariate and multiple regression analyses. There were 210 patients who had repair of dissection in the study period, with 109 patients in Group A and 101 in Group B. The average age of this sample was 59.5 (standard deviation = 16.0), 65.7% were male and 18.1% died prior to discharge following repair. The greatest percentage of deaths occurred in winter (31.6%, n = 12), while the least were in summer (21.1%, n = 8) and fall (21.1%, n = 8). An overall χ(2) test found there was no difference in mortality for season (P = 0.55). Univariate analyses also found the age of patients who died vs lived was significantly higher (65.9 vs 58.1 years; P = 0.001), and a significantly greater (P = 0.029) percentage of patients with diabetes vs without diabetes died (41.7 vs 16.7%). Univariate analyses found all other covariates were not significantly related to mortality. In the multiple logistic regression model, there was

  12. The influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair

    PubMed Central

    Shuhaiber, Jeffrey H.; Fava, Joseph L.; Shin, Tai; Dobrilovic, Nikola; Ehsan, Afshin; Bert, Arthur; Sellke, Frank

    2013-01-01

    OBJECTIVES The effect of the lunar cycle and seasonal variation on ascending aortic dissection surgery outcomes is unknown. We investigated these temporal effects on risk-adjusted hospital mortality and then on the length of stay (LOS) following surgery for survivors. METHODS We examined prospectively collected data from cardiac operations at two major centres within a single state between January 1996 and December 2011. We first examined the relationship between the lunar cycle and seasonal variation, along with demographic and risk profile covariates, with mortality using univariate analyses, followed by multiple logistic regression modelling that controlled for demographic and patient risk variables including age, gender, risk profile (diabetes, hypertension, dyslipidaemia and renal failure), and two surgical groups: Group A, consisting of patients having repair of ascending aorta dissection repair only, and Group B, with those having ascending aorta repair plus aortic valve surgery or coronary bypass surgery or both. We further examined the relationship with LOS using both univariate and multiple regression analyses. RESULTS There were 210 patients who had repair of dissection in the study period, with 109 patients in Group A and 101 in Group B. The average age of this sample was 59.5 (standard deviation = 16.0), 65.7% were male and 18.1% died prior to discharge following repair. The greatest percentage of deaths occurred in winter (31.6%, n = 12), while the least were in summer (21.1%, n = 8) and fall (21.1%, n = 8). An overall χ2 test found there was no difference in mortality for season (P = 0.55). Univariate analyses also found the age of patients who died vs lived was significantly higher (65.9 vs 58.1 years; P = 0.001), and a significantly greater (P = 0.029) percentage of patients with diabetes vs without diabetes died (41.7 vs 16.7%). Univariate analyses found all other covariates were not significantly related to mortality. In the multiple logistic

  13. Mortality outcomes of ruptured abdominal aortic aneurysms and rural presentation.

    PubMed

    Munday, Emily; Walker, Stuart

    2016-10-01

    Centralisation of vascular surgery services has coincided with a move towards endovascular repair of ruptured abdominal aortic aneurysms with the goal to improve patient outcomes. The aim of this study was to assess the effect of rural presentation and transfer times on survival from ruptured abdominal aortic aneurysm. A retrospective review. All patients presenting with ruptured abdominal aortic aneurysm to public hospitals in Tasmania between July 2006 and April 2013. Demographic data, Glasgow aneurysm score, Hardman index, transfer times, operative technique and 30-day mortality were collected from medical records. Over the study period 127 patients presented to public hospitals in Tasmania with ruptured abdominal aortic aneurysm. A total of 27 presented to north west hospitals where no vascular surgery service is provided (NWRH), 23 to a northern hospital where an intermittent vascular surgery service is provided (LGH) and 77 to the state tertiary vascular surgery service (RHH). Of these, 4 (14.8%) died at NWRH, 6 (26.1%) died at LGH and 43 (55.8%) died at RHH without operation. Of the 35 patients transferred from NWRH and LGH to RHH, 5 died without operation. Median time from presentation to theatre at RHH if transferred from NWRH was 6.25 hours, from the LGH 4.75 hours, compared to 2.75 hours when presenting directly to RHH. Open repair was performed in 41 patients and endovascular repair in 23 patients. Overall 30-day mortality in those treated at RHH was 26.6% (39.0% for open repair, 4.3% for endovascular repair). Mortality for intended operative patients initially presenting to non-RHH hospitals was 33.3% vs. 32.3% for those initially presenting to RHH. p Value 0.93. There was no clinical or statistical disadvantage to rural presentation and transfer for patients presenting with ruptured abdominal aortic aneurysm in Tasmania. Endovascular repair has a role despite long transfer times. © The Author(s) 2015.

  14. Emergency rescue endovascular stent grafting of ascending aorta to relieve life-threatening coronary obstruction in a case of acute aortic dissection.

    PubMed

    Tauchi, Yuuya; Tanioka, Hideki; Kondoh, Haruhiko; Satoh, Hisashi; Matsuda, Hikaru

    2014-12-01

    Myocardial ischemia associated with acute aortic dissection is frequently a fatal complication, and the emergent management still remains a challenge. We report a patient with life-threatening myocardial ischemia due to acute aortic dissection managed by rescue stent grafting of the ascending aorta. Coronary blood flow improved immediately with this endovascular procedure, hemodynamic status was ameliorated dramatically, followed by uneventful open repair. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Preoperative Embolization of a Tumor-Bearing Horseshoe Kidney Via Both Channels of a Concomitant Aortic Dissection

    SciTech Connect

    Palmowski, Moritz Kiessling, Fabian; Lopez-Benitez, Ruben; Kauffmann, Guenter Werner; Hallscheidt, Peter

    2007-06-15

    Renal cell carcinoma arising in a horseshoe kidney is a rare entity. Preoperative tumor embolization can be performed to prevent massive bleeding complications during organ-preserving surgery. We report the first case of a patient with a tumor-bearing horseshoe-kidney in whom the preoperative embolization, already complex because of the abnormal vascular supply, was additionally complicated by an aortic dissection. An aberrant, horseshoe-kidney-supplying artery originated from the false dissection channel of the aorta, and thus had to be catheterized separately while the other tumor-supplying vessels could be reached via the true aortic lumen. After devascularization of the tumor, organ-preserving surgery was performed without bleeding complications.

  16. TGFB2 mutations cause familial thoracic aortic aneurysms and dissections associated with mild systemic features of Marfan syndrome.

    PubMed

    Boileau, Catherine; Guo, Dong-Chuan; Hanna, Nadine; Regalado, Ellen S; Detaint, Delphine; Gong, Limin; Varret, Mathilde; Prakash, Siddharth K; Li, Alexander H; d'Indy, Hyacintha; Braverman, Alan C; Grandchamp, Bernard; Kwartler, Callie S; Gouya, Laurent; Santos-Cortez, Regie Lyn P; Abifadel, Marianne; Leal, Suzanne M; Muti, Christine; Shendure, Jay; Gross, Marie-Sylvie; Rieder, Mark J; Vahanian, Alec; Nickerson, Deborah A; Michel, Jean Baptiste; Jondeau, Guillaume; Milewicz, Dianna M

    2012-07-08

    A predisposition for thoracic aortic aneurysms leading to acute aortic dissections can be inherited in families in an autosomal dominant manner. Genome-wide linkage analysis of two large unrelated families with thoracic aortic disease followed by whole-exome sequencing of affected relatives identified causative mutations in TGFB2. These mutations-a frameshift mutation in exon 6 and a nonsense mutation in exon 4-segregated with disease with a combined logarithm of odds (LOD) score of 7.7. Sanger sequencing of 276 probands from families with inherited thoracic aortic disease identified 2 additional TGFB2 mutations. TGFB2 encodes transforming growth factor (TGF)-β2, and the mutations are predicted to cause haploinsufficiency for TGFB2; however, aortic tissue from cases paradoxically shows increased TGF-β2 expression and immunostaining. Thus, haploinsufficiency for TGFB2 predisposes to thoracic aortic disease, suggesting that the initial pathway driving disease is decreased cellular TGF-β2 levels leading to a secondary increase in TGF-β2 production in the diseased aorta.

  17. Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer.

    PubMed

    Li, Xianxian; Xing, Hui; Li, Lin; Huang, Yanli; Zhou, Min; Liu, Qiong; Qin, Xiaomin; He, Min

    2014-03-01

    Lymph node metastasis has an important effect on prognosis of patients with ovarian cancer. Moreover, the impact of para-aortic lymph node (PAN) removal on patient prognosis is still unclear. In this study, 80 patients were divided into groups A and B. Group A consisted of 30 patients who underwent PAN + pelvic lymph node (PLN) dissection, whereas group B consisted of 50 patients who only underwent PLN dissection. Analysis of the correlation between PAN clearance and prognosis in epithelial ovarian cancer was conducted. Nineteen cases of lymph node metastasis were found in group A, among whom seven cases were positive for PAN, three cases for PLN, and nine cases for both PAN and PLN. In group B, 13 cases were positive for lymph node metastasis. Our study suggested that the metastatic rate of lymph node is 40.0%. Lymph node metastasis was significantly correlated with FIGO stage, tumor differentiation, and histological type both in groups A and B (P < 0.05). In groups A and B, the three-year survival rates were 77.9% and 69.0%, and the five-year survival rates were 46.7% and 39.2%, respectively. However, the difference was not statistically significant (P > 0.05). The three-year survival rates of PLN metastasis in groups A and B were 68.5% and 41.4%, and the five-year survival rates were 49.7% and 26.4%, respectively. Furthermore, PLN-positive patients who cleared PAN had significantly higher survival rate (P = 0.044). In group A, the three-year survival rates of positive and negative lymph nodes were 43.5% and 72.7%, and the five-year survival rates were 27.2% and 58.5%, respectively. The difference was statistically significant (P = 0.048). Cox model analysis of single factor suggested that lymph node status affected the survival rate (P < 0.01), which was the death risk factor. Consequently, in ovarian carcinoma cytoreductive surgery, resection of the para-aortic lymph node, which has an important function in clinical treatment and prognosis of patients with

  18. [Operation of acute dissecting aortic aneurysm in the 25th week of pregnancy using hypothermic extracorporeal circulation].

    PubMed

    Thaler, C J; Korell, M; Klinner, U; Reichart, B; Hepp, H

    1992-09-01

    We report on a 24 + 2 weeks pregnant woman with Marfan's syndrome, who acutely developed a dissecting aortic aneurysm with aortic valve insufficiency. Emergency surgery was performed by using hypothermic extracorporeal circulation, whilst the aortic valve and ascending aorta were replaced by a synthetic graft. Foetal heart rates, continuously monitored by using Doppler ultrasound, were shown to be closely correlated with perfusion pressures. By applying perfusion pressures of 90-100 mmHg, we were able to maintain foetal heart rates of approximately 100/min. During the first postoperative day, the CTG was normal for gestational age and no contractions were noted. During the second postoperative night, the patient prematurely delivered a dead 820 g infant (Apgar score 0/0/0/0). In view of this case report, opportunities and problems associated with an application of extracorporeal circulation during pregnancy are discussed.

  19. Evaluation of Acute Aortic Dissection Type a Factors and Comparison the Postoperative Clinical Outcomes between Two Surgical Methods

    PubMed Central

    Shemirani, Hasan; Mirmohamadsadeghi, Amir; Mahaki, Behzad; Farhadi, Sadaf; Badalabadi, Reza Mohseni; Bidram, Peyman; Badalabadi, Mehdi Mohseni

    2017-01-01

    Background: Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. Materials and Methods: In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP) and retrograde cerebral one (RCP) on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP) time and excessive blood transfusion, was assessed. Results: Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP (P < 0.001). Excessive blood transfusion and unstable hemodynamic condition had significant effect on surgical mortality (P = 0.014, 0.030, respectively). CPBP time and unstable hemodynamic condition affected long-term mortality significantly (P = 0.002). Conclusion: The result found that ACP is the preferable kind of surgery in comparison with RCP according to the surgical and long-term mortality. PMID:28808651

  20. Optimal clinical pathway for the patient with type B acute aortic dissection.

    PubMed

    Niino, Tetsuya; Hata, Mitsumasa; Sezai, Akira; Yoshitake, Isamu; Unosawa, Satoshi; Shimura, Kazuma; Osaka, Shunji; Minami, Kazutomo

    2009-02-01

    The traditional medical treatment for type B acute aortic dissection (AAD) is widely accepted, but the optimal clinical pathway has not been confirmed. Methods and Results From admissions over the past 12 years, 210 patients with uncomplicated type B AAD were divided into 2 groups: Conventional therapy group (CG) of 90 who were treated by 7 days of bed rest and intravenous antihypertensive agents and the Clinical pathway group (CPG) of 120 who were treated by early rehabilitation. In the CPG, patients were administered oral medication from the first day after onset and took a short walk from the third day after onset. The incidence of respiratory complications, and of delirium, was significantly decreased in the CPG. Early mortality was similar: 3.3% and 2.5%, respectively. The diameter of the aorta had not enlarged in either group 1 month later. Conclusions The clinical pathway of treatment for uncomplicated type B AAD was safer and better for preventing early complications and cost benefit.

  1. Acute Aortic Dissection Biomarkers Identified Using Isobaric Tags for Relative and Absolute Quantitation

    PubMed Central

    Xiao, Ziya; Xue, Yuan; Gu, Guorong; Zhang, Yaping; Zhang, Jin; Fan, Fan; Luan, Xiao; Deng, Zhi; Tao, Zhengang; Song, Zhen-ju; Tong, Chaoyang; Wang, Haojun

    2016-01-01

    The purpose of this study was to evaluate the utility of potential serum biomarkers for acute aortic dissection (AAD) that were identified by isobaric Tags for Relative and Absolute Quantitation (iTRAQ) approaches. Serum samples from 20 AAD patients and 20 healthy volunteers were analyzed using iTRAQ technology. Protein validation was performed using samples from 120 patients with chest pain. A total of 355 proteins were identified with the iTRAQ approach; 164 proteins reached the strict quantitative standard, and 125 proteins were increased or decreased more than 1.2-fold (64 and 61 proteins were up- and downregulated, resp.). Lumican, C-reactive protein (CRP), thrombospondin-1 (TSP-1), and D-dimer were selected as candidate biomarkers for the validation tests. Receiver operating characteristic (ROC) curves show that Lumican and D-dimer have diagnostic value (area under the curves [AUCs] 0.895 and 0.891, P < 0.05). For Lumican, the diagnostic sensitivity and specificity were 73.33% and 98.33%, while the corresponding values for D-dimer were 93.33% and 68.33%. For Lumican and D-dimer AAD combined diagnosis, the sensitivity and specificity were 88.33% and 95%, respectively. In conclusion, Lumican has good specificity and D-dimer has good sensitivity for the diagnosis of AAD, while the combined detection of D-dimer and Lumican has better diagnostic value. PMID:27403433

  2. Evolution of cerebral perfusion techniques in type a aortic dissection surgery: a single center experience.

    PubMed

    Salah, K; van Straten, A H M; Soliman Hamad, M A; ter Woorst, J F; Tan, M E S H

    2012-09-01

    The purpose of this study was to investigate the effect of using antegrade selective cerebral perfusion (ASCP) with moderate hypothermia on hospital mortality after surgery for acute type A aortic dissection (AAAD). Between January 1998 and December 2008, 142 consecutive patients were operated on for AAAD. Patients were divided into two subgroups: the cohort of patients operated on from January 1998 until December 2003 (without ASCP) (P1998-2003, n=64) and the cohort operated on from January 2004 until December 2008 (with ASCP)(P2004-2008, n=78). The difference in hospital mortality was statistically significant (P1998-2003: 42.2%; P2004-2008: 14.1%, p<0.0005). Survival rates were 51.6±6.2% vs. 75.1±5.5% and 45.9±6.2% vs. 69.7±7.3% for one and four years, respectively (p=0.001). Multivariate logistic regression analysis revealed that ASCP was the only independent protective factor of hospital mortality (p=0.047). In patients operated on for AAAD, antegrade selective cerebral perfusion with moderate hypothermia is a significant factor in decreasing hospital mortality.

  3. N-(2-Aminoethyl) Ethanolamine-Induced Morphological, Biochemical, and Biophysical Alterations in Vascular Matrix Associated With Dissecting Aortic Aneurysm.

    PubMed

    Chen, Zhenping; Xu, Ya; Bujalowski, Paul; Oberhauser, Andres F; Boor, Paul J

    2015-12-01

    Dissecting aortic aneurysm (DAA) is an extended tear in the wall of the aorta along the plane of the vascular media. Our previous studies indicated in a developmental animal model, that DAA was related to pathological alteration in collagen, especially collagen type III. Accordingly, in the present studies, neonatal aortic vascular smooth muscle cells (VSMC) and timed pregnant Sprague-Dawley rat dams were treated with N-(2-aminoethyl) ethanolamine (AEEA), which, as shown previously, causes DAA in offspring. Morphological changes in extracellular matrix (ECM) produced by VSMC in vitro were detailed with scanning electron microscopy (SEM), and biochemical changes in cells and ECM produced by VSMCs were defined by Western blotting. Biophysical changes of the collagen extracted from both the ECM produced by VSMC and extracted from fetal rat aortas were studied with atomic force microscopy (AFM). ECM disruption and irregularities were observed in VSMCs treated with AEEA by SEM. Western blotting showed that collagen type I was much more extractable, accompanied by a decrease of the pellet size after urea buffer extraction in the AEEA-treated VSMC when compared with the control. AFM found that collagen samples extracted from the fetal rat aortas of the AEEA-treated dam, and in the in vitro formed ECM prepared by decellularization, became stiffer, or more brittle, indicating that the 3D organization associated with elasticity was altered by AEEA exposure. Our results show that AEEA causes significant morphological, biochemical, and biomechanical alterations in the ECM. These in vitro and in vivo strategies are advantageous in elucidating the underlying mechanisms of DAA.

  4. N-(2-Aminoethyl) Ethanolamine-Induced Morphological, Biochemical, and Biophysical Alterations in Vascular Matrix Associated With Dissecting Aortic Aneurysm

    PubMed Central

    Chen, Zhenping; Xu, Ya; Bujalowski, Paul; Oberhauser, Andres F.; Boor, Paul J.

    2015-01-01

    Dissecting aortic aneurysm (DAA) is an extended tear in the wall of the aorta along the plane of the vascular media. Our previous studies indicated in a developmental animal model, that DAA was related to pathological alteration in collagen, especially collagen type III. Accordingly, in the present studies, neonatal aortic vascular smooth muscle cells (VSMC) and timed pregnant Sprague-Dawley rat dams were treated with N-(2-aminoethyl) ethanolamine (AEEA), which, as shown previously, causes DAA in offspring. Morphological changes in extracellular matrix (ECM) produced by VSMC in vitro were detailed with scanning electron microscopy (SEM), and biochemical changes in cells and ECM produced by VSMCs were defined by Western blotting. Biophysical changes of the collagen extracted from both the ECM produced by VSMC and extracted from fetal rat aortas were studied with atomic force microscopy (AFM). ECM disruption and irregularities were observed in VSMCs treated with AEEA by SEM. Western blotting showed that collagen type I was much more extractable, accompanied by a decrease of the pellet size after urea buffer extraction in the AEEA-treated VSMC when compared with the control. AFM found that collagen samples extracted from the fetal rat aortas of the AEEA-treated dam, and in the in vitro formed ECM prepared by decellularization, became stiffer, or more brittle, indicating that the 3D organization associated with elasticity was altered by AEEA exposure. Our results show that AEEA causes significant morphological, biochemical, and biomechanical alterations in the ECM. These in vitro and in vivo strategies are advantageous in elucidating the underlying mechanisms of DAA. PMID:26443843

  5. Postsurgical aortic false aneurysm: pathogenesis, clinical presentation and surgical strategy.

    PubMed

    Raffa, Giuseppe M; Malvindi, Pietro G; Ornaghi, Diego; Basciu, Alessio; Barbone, Alessandro; Tarelli, Giuseppe; Settepani, Fabrizio

    2013-08-01

    Postsurgical aortic false aneurysm occurs in less than 0.5% of all cardiac surgical cases and its management is a challenge in terms of preoperative evaluation and surgical approach. Although infections are well recognized as risk factors, technical aspects of a previous operation may have a role in pseudoaneurysm formation. The risk factors and clinical presentation of pseudoaneurysms and the surgical strategy are revisited in this article.

  6. Triple-branched stent graft for arch repair in a pregnant woman with acute DeBakey type I aortic dissection.

    PubMed

    Zhang, Qian; Ma, Xiaochun; Wang, Zhengjun; Zou, Chengwei

    2017-03-12

    A woman aged 36 years at 36 weeks of pregnancy sought medical attention at the Shandong Provincial Hospital affiliated to Shandong University, Shandong, China, after experiencing acute chest pain. The patient was diagnosed with chronic hypertension, severe pre-eclampsia, acute aortic dissection, aortic regurgitation, and heart failure. Computed tomography examination demonstrated a DeBakey type I aortic dissection that involved the origin of the innominate artery, the left common carotid artery, and the left subclavian artery. This article is protected by copyright. All rights reserved.

  7. A Contained Ruptured Abdominal Aortic Aneurysm Presenting with Vertebral Erosion.

    PubMed

    Li, Yongqi; Li, Lei; Zhang, Dongming; Wang, Xiaomei; Sun, Weidong; Wang, Han

    2017-02-24

    Chronic contained rupture (CCR) of abdominal aortic aneurysm (AAA) with vertebral erosion is a rare condition. Although it has been reported previously, it is still liable to be misdiagnosed. We present a case of CCR of AAA with vertebral erosion. A brief analysis of similar cases reported in the last 5 years is presented. A 71-year-old male was admitted to our hospital because of severe prickling pain in his left thigh. Computerized tomography angiography revealed an AAA which had caused erosion of L3 vertebral body and the left psoas muscle. An aortotomy was performed, and the excised aortic aneurysm replaced with a Dacron graft. Postoperative computed tomography (CT) angiography indicated a normal aortic graft. The patient was discharged 13 days after the surgery. In conclusion, pain in lower back and leg could be associated with vertebral erosion caused by CCR of AAA. Ultrasonography, CT, or magnetic resonance imaging of abdomen should be routinely performed in cases of lumbago that have associated risk factors for AAA.

  8. Surgery for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique: experience with 252 patients.

    PubMed

    Wu, Hong-bing; Zhang, Hao; Wang, Zhi-wei; Hu, Rui; Li, Luo-cheng; Zhang, Min; Hu, Xiao-ping

    2014-11-01

    The elephant trunk method was introduced to treat aortic disease. There are a variety of modified elephant trunk methods, including the stented elephant trunk. We retrospectively reviewed our experience and evaluated the effectiveness of surgical treatment for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique. From August 2005 to December 2012, 252 patients with acute aortic dissection underwent surgical treatment using the Chinese CRONUS stented elephant trunk technique at the Renmin Hospital of Wuhan University. We review the characteristics of the patients, the surgical method, and the prognosis. Furthermore, we modified the stented elephant trunk technique to simplify the surgical procedure using stented elephant trunk fenestration in 81 patients. The procedure was technically successful in all patients. The mean duration of cardiopulmonary bypass, myocardial ischemia, and circulatory arrest was 158±34 minutes, 98±24 minutes, and 27±9 minutes, respectively. The mean stay in the intensive care unit was 74±11 hours. The in-hospital mortality rate was 3.2% (8/252). A 92.2% (225/244) follow-up rate was achieved. Five patients died during follow-up. The diameter of the descending aorta significantly decreased in 173 patients (78.6%), did not change 39 patients (17.7%), and dilated in 8 patients (3.7%). In surgery for acute aortic dissection, the Chinese CRONUS stented elephant trunk technique had a low prevalence of morbidity and mortality in our patients. The satisfactory effects demonstrated that the technique is safe and effective in closing the residual false lumen of the descending aorta. Stented elephant trunk fenestration could further simplify the surgical procedure with minimal invasion. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  9. Unexpected cause of a right hemiplegia secondary to the painless full-length aortic dissection: a case report and literature review.

    PubMed

    Huang, Shu; Sun, Jialan; Li, Longxuan

    2015-01-01

    Painless aortic dissections in general are uncommon and are frequently misdiagnosed. Here we reported a rare case of acute ischemic stroke secondary to completely painless acute full-length dissection (DeBakey I) and provide a brief review of the literature. A 56-year-old man was referred to our department with right hemiplegia. Ischaemic stroke and thrombolytic treatment were considered initially. At the second examination, the patient was found to have decreased blood pressure, asymmetrical blood pressure/pulses between the bilateral limbs, and sudden loss of pulse in a lower extremity. Laboratory results revealed leucocytosis, elevated creatinine and CK without obvious cause. An aortic dissection was subsequently confirmed by contrast enhanced thoracic and abdominal CT scan. Our report provides some clues for the early diagnosis of painless aortic dissections.

  10. Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

    PubMed Central

    Bucsky, Bence S.; Richardt, Doreen; Petersen, Michael; Sievers, Hans H.

    2016-01-01

    Background The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Methods Between January 2003 and December 2015, 235 patients underwent repair of AADA. All patients were evaluated for the type of arterial cannulation (femoral vs. central) for initial bypass. Demographic data and outcome parameters were accessed. Results One hundred and twenty seven (54.0%) were initially cannulated in the central aortic vessels (ascending aorta or subclavian/axillary artery) and 108 (46.0%) in the femoral artery. Patients were comparable between age (62.4±14.4 vs. 62.9±14.4 years, P=0.805), gender (male, 62.2 vs. 69.4%, P=0.152) and previous sternotomy (15.7 vs. 16.7%, P=0.861) between both cannulation groups; while EuroSCORE I (11.5±4.0 vs. 12.7±4.2, P=0.031) and ASA Score (3.5±0.81 vs. 3.8±0.57, P=0.011) were significantly higher in the femoral artery cannulation group. Bypass (249±102 vs. 240±81 min, P=0.474), X-clamp (166±85 vs. 157±67 min, P=0.418) and circulatory arrest time (51.6±28.7 vs. 48.3±21.7 min, P=0.365) were similar between the groups as were lowest temperature (18.1±2.0 vs. 18.1±2.2, P=0.775). Postoperative neurologic deficit and 30-day mortality were comparable between both cannulation groups (11.7 vs. 7.2%, P=0.449 and 20.2 vs. 16.9%, P=0.699, central vs. peripheral cannulation). Multivariate analysis revealed only EuroScore I above 13 as single preoperative predictor for mortality. Conclusions AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. PMID:27563543

  11. Distal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique.

    PubMed

    Kölbel, Tilo; Lohrenz, Christina; Kieback, Arne; Diener, Holger; Debus, Eike Sebastian; Larena-Avellaneda, Axel

    2013-08-01

    To report a technique to create an extra-large vascular plug for occlusion of a large distal false lumen in chronic aortic dissection. The "candy-plug" technique is demonstrated in a 58-year-old multimorbid man with a history of complicated acute type B aortic dissection and a 9-cm chronic thoracic false lumen aneurysm. The patient underwent a staged repair with a cervical debranching procedure as a first step and a thoracic endovascular aortic repair from the innominate artery to the celiac artery as a second step. To occlude the large false lumen from a distal route, a stent-graft was modified on-table with a diameter-restricting suture, giving it a wrapped candy-like shape. This plug was deployed into the false lumen, and the remaining opening was occluded with a standard vascular plug. On 3-month follow-up imaging, the thoracic false lumen aneurysm remained completely thrombosed. The candy-plug technique can facilitate complete occlusion of chronic thoracic false lumen aneurysm by prohibiting distal false lumen backflow.

  12. The effects of a neutrophil elastase inhibitor on the postoperative respiratory failure of acute aortic dissection.

    PubMed

    Furusawa, T; Tsukioka, K; Fukui, D; Sakaguchi, M; Seto, T; Terasaki, T; Wada, Y; Amano, J

    2006-09-01

    Postoperative respiratory failure is often encountered in patients suffering from acute aortic dissection (AAD) and is believed to be influenced by release of neutrophil elastase after cardiopulmonary bypass. Sivelestat is a specific neutrophil elastase inhibitor, and this study aims to evaluate the effects of sivelestat on postoperative respiratory failure due to AAD. Patients who were operated for AAD from January 2000 to April 2005 and who had less than 300 mmHg initial postoperative PaO (2)/FiO (2) were investigated retrospectively and divided into two groups. Group 1 (n = 9) received intravenous administration of sivelestat immediately after the operation, while Group II (n = 9) received no sivelestat. There were no significant differences between Group I and II with respect to patients' characteristics or background (age, body weight, operating time, cardiopulmonary bypass time, amount of bleeding, preoperative WBC number and initial PaO (2)/FiO (2)). Though patients in Group I showed a subtle improvement in certain parameters such as PaO (2)/FiO (2), A-aDO (2) and respiratory index (RI) over a 3-day observation period compared to those of Group II, there were no significant differences. Neither postoperative mechanical ventilation time nor ICU stay differed between Group I and II. However, Group I showed a significantly greater improvement in the ratio of RI to initial RI on the 3POD compared to that of Group II (61.6 +/- 44.2 % vs. 111.9 +/- 40.9 %, P = 0.02). Inhibiting the activity of the neutrophil elastase may attenuate the postoperative respiratory complications of patients with AAD.

  13. Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak.

    PubMed

    Reginelli, Alfonso; Capasso, Raffaella; Ciccone, Vincenzo; Croce, Maria Rosaria; Di Grezia, Graziella; Carbone, Mattia; Maggialetti, Nicola; Barile, Antonio; Fonio, Paolo; Scialpi, Michele; Brunese, Luca

    2016-09-01

    Computed tomography angiography (CTA) has been widely used in the diagnostic evaluation of many aortic diseases, but no standardized techniques actually exist for aortic CTA. The aim of this study was to describe the usefulness of triphasic CTA in aortic assessment in both non-traumatic emergency and surveillance conditions. We performed non ECG-gated CTA examinations with a 64-slice CT scanner using a triphasic protocol consisting of an unenhanced acquisition, and two (early and delayed) contrastographic phases with a delay of 25-30 s and 100-120 s respectively after the injection of contrast medium. Were retrospectively selected adult patients with imaging findings of acute aortic dissection (AAD) or endoleak (EL) from November 2012 to November 2014. AAD was detected in 36 (67%) patients: 23 type A-AADs, and 13 type B-AADs. The presence of EL was observed in 18 (33%) patients: 1 type Ia, 5 types IIa, 2 types IIb, 1 type IIIa and 9 types IIIb. Triphasic CTA is useful to provide correct and prompt diagnosis of AAD in emergency, allowing the evaluation of type and atypical forms of AAD, and the identification of possible branch-vessel involvement and complications. During surveillance, triphasic CTA assures accurate and complete assessment of all known and unknown ELs and it is essential for first follow-up examination. Triphasic CTA represents a reliable imaging tool for aortic assessment in both non-traumatic emergency and surveillance after endovascular aneurysm repair. Modified protocol could be employed in selected patients and tailored in their known disease. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Acute Paraplegia as a Presentation of Aortic Saddle Embolism

    PubMed Central

    Guishard, Kim

    2016-01-01

    Background. Acute onset paraplegia has a myriad of causes most often of a nonvascular origin. Vascular etiologies are infrequent causes and most often associated with postsurgical complications. Objective. To describe the occurrence and possible mechanism for aortic saddle embolism as a rare cause of acute paraplegia. Case Report. Described is a case of a 46-year-old female who presented with the sudden onset of nontraumatic low back pain with rapidly progressive paraplegia which was subsequently determined to be of vascular origin. PMID:27822396

  15. Rare presentation of ruptured syphilitic aortic aneurysm with pseudoaneurysm.

    PubMed

    de Almeida Feitosa, Israel Nilton; Dantas Leite Figueiredo, Magda; de Sousa Belem, Lucia; Evelin Soares Filho, Antônio Wilon

    2015-11-01

    We report the interesting case of a rare form of presentation of rupture of the ascending aorta with formation of a pseudoaneurysm, diagnosed following the development of a large mass on the surface of the chest over a period of about eight months. Serological tests were positive for syphilis. Echocardiography and computed tomography angiography were essential to confirm the diagnosis and therapeutic management. Cardiovascular syphilis is a rare entity since the discovery of penicillin. Rupture of an aortic aneurysm with formation of a pseudoaneurysm is a potentially fatal complication. The postoperative period was uneventful and the patient was discharged from hospital within days of surgery.

  16. [Thoraco-abdominal aortic replacement in chronic phase in a patient with temporary paraplegia after Stanford B acute dissection].

    PubMed

    Takahashi, Goro; Hata, Masaki; Tabayashi, Koichi

    2013-07-01

    A 42-year-old man underwent was performed with thoraco-abdominal aneurysm replacement accompaniedy with reconstruction of abdominal branches and intercostal arteries. Eighteen months before, he had suffered from Stanford already been cured with paraplegia on being type B acute aortic dissection combined with paraplegia. When paraplegia had been occurred, cerebrospinal fluid drainage was had been performed promptly, and 4 days later, neurologic deficit was disappeared in 1 day. During the thoraco-abdominal aortic operation, cerebrospinal fluid drainage was performed done again. After the operation, paraplegia did was not occurred and he did not feel somewhat wrong with his legs. He was discharged from hospital on foot by himself. This case showed the efficacy of cerebral spinal fluid drainage for not only both with the prevention but also and treatment of paraplegia.

  17. Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

    PubMed Central

    Pan, Xu-Dong; Li, Bin; Ma, Wei-Guo; Zheng, Jun; Liu, Yong-Min; Zhu, Jun-Ming; Huang, Lian-Jun

    2017-01-01

    Background In patients with type A dissection, residual dissection and new distal entry tears following the frozen elephant trunk (FET) procedure adversely affect long-term prognosis. Management include open and endovascular repair, while clinical experience is limited. We evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in management of residual intimal tear or distal new entry tear following FET in patients with type A aortic dissection (TAAD). Methods Between May 2003 and April 2013, we performed FET and total arch replacement for 1,003 patients with TAAD. Among these, 23 patients (2.3%) required TEVAR for distal new entry (n=2) or residual intimal tear (n=21) at a mean of 2.0±1.6 years after FET. Mean age was 50.1±11.5 years. Marfan syndrome was seen in 2 patients (8.7%). Results Procedural success was 100%. The distal landing zone was above the 11th thoracic vertebra (T11) in 86.9% (20/23). Neither death nor any paraplegia or stroke occurred early after TEVAR. Follow-up was complete in 100% averaging 2.8±1.7 years (0.3–6.4). One non-Marfan patient died of distal aortic rupture at 4 months after TEVAR. No late stroke or paraplegia occurred. Survival was 95.7% (95% CI, 72.9–99.4%) at 3 and 5 years, respectively. CTA detected false lumen obliteration by thrombus around the endograft in the descending aorta in 91.3% (21/23) of patients. Conclusions These early and midterm outcomes show the efficacy of TEVAR in obliterating the residual intimal tear or distal new entry after FET in patients with TAAD. TEVAR may be an alternative approach to distal new entry or residual intimal tear following FET for patients with TAAD. PMID:28449459

  18. Repair of Chronic Aneurysmal Aortic Dissection Using a Stent Graft and an Amplatzer(®) Vascular Plug: A Case Study.

    PubMed

    Kanaoka, Yuji; Ohki, Takao; Ozawa, Hirotsugu

    2017-02-01

    We report a case in which a stent graft and an Amplatzer(®) vascular plug (AVP) were effective for the treatment of chronic aneurysmal aortic dissection. The patient was a 52-year-old man. At 45 years of age, he developed acute aortic dissection, for which he underwent surgery 4 times with prosthetic graft replacement in the abdominal aorta, descending thoracic, ascending aorta (without neck branch reconstruction), and thoracoabdominal aorta with the reconstruction of the celiac, superior mesenteric, and bilateral renal arteries. At the time of thoracoabdominal aortic surgery, strong adhesion was evident, particularly in the thoracoabdominal area. The adhesion was dissected in a part of the chest, and prosthetic graft replacement was performed the following day. Subsequently, the dissection of the residual distal aortic arch enlarged, and the patient was examined at our hospital. Computed tomography (CT) revealed a small intimal tear at the site of anastomosis distal to the graft in the ascending aorta and a large intimal tear in the descending thoracic aorta with a maximum diameter of 67 mm. Furthermore, open repair by prosthetic graft replacement seemed difficult; therefore, treatment with stent grafting was considered. Because the prosthetic graft in the abdomen was extremely tortuous, stent-graft insertion via the femoral artery seemed to be impossible. The planned treatment involved the placement of a thoracic stent graft using the chimney technique which included reconstruction of the brachiocephalic artery and left common carotid arteries using chimney stent graft and coverage of the left subclavian artery. The thoracic stent graft was planned to be inserted via the abdominal prosthetic graft site because the abdominal prosthetic graft was crooked and was located close to the body surface. However, a small intimal tear distal to the graft in the ascending aorta which had not been revealed by intraoperative aortography was detected by the selective

  19. Experimental in vivo and ex vivo models for the study of human aortic dissection: promises and challenges

    PubMed Central

    Jiang, Ding-Sheng; Yi, Xin; Zhu, Xue-Hai; Wei, Xiang

    2016-01-01

    Aortic dissection (AD) is a life-threatening aortopathy with high mortality. To mimic spontaneous AD, investigate the pathogenesis of AD and develop novel therapeutic targets and measures, multiple AD experimental models have been generated, including drugs or chemicals induced experimental models, genetically modified experimental models, surgically or invasively induced experimental models, and ex vivo models. However, the perfect model of AD that replicates every aspect of the natural disease has not be generated yet. This review provides an overview of the experimental models used in AD preclinical research. The value and challenges of each in vivo and ex vivo model are discussed. PMID:28077990

  20. Weather conditions and their effect on the increase of the risk of type A acute aortic dissection onset in Berlin.

    PubMed

    Taheri Shahraiyni, Hamid; Sodoudi, Sahar; Cubasch, Ulrich

    2016-08-01

    In this study, a minimum distance classification and forward feature selection technique are joined to determine the relationship between weather conditions and the increase of the risk of type A acute aortic dissection (AAD) events in Berlin. The results demonstrate that changes in the amount of cloudiness and air temperature are the most representative weather predictors among the studied parameters. A discrimination surface was developed for the prediction of AAD events 6 h ahead, and it is found that, under a specific amount of cloudiness and air temperature, the risk of AAD events in Berlin increases about 20 %.

  1. Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations.

    PubMed

    Poninska, J K; Bilinska, Z T; Franaszczyk, M; Michalak, E; Rydzanicz, M; Szpakowski, E; Pollak, A; Milanowska, B; Truszkowska, G; Chmielewski, P; Sioma, A; Janaszek-Sitkowska, H; Klisiewicz, A; Michalowska, I; Makowiecka-Ciesla, M; Kolsut, P; Stawinski, P; Foss-Nieradko, B; Szperl, M; Grzybowski, J; Hoffman, P; Januszewicz, A; Kusmierczyk, M; Ploski, R

    2016-05-04

    Thoracic aortic aneurysms and dissections (TAAD) are silent but possibly lethal condition with up to 40 % of cases being hereditary. Genetic background is heterogeneous. Recently next-generation sequencing enabled efficient and cost-effective examination of gene panels. Aim of the study was to define the diagnostic yield of NGS in the 51 TAAD patients and to look for genotype-phenotype correlations within families of the patients with TAAD. 51 unrelated TAAD patients were examined by either whole exome sequencing or TruSight One sequencing panel. We analyzed rare variants in 10 established thoracic aortic aneurysms-associated genes. Whenever possible, we looked for co-segregation in the families. Kaplan-Meier survival curve was constructed to compare the event-free survival depending on genotype. Aortic events were defined as acute aortic dissection or first planned aortic surgery. In 21 TAAD patients we found 22 rare variants, 6 (27.3 %) of these were previously reported, and 16 (73.7 %) were novel. Based on segregation data, functional analysis and software estimations we assumed that three of novel variants were causative, nine likely causative. Remaining four were classified as of unknown significance (2) and likely benign (2). In all, 9 (17.6 %) of 51 probands had a positive result when considering variants classified as causative only and 18 (35.3 %) if likely causative were also included. Genotype-positive probands (n = 18) showed shorter mean event free survival (41 years, CI 35-46) than reference group, i.e. those (n = 29) without any plausible variant identified (51 years, CI 45-57, p = 0.0083). This effect was also found when the 'genotype-positive' group was restricted to probands with 'likely causative' variants (p = 0.0092) which further supports pathogenicity of these variants. The mean event free survival was particularly low (37 years, CI 27-47) among the probands with defects in the TGF beta signaling (p = 0.0033 vs. the

  2. Descending thoracic aortic mural thrombus presentation and treatment strategies.

    PubMed

    Meyermann, Karol; Trani, Jose; Caputo, Francis J; Lombardi, Joseph V

    2017-09-01

    Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. A review of the literature using PubMed was conducted, and all relevant publications describing descending TAMT of the past 15 years were reviewed. Variables included for this analysis were presentation, initial treatment strategy employed, outcome measures of thrombus resolution or regression, recurrence of symptomatic emboli, and mortality. Seventy-four patients were included in this analysis. Women were significantly more likely to be described with descending TAMT. The majority (82.4%) of cases reported were diagnosed after an embolic event. Patients were equally likely to receive medical, open surgical, or endovascular therapy as the initial treatment modality. However, there is a trend within the past 5 years to report cases describing successful thoracic endovascular aortic repair for initial management. Of patients who initially underwent medical management, nine patients (34.6%) had persistent thrombus. Of the patients who initially underwent open surgical repair, six patients (31.6%) had persistent thrombus; of these patients, four underwent endovascular repair. Twenty-nine patients (39.2%) with descending TAMT initially underwent thoracic endovascular aortic repair. Twenty-seven (93.1%) had fully excluded thrombus at the time of the procedure, with no recurrence or evidence of repeated embolic phenomena at follow-up. Whereas mural thrombus of the thoracic aorta is uncommon, it must be considered in the differential diagnosis of embolic events. Although endovascular therapy may be a useful first-line option for TAMT with reports of positive outcomes in select literature, further study of this treatment option is required. Copyright © 2017. Published by Elsevier Inc.

  3. A Gly1127Ser mutation in an EGF-like domain of the fibrillin-1 gene is a risk factor for ascending aortic aneurysm and dissection.

    PubMed Central

    Francke, U; Berg, M A; Tynan, K; Brenn, T; Liu, W; Aoyama, T; Gasner, C; Miller, D C; Furthmayr, H

    1995-01-01

    Ascending aortic disease, ranging from mild aortic root enlargement to aneurysm and/or dissection, has been identified in 10 individuals of a kindred, none of whom had classical Marfan syndrome (MFS). Single-strand conformation analysis of the entire fibrillin-1 (FBN1) cDNA of an affected family member revealed a G-to-A transition at nucleotide 3379, predicting a Gly1127Ser substitution. The glycine in this position is highly conserved in EGF-like domains of FBN1 and other proteins. This mutation was present in 9 of 10 affected family members and in 1 young unaffected member but was not found in other unaffected members, in 168 chromosomes from normal controls, and in 188 chromosomes from other individuals with MFS or related phenotypes. FBN1 intragenic marker haplotypes ruled out the possibility that the other allele played a significant role in modulating the phenotype in this family. Pulse-chase studies revealed normal fibrillin synthesis but reduced fibrillin deposition into the extracellular matrix in cultured fibroblasts from a Gly1127Ser carrier. We postulate that the Gly1127Ser FBN1 mutation is responsible for reduced matrix deposition. We suggest that mutations such as this one may disrupt EGF-like domain folding less drastically than do substitutions of cysteine or of other amino acids important for calcium-binding that cause classical MFS. The Gly1127Ser mutation, therefore, produces a mild form of autosomal dominantly inherited weakness of elastic tissue, which predisposes to ascending aortic aneurysm and dissection later in life. Images Figure 2 Figure 3 Figure 4 PMID:7762551

  4. A Gly1127Ser mutation in an EGF-like domain of the Fibrillin-I gene is a risk factor for ascending aortic aneurysm and dissection

    SciTech Connect

    Francke, U.; Berg, M.A.; Tynan, K.

    1995-06-01

    Ascending aortic disease, ranging from mild aortic root enlargement to aneurysm and/or dissection, has been identified in 10 individuals of a kindred, none of whom had classical Marfan syndrome (MFS). Single-strand conformation analysis of the entire fibrillin-1 (FBN1) cDNA of an affected family member revealed a G-to-A transition at nucleotide 3379, predicting a Gly1127Ser substitution. The glycine in this position is highly conserved in EGF-like domains of FBN1 and other proteins. This mutation was present in 9 of 10 affected family members and in 1 young unaffected member but was not found in other unaffected members, in 168 chromsomes from normal controls, and in 188 chromosomes from other individuals with MFS or related phenotypes. FBN1 intragenic marker haplotypes ruled out the possibility that the other allele played a significant role in modulating the phenotype in this family. Pulse-chase studies revealed normal fibrillin synthesis but reduced fibrillin deposition into the extracellular matrix in cultured fibroblasts from a Gly1127Ser carrier. We postulate that the Gly1127Ser FBN1 mutation is responsible for reduced matrix deposition. We suggest that mutations such as this one may disrupt EFG-like domain folding less drastically than do substitutions of cysteine or of other amino acids important for calcium-binding that cause classical MFS. The Gly 1127Ser mutation, therefore, produces a mild form of autosomal dominantly inherited weakness of elastic tissue, which predisposes to ascending aortic aneurysm and dissection later in life. 33 refs., 6 figs.

  5. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample.

    PubMed

    Zimmerman, Kate P; Oderich, Gustavo; Pochettino, Alberto; Hanson, Kristine T; Habermann, Elizabeth B; Bower, Thomas C; Gloviczki, Peter; DeMartino, Randall R

    2016-09-01

    Population-based assessment of aortic dissection (AD) hospitalizations in the general United States population is limited. We assessed the current trends in AD admissions and in-hospital mortality for surgical and medical AD treatment. Patients admitted for primary diagnosis of AD were identified from the National Inpatient Sample database (2003-2012). Patients were identified by International Classification of Diseases-Ninth Revision diagnosis codes and categorized by treatment type: type A open surgical repair (TASR), type B open surgical repair (TBSR), thoracic endovascular aortic repair (TEVAR), and medical management (MM). Our primary outcomes were to evaluate admission trends and in-hospital mortality of AD. Secondary outcomes included postoperative complications. We used weighted national estimates of admissions to assess trends over time using linear regression. We also identified factors associated with mortality via a hierarchical multivariable logistic regression model. We identified 15,641 patients (60.7% male; mean age, 63.5 years) admitted with a primary diagnosis of AD between 2003 and 2012. Intervention types included TASR in 3253 (20.8%), TBSR in 3007 (19.2%), TEVAR in 1417 (9.1%), and MM in 7964 (50.9%). Overall weighted admissions for AD increased significantly, from 6980 in 2003 to 8875 in 2012 (P < .01, test of trend), with increases in admission for TASR, from 1143 in 2003 to 2130 in 2012 (P < .01, test of trend), and TEVAR from 96 in 2005 to 1130 in 2012 (P < .01, test of trend). TBSR and MM admissions were stable, with TBSR admissions at 1519 in 2003 and 1540 in 2012 (P = .9, test of trend) and MM admissions at 4319 in 2003 and 4075 in 2012 (P = .8, test of trend). During the same interval, overall in-hospital mortality rates for AD decreased from 18.1% to 13.0% (P < .01, test of trend). When stratified by intervention type, mortality rates decreased for TASR, from 20.5% to 14.8% (P < .01, test of trend), for TBSR, from 18.0% to 14

  6. Hybrid Treatment of Acute Abdominal Aortic Thrombosis Presenting with Paraplegia.

    PubMed

    Azzarone, Matteo; De Troia, Alessandro; Iazzolino, Luigi; Nabulsi, Bilal; Tecchio, Tiziano

    2016-05-01

    Acute thrombotic or embolic occlusion of the abdominal aorta is a rare vascular emergency associated with high morbidity and mortality rates. Classically, the clinical presentation is a severe peripheral ischemia with bilateral leg pain as the predominant feature. Aortic occlusion presenting as an isolated acute onset of paraplegia due to spinal cord ischemia is very rare and requires improved awareness to prevent adverse outcomes associated with delayed diagnosis. We report the case of a 54-year-old man who presented with sudden paraplegia due to the thrombotic occlusion of the infrarenal aorta involving the first segment of the common iliac arteries on both sides; emergent transperitoneal aorto iliac thrombectomy combined with the endovascular iliac kissing-stent technique were performed achieving perioperative complete regression of the symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Dissecting thoracoabdominal aortic aneurysm in a free-ranging Florida panther (felis concolor coryi).

    PubMed

    Rotstein, D S; Taylor, S K; Bossart, G D; Miller, D

    2000-06-01

    A 12-yr-old female free-ranging Florida panther (Felis concolor coryi) was found dead in good flesh. The panther had a ruptured thoracoabdominal aneurysm and 0.5 L of unclotted blood in its thorax. Intimal plaques 6.0 x 3.0 x 3.0 cm and 4.0 x 3.0 x 1.0 cm were present in the thoracic and abdominal aorta extending below the bifurcation of the renal arteries. Histologic examination revealed necrohemorrhagic aortitis with a mixed inflammatory infiltrate of lymphocytes, macrophages, and neutrophils. Death was almost certainly due to exsanguination and hypovolemic shock secondary to the ruptured aneurysm, and the aortitis with the resultant aneurysm may have been secondary to an infectious or a toxic process. This is the first reported death of a free-ranging mammal from a ruptured aortic aneurysm.

  8. The frequency of initial misdiagnosis of acute aortic dissection in the emergency department and its impact on outcome.

    PubMed

    Pourafkari, Leili; Tajlil, Arezou; Ghaffari, Samad; Parvizi, Rezayat; Chavoshi, Mohammadreza; Kolahdouzan, Kasra; Khaki, Nasrin; Parizad, Raziyeh; Hobika, Geoffery G; Nader, Nader D

    2016-09-03

    We determine the frequency of initial misdiagnosis and inappropriate treatment with antiplatelets/anticoagulants in the emergency department (ED) and the resultant clinical outcomes in patients with acute type A aortic dissection (AAOD). Medical records of patients with a final diagnosis of AAOD admitted from March 2004 through October 2015 to our tertiary-level heart hospital were evaluated. Patients with suspected dissection in ED were compared to those with initial misdiagnosis regarding demographics and clinical presentation, laboratory and echocardiographic findings. Our primary outcome was hospital mortality in two groups. Long-term mortality after discharge was our secondary outcome. Among 189 patients, 47 (24.8 %) were initially misdiagnosed and received antiplatelets/anticoagulants in ED (Group F), and 142 (75.1 %) were appropriately diagnosed in ED (Group T). The mean age in group F was 60.4 ± 15.0 vs. 57.4 ± 16.0 years in group T (p = 0.260). In group F, 70.2 % were male vs. 60.6 % in group T (p = 0.311). Hospital mortality was 48.9 % in group F vs. 43.7 % in group T (p = 0.645). Long-term mortality was significantly higher in group F (55.6 vs. 21.2 %, p = 0.007). Univariate hazard ratio (HR) of initial misdiagnosis for long-term mortality was 2.56 (95 % CI 1.08-6.06, p = 0.031). In multivariate Cox regression analysis with adjustment for age and type of management (surgical/medical), initial misdiagnosis lost its significance for predicting long-term mortality (HR 2.14, 95 % CI 0.89-5.13, p = 0.086). Initial misdiagnosis of AAOD is a common problem. Hospital mortality is not significantly affected by receiving antiplatelets/anticoagulants. Although long-term mortality is higher in patients with initial misdiagnosis, it is not an independent predictor for long-term mortality.

  9. Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

    PubMed Central

    Misenheimer, Jacob A.; Ramaraj, Radhakrishnan

    2017-01-01

    Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials—the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal—have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic. PMID:28265210

  10. Screening and management for ischemic heart disease in patients undergoing emergency surgery for a type A acute aortic dissection.

    PubMed

    Hata, Mitsumasa; Shiono, Motomi; Hata, Hiroaki; Sezai, Akira; Akiyama, Kenji; Orime, Yukihiko; Wakui, Shinji

    2014-09-01

    We assessed the incidence of coronary artery disease (CAD) during hospitalization after emergency surgery for a type A acute aortic dissection. A total of 123 patients underwent multi-slice computed tomography (MSCT) scans during an early stage after surgery. The patients were divided into two groups: group I consisted of 14 patients (11.4%) who had coronary artery stenosis of more than 75% on MSCT, and group II consisted of 109 patients (88.6%) who had no coronary lesions. The prevalence of diabetes, dyslipidemia and a smoking history was significantly higher in group I. Although the serum low-density lipoprotein cholesterol levels were similar, the high-density lipoprotein cholesterol (HDL) level was significantly lower in group I (36.4 ± 7.9 mg/dl) than in group II (49.6 ± 13.5 mg/dl, P = 0.0005). The maximum carotid intima-media thickness (IMT) was significantly thicker in group I (1.17 ± 0.37 mm) compared to group II (0.96 ± 0.33 mm, P = 0.0297). The logistic regression analysis detected that a carotid IMT over 1.1 mm (odds ratio 4.35, P = 0.0371) and HDL less than 40 mg/dl (odds ratio 3.90, P = 0.0482) were predictors for CAD. CAD screening should be recommended for patients with aortic dissection who have several atherosclerosis risk factors, even after emergency surgery.

  11. Huge dissected ascending aorta associated with pseudo aneurysm and aortic coarctation feridoun.

    PubMed

    Sabzi, Feridoun; Khosravi, Donya

    2015-07-01

    We report a unique case of chronic dissection of the ascending aorta complicated with huge and thrombotic pseudoaneurysm in a patient with coarctation of descending aorta. Preoperative investigations such as transesophageal echocardiography (TEE) confirmed the diagnosis of dissection. Intraoperative findings included a12 cm eccentric bulge of the right lateral side of dilated the ascending aorta filled with the clot and a circular shaped intimal tear communicating with an extended hematoma and dissection of the media layer. The rarity of the report is an association of the chronic dissection with huge pseudoaneurysm and coarctation. The patient underwent staged repair of an aneurysm and coarctation and had an uneventful postoperative recovery period.

  12. Standard of Practice for the Endovascular Treatment of Thoracic Aortic Aneurysms and Type B Dissections

    SciTech Connect

    Fanelli, Fabrizio; Dake, Michael D.

    2009-09-15

    Thoracic endovascular aortic repair (TEVAR) represents a minimally invasive technique alternative to conventional open surgical reconstruction for the treatment of thoracic aortic pathologies. Rapid advances in endovascular technology and procedural breakthroughs have contributed to a dramatic transformation of the entire field of thoracic aortic surgery. TEVAR procedures can be challenging and, at times, extraordinarily difficult. They require seasoned endovascular experience and refined skills. Of all endovascular procedures, meticulous assessment of anatomy and preoperative procedure planning are absolutely paramount to produce optimal outcomes. These guidelines are intended for use in quality-improvement programs that assess the standard of care expected from all physicians who perform TEVAR procedures.

  13. Single-center experience in the management of spontaneous isolated abdominal aortic dissection.

    PubMed

    Böckler, Dittmar; Bianchini Massoni, Claudio; Geisbüsch, Philipp; Hakimi, Maani; von Tengg-Kobligk, Hendrik; Hyhlik-Dürr, Alexander

    2016-03-01

    This study aims to report the management of patients with spontaneous isolated dissection of the abdominal aorta (sIAAD). A cohort of 18 consecutive patients (12 male, mean age 58 years) with sIAAD was treated between 1990 and 2009. Dissection was asymptomatic in ten and symptomatic in eight patients. Retrospective data analysis from patient charts was performed. Follow-up included clinical examination, ultrasound, and/or CT-angiography. Mean follow-up was 54 months (range 1-211). In total, eight out of 18 received invasive treatment. All asymptomatic patients initially underwent conservative treatment and surveillance. Spontaneous false lumen thrombosis occurred in four (40 %), and three patients showed relevant aneurysmatic progression and underwent elective invasive treatment (open n = 2, endovascular n = 1), representing a crossover rate of 30 %. Late mortality was 20 % (n = 2) in this group. In symptomatic patients, five underwent urgent treatment due to persistent abdominal or back pain (n = 4) or contained rupture (n = 1); one was treated for claudication. The remaining two patients presented with irreversible spinal cord ischemia and were treated conservatively. Three patients were treated by open surgery and three by endovascular interventions (two stentgrafts, one Palmaz XXL stent). Early and late morbidity and mortality was 0 % in this group. There were no reinterventions The majority of patients with sIADD require invasive treatment, with EVAR being the preferable treatment option today. In asymptomatic IADD, primary surveillance is justifiable, but close surveillance due to expansion is necessary.

  14. Genome-wide association study identifies a susceptibility locus for thoracic aortic aneurysms and aortic dissections spanning FBN1 at 15q21.1

    PubMed Central

    LeMaire, Scott A; McDonald, Merry-Lynn N; Guo, Dong-chuan; Russell, Ludivine; Miller, Charles C; Johnson, Ralph J; Bekheirnia, Mir Reza; Franco, Luis M; Nguyen, Mary; Pyeritz, Reed E; Bavaria, Joseph E; Devereux, Richard; Maslen, Cheryl; Holmes, Kathryn W; Eagle, Kim; Body, Simon C; Seidman, Christine; Seidman, J G; Isselbacher, Eric M; Bray, Molly; Coselli, Joseph S; Estrera, Anthony L; Safi, Hazim J; Belmont, John W; Leal, Suzanne M; Milewicz, Dianna M

    2011-01-01

    Although thoracic aortic aneurysms and dissections (TAAD) can be inherited as a single-gene disorder, the genetic predisposition in the majority of affected people is poorly understood. In a multistage genome-wide association study (GWAS), we compared 765 individuals who had sporadic TAAD (STAAD) with 874 controls and identified common SNPs at a 15q21.1 locus that were associated with STAAD, with odds ratios of 1.6–1.8 that achieved genome-wide significance. We followed up 107 SNPs associated with STAAD with P < 1 × 10−5 in the region, in two separate STAAD cohorts. The associated SNPs fall into a large region of linkage disequilibrium encompassing FBN1, which encodes fibrillin-1. FBN1 mutations cause Marfan syndrome, whose major cardiovascular complication is TAAD. This study shows that common genetic variants at 15q21.1 that probably act via FBN1 are associated with STAAD, suggesting a common pathogenesis of aortic disease in Marfan syndrome and STAAD. PMID:21909107

  15. Thoraco-abdominal Aorta Dissection: Look Again Before You Leap.

    PubMed

    Zeina, Abdel-Rauf; Trachtengerts, Victoria; Abadi, Sobhi; Jarchowsky, Jacob; Soimu, Uri; Nachtigal, Alicia

    2009-01-01

    Aortic dissection is a life-threatening condition that might require immediate assessment and therapy. We present the case of a 71-year-old woman with essential hypertension complaining about low back pain; unenhanced thoracic-lumbar spine computed tomography examination (CT) revealed a hyperdense thin line across the aorta with an appearance of "double aortic lumen". Enhanced CT scan confirmed the diagnosis of type B aortic dissection. Radiologists should be familiar with this finding that could be considered a new radiological sign of aortic dissection on unenhanced CT examination.

  16. Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case-control study.

    PubMed

    Kobayashi, Misato; Chaykovska, Lyubov; van der Loo, Bernd; Nguyen, Thi Dan Linh; Puippe, Gilbert; Salzberg, Sacha; Ueda, Hideki; Maisano, Francesco; Pecoraro, Felice; Lachat, Mario

    2016-10-01

    To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up. © The Author(s) 2016.

  17. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

    PubMed

    Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

    2016-04-01

    The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases.

  18. Pericardial tear as a consequence of cardiopulmonary resuscitation (CPR) involving chest compression: a report of two postmortem cases of acute type A aortic dissection with hemopericardium.

    PubMed

    Okuda, Takahisa; Takanari, Hiroki; Shiotani, Seiji; Hayakawa, Hideyuki; Ohno, Youkichi; Fowler, David R

    2015-05-01

    We present two cases of a pericardial tear as a consequence of cardiopulmonary resuscitation involving chest compressions in fatal acute type A aortic dissection (AoD) with hemopericardium. For each case, postmortem computed tomography revealed a hematoma in the false lumen of the ascending aorta with a slight hemopericardium and a large left hemothorax, as well as focal pericardial dimpling and discontinuity around the left ventricle. At autopsy, we confirmed a convex lens-shape gaping pericardial tear at the left posterolateral site of the pericardium and a massive volume of bloody fluid in the left thoracic cavity. It has been hypothesized that the pericardium ruptured due to chest compressions during resuscitation in these cases of acute type A AoD with hemopericardium and that intrapericardial blood leakage through the pericardial tear resulted in a hemothorax. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Relief of Mesenteric Ischemia by Z-Stent Placement into the Superior Mesenteric Artery Compressed by the False Lumen of an Aortic Dissection

    SciTech Connect

    Yamakado, Koichiro; Takeda, Kan; Nomura, Yoshiyuki; Kato, Noriyuki; Hirano, Tadanori; Matsumura, Kaname; Nakagawa, Tsuyoshi; Yuasa, Hiroshi; Yada, Isao

    1998-01-15

    In a 58-year-old man acute aortic dissection compromised the origin of the superior mesenteric artery (SMA), resulting in mesenteric ischemia. After failed balloon angioplasty a Gianturco Z-stent was placed. The stenosis improved immediately, followed by resolution of the clinical signs of mesenteric ischemia. SMA flow was well preserved 1 year after stenting.

  20. Coexistence of pulmonary embolism, aortic dissection, and persistent left superior vena cava in the same patient.

    PubMed

    Elmali, Muzaffer; Gulel, Okan; Bahcivan, Muzaffer

    2008-11-01

    We report a patient with pulmonary embolism, dissection in the descending and abdominal aorta, and persistent left superior vena cava. To our knowledge, coexistence of these three clinical entities has never been described before in the same patient.

  1. Use of a stent-graft and vascular occlude to treat primary and re-entry tears in a patient with a Stanford type B aortic dissection

    PubMed Central

    Shi, Huihua; Lu, Min; Jiang, Mier

    2013-01-01

    Thoracic endovascular aortic repair for aortic dissections is recognized as an effective treatment. We herein report the case of a 72-year-old male with a Stanford type B aortic dissection. A stent-graft and double-disk vascular occluder was used to repair the primary and re-entry tears, respectively. At 3 month postoperatively, computed tomographic angiography revealed no endoleaks, the stent-graft and vascular occluder to be in optimal positions, the false lumen was almost completely thrombosed, and the visceral arteries were patent. This case illustrates that it is feasible to treat re-entry tears with a vascular occluder after primary proximal stent-graft repairs. PMID:24598963

  2. Genes Predisposing to Thoracic Aortic Aneurysms and Dissections: Associated Phenotypes, Gene-Specific Management, and Genetic Testing

    PubMed Central

    Milewicz, Dianna M.; Carlson, Alicia A.; Regalado, Ellen S.

    2011-01-01

    Thoracic aortic aneurysms leading to type A dissections (TAAD) are the major diseases affecting the aorta. A genetic predisposition for TAAD can occur as part of a genetic syndrome, as is the case for Marfan syndrome, due to mutations in FBN1, and Loeys-Dietz syndrome, which results from mutations in either TGFBR1 or TGFBR2. A predisposition to TAAD in the absence of syndromic features can be inherited in an autosomal dominant manner with decreased penetrance and variable expression, termed familial TAAD. Familial TAAD exhibits clinical and genetic heterogeneity. Genetic heterogeneity for familial TAAD has been demonstrated by the identification of four genes leading to TAAD, including TGFBR2 and TGFBR1, MYH11, and ACTA2. The phenotype and management of patients harboring mutations in these genes, along with genetic testing, will be addressed in this review. PMID:20452526

  3. A Case of an Upper Gastrointestinal Bleeding Due to a Ruptured Dissection of a Right Aortic Arch

    SciTech Connect

    Born, Christine; Forster, Andreas; Rock, Clemens; Pfeifer, Klaus-Juergen; Rieger, Johannes; Reiser, Maximilian

    2003-09-15

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.

  4. Contralateral approach to iliac artery recanalization with kissing nitinol stents present in the aortic bifurcation☆

    PubMed Central

    Joseph, George; Hooda, Amit; Thomson, Viji Samuel

    2015-01-01

    A 69-year-old man, who had earlier undergone reconstruction of the aortic bifurcation with kissing nitinol stents, presented with occlusion of the left external iliac artery. The occlusion was successfully and safely recanalized using contralateral femoral approach with passage of interventional hardware through the struts of the stents in the aortic bifurcation. Presence of contemporary flexible nitinol stents with open-cell design in the aortic bifurcation is not a contraindication to the use of the contralateral femoral approach. PMID:26702686

  5. Contralateral approach to iliac artery recanalization with kissing nitinol stents present in the aortic bifurcation.

    PubMed

    Joseph, George; Hooda, Amit; Thomson, Viji Samuel

    2015-01-01

    A 69-year-old man, who had earlier undergone reconstruction of the aortic bifurcation with kissing nitinol stents, presented with occlusion of the left external iliac artery. The occlusion was successfully and safely recanalized using contralateral femoral approach with passage of interventional hardware through the struts of the stents in the aortic bifurcation. Presence of contemporary flexible nitinol stents with open-cell design in the aortic bifurcation is not a contraindication to the use of the contralateral femoral approach.

  6. Tsutsugamushi disease presenting with aortic valve endocarditis: a case report and literature review

    PubMed Central

    Yu, Shujie; Yu, Xianguan; Zhou, Bin; Liu, Dinghui; Wang, Min; Zhang, Hui; Qian, Xiaoxian

    2016-01-01

    Tsutsugamushi disease is a zoonotic disease caused by Orientia tsutsugamushi in which humans are accidental hosts. Infective endocarditis associated with Tsutsugamushi disease has not been previously reported. We are describing a case of Tsutsugamushi disease presenting with aortic valve endocarditis. The clinical data of a 67-year-old female with O. tsutsugamushi-induced aortic valve endocarditis was summarized retrospectively and analyzed with a literature review. Treatment of O. tsutsugamushi-induced aortic valve endocarditis with chloramphenicol is recommended. PMID:28078179

  7. Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

    PubMed Central

    Chivasso, Pierpaolo; Guida, Gustavo; Vohra, Hunaid A.

    2016-01-01

    Background The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies. Methods A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury. Results A total of 11 retrospective observational studies have been included in the quantitative meta-analysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population [relative risk (RR) =2.25; 95% CI, 1.79–2.83; I2=0%; P<0.0001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR =1.15; 95% CI, 0.89–1.5; I2=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5–1.25, I2=14%, P=0.31) after surgery were comparable to the younger cohort of patients. Conclusions Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable. PMID:27563539

  8. Osborne-Mendel rats simultaneously develop cardiac and renal dysfunction, left atrial thrombosis, peripheral artery occlusion, and ascending aortic dissection.

    PubMed

    Asahina, Makoto; Matsumoto, Hideki; Yasuhara, Yoshitaka; Suzuki, Noriko; Takami, Ritsuko; Takeyama, Michiyasu; Tozawa, Ryuichi

    2017-04-01

    Although chronic kidney disease (CKD) is strongly associated with onsets of cardiovascular disease (CVD), the pathogenic mechanism between these diseases has not been fully understood. To develop and validate new therapeutic strategies for this complication, appropriate experimental models that reflect the complexity of the underlying pathophysiology are needed. The Osborne-Mendel (OM) rat was identified as an atherosclerosis-prone and a premature-death rat strain among 16 inbred rat strains when fed high-cholesterol containing diet. When fed high-cholesterol diet, OM rats showed simultaneous occurrence of aortic aneurysm, aortic dissection, peripheral artery occlusion, and left atrial thrombosis. OM rats had significantly lower max dP/dt and higher min dP/dt than F344 rats did, indicating impaired left ventricle contractility and relaxation. OM rats developed renal dysfunction, showing increased urinary albumin excretion. OM rats also showed mild hypertension, decreased endothelial function, and enhanced coagulation and platelet aggregation, compared with F344 rats. We now report that OM rat would be a novel spontaneous animal model which simultaneously demonstrates cardiac and renal dysfunction, and CVD events. This model could be a useful model for the pre-clinical testing of pharmacological therapies and could provide new insight into potential targets and pathways for the treatment of CKD and CVD. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Assessment of Wall Elasticity Variations on Intraluminal Haemodynamics in Descending Aortic Dissections Using a Lumped-Parameter Model

    PubMed Central

    Rudenick, Paula A.; Bijnens, Bart H.; Segers, Patrick; García-Dorado, David; Evangelista, Arturo

    2015-01-01

    Descending aortic dissection (DAD) is associated with high morbidity and mortality rates. Aortic wall stiffness is a variable often altered in DAD patients and potentially involved in long-term outcome. However, its relevance is still mostly unknown. To gain more detailed knowledge of how wall elasticity (compliance) might influence intraluminal haemodynamics in DAD, a lumped-parameter model was developed based on experimental data from a pulsatile hydraulic circuit and validated for 8 clinical scenarios. Next, the variations of intraluminal pressures and flows were assessed as a function of wall elasticity. In comparison with the most rigid-wall case, an increase in elasticity to physiological values was associated with a decrease in systolic and increase in diastolic pressures of up to 33% and 63% respectively, with a subsequent decrease in the pressure wave amplitude of up to 86%. Moreover, it was related to an increase in multidirectional intraluminal flows and transition of behaviour as 2 parallel vessels towards a vessel with a side-chamber. The model supports the extremely important role of wall elasticity as determinant of intraluminal pressures and flow patterns for DAD, and thus, the relevance of considering it during clinical assessment and computational modelling of the disease. PMID:25881158

  10. Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room

    PubMed Central

    Hirata, Kazuhito; Wake, Minoru; Takahashi, Takanori; Nakazato, Jun; Yagi, Nobuhito; Miyagi, Tadayoshi; Shimotakahara, Junichi; Mototake, Hidemitsu; Tengan, Toshiho; Takara, Tsuyoshi R.; Yamaguchi, Yutaka

    2015-01-01

    Background Initial diagnosis of acute aortic dissection (AAD) in the emergency room (ER) is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD. Methods We conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78). An inappropriate initial diagnosis (IID) was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD) was also evaluated. Delayed diagnosis (DD) was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile). In addition, TFD was compared with respect to each clinical variable using a rank sum test. Results An IID was determined for 37% of patients. Walk-in (WI) visit to the ER [odds ratio (OR) 2.6, 95% confidence interval (CI) = 1.01–6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14–36.82, P = 0.035) were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h). DD (>4.5 h) was observed in 27 cases (21.3%). TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003). Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39–9.9, P = 0.009). TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001). Conclusions WI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital

  11. Timing of Incident Stroke Risk After Cervical Artery Dissection Presenting Without Ischemia.

    PubMed

    Morris, Nicholas A; Merkler, Alexander E; Gialdini, Gino; Kamel, Hooman

    2017-03-01

    Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks. © 2017 American Heart Association, Inc.

  12. Lower heart rate in the early postoperative period does not correlate with long-term outcomes after repair of type A acute aortic dissection.

    PubMed

    Ohnuma, Tetsu; Kimura, Naoyuki; Sasabuchi, Yusuke; Asaka, Kayo; Shiotsuka, Junji; Komuro, Tetsuya; Mouri, Hideyuki; Lefor, Alan T; Adachi, Hideo; Sanui, Masamitsu

    2015-05-01

    Little evidence exists regarding the need for a reduction in postoperative heart rate after repair of type A acute aortic dissection. This single-center retrospective study was conducted to determine if lower heart rate during the early postoperative phase is associated with improved long-term outcomes after surgery for patients with type A acute aortic dissection. We reviewed 434 patients who underwent aortic repair between 1990 and 2011. Based on the average heart rate on postoperative days 1, 3, 5, and 7, 434 patients were divided into four groups, less than 70, 70-79, 80-89, and greater than 90 beats per minute. The mean age was 63.3 ± 12.1 years. During a median follow-up of 52 months (range 16-102), 10-year survival in all groups was 67%, and the 10-year aortic event-free rate was 79%. The probability of survival and being aortic event-free using Kaplan-Meier estimates reveal that there is no significant difference when stratified by heart rate. Cox proportional regression analysis for 10-year mortality shows that significant predictors of mortality are age [Hazard Ratio (HR) 1.04; 95% confidence interval (CI) 1.07-1.06; p = 0.001] and perioperative stroke (HR 2.30; 95% CI 1.18-4.50; p = 0.024). Neither stratified heart rate around the time of surgery nor beta-blocker use at the time of discharge was significant. There is no association between stratified heart rate in the perioperative period with long-term outcomes after repair of type A acute aortic dissection. These findings need clarification with further clinical trials.

  13. Reversible cerebral vasoconstriction syndrome and bilateral vertebral artery dissection presenting in a patient after cesarean section

    PubMed Central

    Mitchell, Lex A; Santarelli, Justin G; Singh, Inder Paul; Do, Huy M

    2013-01-01

    Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. Unilateral vertebral artery dissection has been described in fewer than 40% of cases of RCVS. Bilateral vertebral artery dissection has rarely been reported. We describe the case of a patient with RCVS and bilateral vertebral artery dissection presenting with an intramedullary infarct treated successfully with medical management and careful close follow-up. This rare coexistence should be recognized as the treatment differs. PMID:23354867

  14. Reversible cerebral vasoconstriction syndrome and bilateral vertebral artery dissection presenting in a patient after cesarean section.

    PubMed

    Mitchell, Lex A; Santarelli, Justin G; Singh, Inder Paul; Do, Huy M

    2013-01-24

    Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. Unilateral vertebral artery dissection has been described in fewer than 40% of cases of RCVS. Bilateral vertebral artery dissection has rarely been reported. We describe the case of a patient with RCVS and bilateral vertebral artery dissection presenting with an intramedullary infarct treated successfully with medical management and careful close follow-up. This rare coexistence should be recognized as the treatment differs.

  15. Bilateral Ophthalmic Artery Dissecting Aneurysms Presenting with Recurrent Epistaxis

    PubMed Central

    Al Balushi, Ali; Kitchener, Jacob; Edgell, Randall C.

    2017-01-01

    We present a rare case of bilateral expanding traumatic pseudoaneurysms of the ophthalmic arteries, due to a gunshot. The aneurysms presented with epistaxis. After a failure of conservative management, coil embolization of the aneurysms resulted in complete occlusion, with preservation of flow in the parent vessels. PMID:28243345

  16. Mechanical Strain Induced Expression of Matrix Metalloproteinase-9 via Stretch-Activated Channels in Rat Abdominal Aortic Dissection

    PubMed Central

    Qiu, ZhiHuang; Chen, LiangWan; Cao, Hua; Chen, Qiang; Peng, Hua

    2017-01-01

    Background The aim of the study was to investigate the expression of matrix metalloproteinase-9 (MMP-9) in rat abdominal aortic dissection (AD) induced by mechanical strain, so as to offer a better understanding of the possible mechanisms of AD. Material/Methods Experimental AD in rats was achieved by the injection of porcine pancreatic elastase. At days 0, 1, 3, 5, 7, 14, 21, and 30 after the establishment of AD model, serum MMP-9 levels were measured by enzyme-linked immunosorbent assay (ELISA). Four groups of vascular rings were stretched in vitro with a mechanical strength of 0 g, 1 g, 3 g, or 5 g for 30 min. Another four groups were pretreated with GdCl3, streptomycin, SN50, and SN50M, followed by stretching with 3 g for 30 min. The messenger RNA and the protein of MMP-9 were analyzed by real-time RT-PCR and Western blotting, and NF-κB p65 was detected by ELISA. Results After the establishment of rat abdominal AD model, the serum MMP-9 levels of AD groups increased significantly. The results showed increased expression of MMP-9 in rat AD vessels stretched with mechanical strength of 1 g, 3 g, and 5 g, but this effect was mostly blocked by Gd Cl3 and streptomycin. The NF-κB activity in aortic rings was activated by stretching with a mechanical strength of 3 g and was blocked by SN50, but not by SN50M. Conclusions The expression of MMP-9 in serum was increased significantly after rat abdominal AD formation. Mechanical strain induced MMP-9 expression in AD vessels, which was mediated through the activation of the stretch-activated channel-induced NF-κB pathway. PMID:28286334

  17. Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection

    PubMed Central

    Rausch, Laura A.; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection by the method of cerebral perfusion used. Methods A total of 324 patients from five academic medical centers underwent repair of acute type A aortic dissection between January 2000 and December 2010. Of those, antegrade cerebral perfusion (ACP) was used for 84 patients, retrograde cerebral perfusion (RCP) was used for 55 patients, and deep hypothermic circulatory arrest (DHCA) was used for 184 patients during repair. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality and Cox Regression hazard ratios were calculated to determine the predictors of long term mortality. Results Operative mortality was not influenced by the type of cerebral protection (19% for ACP, 14.5% for RCP and 19.1% for DHCA, P=0.729). In multivariable logistic regression analysis, hemodynamic instability [odds ratio (OR) =19.6, 95% confidence intervals (CI), 0.102–0.414, P<0.001] and CPB time >200 min(OR =4.7, 95% CI, 1.962–1.072, P=0.029) emerged as independent predictors of operative mortality. Actuarial 5-year survival was unchanged by cerebral protection modality (48.8% for ACP, 61.8% for RCP and 66.8% for no cerebral protection, log-rank P=0.844). Conclusions During surgical repair of type A aortic dissection, ACP, RCP or DHCA are safe strategies for cerebral protection in selected patients with type A aortic dissection. PMID:27563545

  18. Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis.

    PubMed

    Smith, Holly N; Boodhwani, Munir; Ouzounian, Maral; Saczkowski, Richard; Gregory, Alexander J; Herget, Eric J; Appoo, Jehangir J

    2017-03-01

    Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation. Using Ovid MEDLINE, 38 studies were identified reporting outcomes for 2140 patients. Studies were categorized into four groups on the basis of extent of surgical aortic resection and the method of descending thoracic aortic stent graft deployment; during circulatory arrest (frozen stented elephant trunk) or with normothermic perfusion and use of fluoroscopy (warm stent graft): (I) surgical total arch replacement, (II) total arch and frozen stented elephant trunk, (III) hemiarch and frozen stented elephant trunk and (IV) total arch and warm stent graft. Perioperative event rates were obtained for each of the four groups and the entire cohort using pooled summary estimates. Linearized rates of late mortality and reoperation were calculated. Overall pooled hospital mortality for extended arch techniques was 8.6% (95% CI 7.2-10.0). Pooled data categorized by surgical technique resulted in hospital mortality of 11.9% for total arch, 8.6% total arch and frozen stented elephant trunk, 6.3% hemiarch and frozen stented elephant trunk and 5.5% total arch and 'warm stent graft'. Overall incidence of stroke for the entire cohort was 5.7% (95% CI 3.6-8.2). Rate of spinal cord ischaemia was 2.0% (95% CI 1.2-3.0). Pooled linearized rate of late mortality was 1.66%/pt-yr (95% CI 1.34-2.07) with linearized rate of re-operation of 1.62%/pt-yr (95% CI 1.24-2.05). Perioperative results of extended arch procedures are encouraging. Further follow-up is required to see if long-term complications are reduced

  19. Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.

    PubMed

    Amako, Mau; Spear, Rafaëlle; Clough, Rachel E; Hertault, Adrien; Azzaoui, Richard; Martin-Gonzalez, Teresa; Sobocinski, Jonathan; Haulon, Stéphan

    2017-02-01

    The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful. Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen. Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Loss-of-function mutations in the X-linked biglycan gene cause a severe syndromic form of thoracic aortic aneurysms and dissections

    PubMed Central

    Meester, Josephina A.N.; Vandeweyer, Geert; Pintelon, Isabel; Lammens, Martin; Van Hoorick, Lana; De Belder, Simon; Waitzman, Kathryn; Young, Luciana; Markham, Larry W.; Vogt, Julie; Richer, Julie; Beauchesne, Luc M.; Unger, Sheila; Superti-Furga, Andrea; Prsa, Milan; Dhillon, Rami; Reyniers, Edwin; Dietz, Harry C.; Wuyts, Wim; Mortier, Geert; Verstraeten, Aline; Van Laer, Lut; Loeys, Bart L.

    2016-01-01

    Purpose Thoracic aortic aneurysm and dissection (TAAD) is typically inherited in an autosomal dominant manner, but rare X-linked families have been described. So far the only known X-linked gene is FLNA, which is associated with the periventricular nodular heterotopia type of Ehlers-Danlos syndrome. However, mutations in this gene only explain a small number of X-linked TAAD families. Methods We performed targeted resequencing of 368 candidate genes in a cohort of 11 molecularly unexplained Marfan probands. Subsequently, Sanger sequencing of BGN in 360 male and 155 female molecularly unexplained TAAD probands was carried out. Results We found five individuals with loss-of-function mutations in BGN, encoding the small leucine-rich proteoglycan biglycan. The clinical phenotype is characterized by early onset aortic aneurysm and dissection. Other recurrent findings include hypertelorism, pectus deformity, joint hypermobility, contractures and mild skeletal dysplasia. Fluorescent stainings revealed an increase in TGF-β signalling, evidenced by an increase in nuclear pSMAD2 in aortic wall. Our results are in line with prior reports demonstrating that Bgn-deficient male BALB/cA mice die from aortic rupture. Conclusion In conclusion, BGN gene defects in humans cause an X-linked syndromic form of severe TAAD, associated with preservation of elastic fibres and increased TGF-β signalling. PMID:27632686

  1. Wegener's granulomatosis presenting as an abdominal aortic aneurysm: a case report

    PubMed Central

    2009-01-01

    Introduction Aortic aneurysm is not common in young patient. When a young patient presents with abdominal aortic aneurysm, there may be an underlying cause. Case presentation Here, we describe a case of a 33-year-old gentleman who presented with flu like illness, chest and abdominal pains following a tooth extraction. A chest X-ray and subsequent computerised tomogram of the chest and abdomen demonstrated lung nodules and an abdominal aortic aneurysm. The aneurysm was repaired and his serology was positive for Wegener's granulomatosis. A nasal mucosal biopsy confirmed WG. He was treated with oral steroids and cyclophosphamide. His graft leaked and had to be replaced with a synthetic graft. Two months after his re-operation, he remains well. Conclusion Whenever a young patient presents with an abdominal aortic aneurysm, an underlying connective disease should be excluded because early steroid/immunosuppressive treatment may prevent the development of further aneurysms. PMID:20066062

  2. Trends in Aortic Dissection Hospitalizations, Interventions, and Outcomes among Medicare Beneficiaries in the United States, 2000–2011

    PubMed Central

    Mody, Purav S.; Wang, Yun; Geirsson, Arnar; Kim, Nancy; Desai, Mayur M.; Gupta, Aakriti; Dodson, John A.; Krumholz, Harlan M.

    2015-01-01

    Background The epidemiology of aortic dissection (AD) has not been well-described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. Methods and Results The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32,057 initial AD hospitalizations were identified between 2000 and 2011. The overall hospitalization rate for AD remained unchanged at 10 per 100,000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2–6.5; adjusted, 6.4%; 95% CI, 5.7–6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1–5.2; adjusted, 6.2%; 95% CI, 5.3–6.7) respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3–10.2; adjusted, 7.3%; 95% CI, 5.8–7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5–9.1%; adjusted, 8.2%; 95% CI, 6.7 – 9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5–4.2; adjusted, 2.9%; 95% CI, 0.7–4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3–4.3; adjusted, 3.9%; 95% CI, 2.5–6.3) for surgical repair of type B dissection. Conclusions While AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair. PMID:25336626

  3. Hypertensive emergency presenting with an isolated celiac artery dissection: A rare case study.

    PubMed

    Swergold, Natalie; Kozusko, Steven; Rivera, Carlos; Sturt, Cindy

    2016-01-01

    To our knowledge the most recent article on celiac dissection was published in 2015 and reported 24 known cases of spontaneous isolated celiac trunk dissection [2]. While some of those cases reported hypertension as a risk factor, no other case presents as hypertensive emergency with an isolated celiac artery dissection. A 43 year-old man with a past medical history of uncontrolled hypertension, for which he had reportedly been non-compliant with follow-up, presented with complaints of severe, sudden-onset epigastric pain which was non-radiating and constant for 1 hour prior to arrival. On CT an intimal flap was noted within the celiac trunk, starting at the origin and extending into the left gastric, splenic, and the common hepatic arteries. The most common symptom in patients with celiac artery dissection is acute or chronic epigastric or abdominal pain [2,4,9,11]. The crux of the diagnosis of this condition relies on contrast enhanced CT. The superiority of the CT scan is because of the contrast tracking capability [11]. The two most common risk factors for celiac artery dissection are hypertension followed by vasculitis. Patients can be managed nonoperatively or with one of a few operative procedures. Conservative treatment consists of anticoagulants, antihypertensives, and antiplatelet therapy [2]. To the best of our knowledge, we present the 25th case of isolated celiac artery dissection. This is the first case of hypertensive emergency induced spontaneous isolated celiac trunk dissection in literature. Our patient was managed primarily with a labetalol drip. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Aneurysm and dissection in a patient with syphilitic aortitis.

    PubMed

    Pivatto Júnior, Fernando; Finkler, Bruno Schaaf; Torres, Felipe Soares; Schaefer, Pedro Guilherme; Sprinz, Eduardo

    In the antibiotic era, aortic aneurysm is a rare complication of syphilis, what makes the diagnostic assumption even more difficult. Nonetheless, this condition should be suspected in patients with aortic aneurysm. Reports of aortic dissection complicating syphilitic aortitis have been distinctly rare in the literature, and their cause-effect relationship has not been definitely established. In this case report, we present a 62-year-old woman with aortic aneurysm and dissection associated with an unexpected diagnosis of syphilitic aortitis. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  5. Case report of severe Cushing's syndrome in medullary thyroid cancer complicated by functional diabetes insipidus, aortic dissection, jejunal intussusception, and paraneoplastic dysautonomia: remission with sorafenib without reduction in cortisol concentration.

    PubMed

    Hammami, Muhammad M; Duaiji, Najla; Mutairi, Ghazi; Aklabi, Sabah; Qattan, Nasser; Abouzied, Mohei El-Din M; Sous, Mohamed W

    2015-09-09

    Normalization of cortisol concentration by multikinase inhibitors have been reported in three patients with medullary thyroid cancer-related Cushing's syndrome. Aortic dissection has been reported in three patients with Cushing's syndrome. Diabetes insipidus without intrasellar metastasis, intestinal intussusception, and paraneoplastic dysautonomia have not been reported in medullary thyroid cancer. An adult male with metastatic medullary thyroid cancer presented with hyperglycemia, hypernatremia, hypokalemia, hypertension, acne-like rash, and diabetes insipidus (urine volume >8 L/d, osmolality 190 mOsm/kg). Serum cortisol, adrenocorticoitropic hormone, dehydroepiandrostenedione sulfate, and urinary free cortisol were elevated 8, 20, 4.4, and 340 folds, respectively. Pituitary imaging was normal. Computed tomography scan revealed jejunal intussusception and incidental abdominal aortic dissection. Sorafenib treatment was associated with Cushing's syndrome remission, elevated progesterone (>10 fold), normalization of dehydroepiandrostenedione sulfate, but persistently elevated cortisol concentration. Newly-developed proximal lower limb weakness and decreased salivation were associated with elevated ganglionic neuronal acetylcholine receptor (alpha-3) and borderline P/Q type calcium channel antibodies. Extreme cortisol concentration may have contributed to aortic dissection and suppressed antidiuretic hormone secretion; which combined with hypokalemia due cortisol activation of mineralocorticoid receptors, manifested as diabetes insipidus. This is the first report of paraneoplastic dysautonomia and jejunal intussusception in medullary thyroid cancer, they may be related to medullary thyroid cancer's neuroendocrine origin and metastasis, respectively. Remission of Cushing's syndrome without measurable reduction in cortisol concentration suggests a novel cortisol-independent mechanism of action or assay cross-reactivity. Normalization of dehydroepiandrostenedione

  6. Dissecting Dissection.

    ERIC Educational Resources Information Center

    AV Magazine, 1996

    1996-01-01

    This journal features articles covering various aspects of dissection. "Biology--The Study of Life" (George Russell) offers students experiments that do not require using invasive procedures. "Animal Cruelty--Behind the Scenes" (Zoe Weil) describes sources of laboratory animals. "Doing without Dissection" (Juliana…

  7. Vertebral artery dissection with compelling evidence on duplex ultrasound presenting only with neck pain

    PubMed Central

    Siepmann, Timo; Borchert, Monique; Barlinn, Kristian

    2016-01-01

    Vertebral artery dissection (VAD) is among the most common identifiable etiologies of stroke in young adults and poses a diagnostic challenge due to nonspecific symptoms and substantial variability of imaging results. Here, we present a case of unspecific neck pain as isolated symptom of VAD with unusually compelling evidence on duplex ultrasound. This observation has clinical relevance as the absence of any neurological symptoms in our patient highlights the necessity of considering cervical artery dissection in patients presenting with unspecific symptoms such as neck pain, even if isolated. Furthermore, our image of intramural hematoma on duplex ultrasound has been captured in an unusual, clear and distinct fashion and might therefore be a useful reference image in the clinical assessment of patients with a suspicion of cervical artery dissection. PMID:27843318

  8. Total arch repair for acute type A aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique

    PubMed Central

    2014-01-01

    Background In total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases. To reduce those two problems, we modified the triple-branched stent graft and developed the arch open technique. Methods and results Total arch repair with open placement of a modified triple-branched stent graft and the arch open technique was performed in 25 consecutive patients with acute type A aortic dissection. There was 1 surgical death. Most survivors had an uneventful postoperative course. All implanted stents were in a good position and wide expansion, there was no space or blood flow surrounding the stent graft. Complete thrombus obliteration of the false lumen was found around the modified triple-branched stent graft in all survivors and at the diaphragmatic level in 20 of 24 patients. Conclusions The modified triple-branched stent graft could provide a good match with the different diameters of the native arch vessels and the various distances between 2 neighboring arch vessels, and it’s placement could become much easier by the arch open technique. Consequently, placement of a modified triple-branched stent graft could be easily used in most patients with acute type A aortic dissection for effective total arch repair. PMID:25085259

  9. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    PubMed

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. New insights into the molecular diagnosis and management of heritable thoracic aortic aneurysms and dissections.

    PubMed

    Campens, Laurence; Renard, Marjolijn; Callewaert, Bert; Coucke, Paul; De Backer, Julie; De Paepe, Anne

    2013-01-01

    Since the identification of the fibrillin‑1 gene as the causal gene for Marfan syndrome, our knowledge of molecular genetics and the applicability of genetic testing for heritable thoracic aneurysms and dissections (H-TAD) in clinical practice have increased substantially. Several new syndromes related to H-TAD have been described and the list of mutated genes in syndromal and nonsyndromal H-TAD is rapidly expanding. This knowledge has led to a significant improvement of our insight into the underlying pathophysiology of H-TAD resulting in new opportunities for targeted treatment, as well as in improved risk stratification. Clinicians involved in the care for H-TAD patients require a basic knowledge of the disease entities and need to be correctly informed on the applicability of genetic testing in their patients and families. Gene‑tailored treatment and management should now be considered as part of good clinical practice. We provide a systematic overview of genetic H-TAD entities and practical recommendations for genetic testing and patient management.

  11. Development of a Patient-Specific Multi-Scale Model to Understand Atherosclerosis and Calcification Locations: Comparison with In vivo Data in an Aortic Dissection

    PubMed Central

    Alimohammadi, Mona; Pichardo-Almarza, Cesar; Agu, Obiekezie; Díaz-Zuccarini, Vanessa

    2016-01-01

    Vascular calcification results in stiffening of the aorta and is associated with hypertension and atherosclerosis. Atherogenesis is a complex, multifactorial, and systemic process; the result of a number of factors, each operating simultaneously at several spatial and temporal scales. The ability to predict sites of atherogenesis would be of great use to clinicians in order to improve diagnostic and treatment planning. In this paper, we present a mathematical model as a tool to understand why atherosclerotic plaque and calcifications occur in specific locations. This model is then used to analyze vascular calcification and atherosclerotic areas in an aortic dissection patient using a mechanistic, multi-scale modeling approach, coupling patient-specific, fluid-structure interaction simulations with a model of endothelial mechanotransduction. A number of hemodynamic factors based on state-of-the-art literature are used as inputs to the endothelial permeability model, in order to investigate plaque and calcification distributions, which are compared with clinical imaging data. A significantly improved correlation between elevated hydraulic conductivity or volume flux and the presence of calcification and plaques was achieved by using a shear index comprising both mean and oscillatory shear components (HOLMES) and a non-Newtonian viscosity model as inputs, as compared to widely used hemodynamic indicators. The proposed approach shows promise as a predictive tool. The improvements obtained using the combined biomechanical/biochemical modeling approach highlight the benefits of mechanistic modeling as a powerful tool to understand complex phenomena and provides insight into the relative importance of key hemodynamic parameters. PMID:27445834

  12. Insurance Status is Associated with Acuity of Presentation and Outcomes for Thoracic Aortic Operations

    PubMed Central

    Andersen, Nicholas D.; Brennan, J. Matthew; Zhao, Yue; Williams, Judson B.; Williams, Matthew L.; Smith, Peter K.; Scarborough, John E.; Hughes, G. Chad

    2014-01-01

    Background Non-elective procedure status is the greatest risk factor for postoperative morbidity and mortality in patients undergoing thoracic aortic operations. We hypothesized that uninsured patients were more likely to require non-elective thoracic aortic operation due to decreased access to preventative care and elective surgical services. Methods and Results An observational study of the Society of Thoracic Surgeons Database identified 51,282 patients who underwent thoracic aortic surgery between 2007–2011 at 940 North American centers. Patients were stratified by insurance status (private insurance, Medicare, Medicaid, other insurance, or uninsured) as well as age < 65 years or age ≥ 65 years to account for differences in Medicare eligibility. The need for non-elective thoracic aortic operation was highest for uninsured patients (71.7%) and lowest for privately insured patients (36.6%). The adjusted risks of non-elective operation were increased for uninsured patients (adjusted risk ratio [ARR], 1.77; 95% confidence interval [CI], 1.70–1.83 for age < 65 years; ARR, 1.46; 95% CI, 1.29–1.62 for age ≥ 65 years) as well as Medicaid patients age < 65 years (ARR, 1.18; 95% CI, 1.10–1.26) when compared to patients with private insurance. The adjusted odds of major morbidity and/or mortality were further increased for all patients age < 65 years without private insurance (ARRs between 1.13 and 1.27). Conclusions Insurance status was associated with acuity of presentation and major morbidity and mortality for thoracic aortic operations. Efforts to reduce insurance-based disparities in the care of patients with thoracic aortic disease appear warranted and may reduce the incidence of aortic emergencies and improve outcomes after thoracic aortic surgery. PMID:24714600

  13. Transperitoneal laparoscopic pelvic and para-aortic lymph node dissection using the argon-beam coagulator and monopolar instruments: an 8-year study and description of technique.

    PubMed

    Abu-Rustum, Nadeem R; Chi, Dennis S; Sonoda, Yukio; DiClemente, Michael J; Bekker, Genia; Gemignani, Mary; Poynor, Elizabeth; Brown, Carol; Barakat, Richard R

    2003-06-01

    The objective was to describe the results, technique, and complications of transperitoneal laparoscopic (LSC) pelvic and aortic lymph node dissection (LND) using the argon-beam coagulator (ABC) and monopolar electrosurgical instruments in women with gynecologic malignancies. A retrospective chart review of 114 patients who underwent LSC pelvic and/or aortic LND in addition to other LSC procedures between 1/1994 and 12/2001 was conducted. All intraoperative complications and complications that occurred within the first 30 postoperative days were included. Complications were graded according to an institutional surgical secondary events reference. During the same time period, 89 patients underwent LSC followed immediately by laparotomy that included LND, resulting in a total of 203 cases. These 203 total cases are used as a denominator to determine the etiology of cases converted from LSC to laparotomy. Monopolar electrosurgical instruments or the 10-mm ABC (Conmed) set at 70 W with argon flow of 3-4 L/m min were used for laparoscopic nodal dissection. Sixty-one of 114 (53%) patients underwent pelvic LND, 35 (31%) underwent both pelvic and aortic LND, and 18 (16%) underwent aortic LND only. Mean patient age and body mass index were 53.3 years (range, 16 to 87 years) and 25 (range, 16 to 40), respectively. In addition, the mean number of pelvic and aortic lymph nodes removed was 10.7 (range, 1 to 39) and 5.7 (range, 0 to 21), respectively. The mean estimated blood loss was 151 mL (range, 25 to 600 ml) and the mean hospital stay was 2.8 days (range, 0 to 35 days). Overall, complications occurred in eight (7%) cases. There were no fatal complications, and no patient required conversion to laparotomy due to uncontrollable bleeding from the laparoscopic nodal dissection. Only 17 of 203 (8%) patients required conversion to laparotomy secondary to adhesions and unsatisfactory exposure. Laparoscopic pelvic and aortic LND for gynecologic malignancies can be satisfactorily

  14. Ang II Enhances Noradrenaline Release from Sympathetic Nerve Endings Thus Contributing to the Up-Regulation of Metalloprotease-2 in Aortic Dissection Patients' Aorta Wall

    PubMed Central

    Hu, Zhipeng; Wang, Zhiwei; Wu, Hongbing; Yang, Zhimin; Jiang, Wanli; Li, Luocheng; Hu, Xiaoping

    2013-01-01

    Object To test the hypothesis that angiotensin II (Ang II) could enhance noradrenaline (NA) release from sympathetic nerve endings of the aorta thus contributing to the up-regulation of matrix metalloproteinase 2 (MMP-2) during the formation of aortic dissection (AD). Methods Ang II, NA, MMP-2, MMP-9 of the aorta sample obtained during operation from aortic dissection patients were detected by High Performance Liquid Chromatography and ELISA and compared with controls. Isotope labelling method was used to test the impact of exogenous Ang II and noradrenaline on the NA release and MMP-2, MMP-9 expression on Sprague Dawley (SD) rat aorta rings in vitro. Two kidneys, one clip, models were replicated for further check of that impact in SD rats in vivo. Results The concentration of Ang II, MMP-2, 9 was increased and NA concentration was decreased in aorta samples from AD patients. Exogenous Ang II enhanced while exogenous NA restrained NA release from aortic sympathetic endings. The Ang II stimulated NA release and the following MMP-2 up-regulation could be weakened by Losartan and chemical sympathectomy. Beta blocker did not influence NA release but down-regulated MMP-2. Long term in vivo experiments confirmed that Ang II could enhance NA release and up-regulate MMP-2. Conclusions AD is initiated by MMP-2 overexpression as a result of increased NA release from sympathetic nervous endings in response to Ang II. This indicates an interaction of RAS and SAS during the formation of AD. PMID:24194850

  15. Aortic events in a nationwide Marfan syndrome cohort.

    PubMed

    Groth, Kristian A; Stochholm, Kirstine; Hove, Hanne; Kyhl, Kasper; Gregersen, Pernille A; Vejlstrup, Niels; Østergaard, John R; Gravholt, Claus H; Andersen, Niels H

    2017-02-01

    Marfan syndrome is associated with morbidity and mortality due to aortic dilatation and dissection. Preventive aortic root replacement has been the standard treatment in Marfan syndrome patients with aortic dilatation. In this study, we present aortic event data from a nationwide Marfan syndrome cohort. The nationwide cohort of Danish Marfan syndrome patients was established from the Danish National Patient Registry and the Cause of Death Register, where we retrieved information about aortic surgery and dissections. We associated aortic events with age, sex, and Marfan syndrome diagnosis prior or after the first aortic event. From the total cohort of 412 patients, 150 (36.4 %) had an aortic event. Fifty percent were event free at age 49.6. Eighty patients (53.3 %) had prophylactic surgery and seventy patients (46.7 %) a dissection. The yearly event rate was 0.02 events/year/patient in the period 1994-2014. Male patients had a significant higher risk of an aortic event at a younger age with a hazard ratio of 1.75 (CI 1.26-2.42, p = 0.001) compared with women. Fifty-three patients (12.9 %) were diagnosed with MFS after their first aortic event which primarily was aortic dissection [n = 44 (83.0 %)]. More than a third of MFS patients experienced an aortic event and male patients had significantly more aortic events than females. More than half of the total number of dissections was in patients undiagnosed with MFS at the time of their event. This emphasizes that diagnosing MFS is lifesaving and improves mortality risk by reducing the risk of aorta dissection.

  16. Association between Diabetes and Risk of Aortic Dissection: A Case-Control Study in a Chinese Population.

    PubMed

    He, Xingwei; Liu, Xintian; Liu, Wanjun; Wang, Bei; Liu, Yujian; Li, Zhuxi; Wang, Tao; Tan, Rong; Gao, Bo; Zeng, Hesong

    2015-01-01

    It is well-recognized that diabetes represents a powerful independent risk factor for cardiovascular diseases. However, very few studies have investigated the relationship between diabetes and risk of aortic dissection (AD). The aim of this case-control study was to evaluate the association between diabetes and risk of AD in Chinese population. A hospital-based case-control study, consisting of 2160 AD patients and 4320 controls, was conducted in a Chinese population. Demographic, clinical characteristics and risk factors were collected. Diabetes rate of patients with overall AD, Stanford type A AD and type B AD group was compared with that of corresponding matched control groups. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between diabetes and AD risk. The prevalence of diabetes was lower in AD cases than that of control subjects, whether it is the overall AD, type A AD or type B AD group (4.7% vs. 10.0%, 2.9% vs. 8.8%, 5.9% vs. 10.9%, all P<0.001). Furthermore, in multivariate model, diabetes was found to be associated with lower AD risk, which not only applies to the overall AD (OR = 0.2, 95%CI: 0.15-0.26), but also type A AD (OR = 0.12, 95% CI: 0.07-0.20) and type B AD (OR = 0.25, 95%CI: 0.18-0.33). We observed the paradoxical inverse relationship between DM and risk of AD in the Chinese population. These results suggest diabetes may play a protective role in the development of AD. However, further studies are needed to enrich related evidence, especially with regard to underlying mechanisms for these trends.

  17. Imaging of abdominal aortic aneurysm: the present and the future

    PubMed Central

    Hong, Hao; Yang, Yunan; Liu, Bo; Cai, Weibo

    2010-01-01

    Abdominal Aortic Aneurysm (AAA) is a common, progressive, and potentially lethal vascular disease. A major obstacle in AAA research, as well as patient care, is the lack of technology that enables non-invasive acquisition of molecular/cellular information in the developing AAA. In this review we will briefly summarize the current techniques (e.g. ultrasound, computed tomography, and magnetic resonance imaging) for anatomical imaging of AAA. We also discuss the various functional imaging techniques that have been explored for AAA imaging. In many cases, these anatomical and functional imaging techniques are not sufficient for providing surgeons/clinicians enough information about each individual AAA (e.g. rupture risk) to optimize patient management. Recently, molecular imaging techniques (e.g. optical and radionuclide-based) have been employed to visualize the molecular alterations associated with AAA, which are discussed in this review. Lastly, we try to provide a glance into the future and point out the challenges for AAA imaging. We believe that the future of AAA imaging lies in the combination of anatomical and molecular imaging techniques, which are largely complementary rather than competitive. Ultimately, with the right molecular imaging probe, clinicians will be able to monitor AAA growth and evaluate the risk of rupture accurately, so that the life-saving surgery can be provided to the right patients at the right time. Equally important, the right imaging probe will also allow scientists/clinicians to acquire critical data during AAA development and to more accurately evaluate the efficacy of potential treatments. PMID:20180767

  18. Imaging of Abdominal Aortic Aneurysm: the present and the future.

    PubMed

    Hong, Hao; Yang, Yunan; Liu, Bo; Cai, Weibo

    2010-11-01

    Abdominal Aortic Aneurysm (AAA) is a common, progressive, and potentially lethal vascular disease. A major obstacle in AAA research, as well as patient care, is the lack of technology that enables non-invasive acquisition of molecular/cellular information in the developing AAA. In this review we will briefly summarize the current techniques (e.g. ultrasound, computed tomography, and magnetic resonance imaging) for anatomical imaging of AAA. We also discuss the various functional imaging techniques that have been explored for AAA imaging. In many cases, these anatomical and functional imaging techniques are not sufficient for providing surgeons/clinicians enough information about each individual AAA (e.g. rupture risk) to optimize patient management. Recently, molecular imaging techniques (e.g. optical and radionuclide-based) have been employed to visualize the molecular alterations associated with AAA, which are discussed in this review. Lastly, we try to provide a glance into the future and point out the challenges for AAA imaging. We believe that the future of AAA imaging lies in the combination of anatomical and molecular imaging techniques, which are largely complementary rather than competitive. Ultimately, with the right molecular imaging probe, clinicians will be able to monitor AAA growth and evaluate the risk of rupture accurately, so that the life-saving surgery can be provided to the right patients at the right time. Equally important, the right imaging probe will also allow scientists/clinicians to acquire critical data during AAA development and to more accurately evaluate the efficacy of potential treatments.

  19. Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture.

    PubMed

    Edmonds, Rebecca D; Tomaszewski, Jeffrey J; Jackman, Stephen V; Chaer, Rabih A

    2008-11-01

    We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.

  20. Mapping of familial thoracic aortic aneurysm/dissection with patent ductus arteriosus to 16p12.2-p13.13.

    PubMed

    Khau Van Kien, Philippe; Mathieu, Flavie; Zhu, Limin; Lalande, Alain; Betard, Christine; Lathrop, Mark; Brunotte, François; Wolf, Jean-Eric; Jeunemaitre, Xavier

    2005-07-12

    Three loci have been shown to be responsible for nonsyndromic familial thoracic aortic aneurysms (TAAs) and aortic dissections (ADs). We recently described a large family in which TAA/AD associates with patent ductus arteriosus (PDA) and provided genetic arguments for a unique pathophysiological entity. Genome-wide scan was performed in 40 subjects belonging to 3 generations in this large pedigree. Using the 7 TAA/AD cases as affected, we observed positive 2-point LOD scores on adjacent markers at chromosome 16p, with a maximum LOD score value of 2.73 at theta=0, a value that increased to 3.56 when 5 PDA cases were included. Multipoint linkage analysis yielded a maximum LOD score of 4.14 in the vicinity of marker D16S3103. Fine mapping allowed the observation of recombinant haplotypes that delimited a critical 20-cM interval at 16p12.2-p13.13. Automatic determination of aortic compliance with cine MRI showed that all subjects bearing the disease haplotype, even asymptomatic, displayed a very low level of aortic compliance and distensibility. Aortic stiffness was strongly associated with disease haplotype with a marked effect of age, indicating subclinical and early manifestation of the disease. Genetic analysis of this family identified a unique locus responsible for both TAA/AD and PDA at chromosome 16p12.2-p13.13 with aortic stiffness as an early hallmark of the disease. TAA/AD with PDA is a new monogenic entity among the genetically heterogeneous group of TAA/AD disease.

  1. Structure of the Elastin-Contractile Units in the Thoracic Aorta and How Genes that Cause Thoracic Aortic Aneurysms and Dissections Disrupt this Structure

    PubMed Central

    Karimi, Ashkan; Milewicz, Dianna M.

    2016-01-01

    The medial layer of the aorta confers elasticity and strength to the aortic wall and is composed of alternating layers of smooth muscle cells (SMCs) and elastic fibers. The SMC elastin-contractile unit is a structural unit that links the elastin fibers to the SMCs and is characterized by the following: 1. Layers of elastin fibers that are surrounded by microfibrils. 2. Microfibrils that bind to the integrin receptors in focal adhesions on the cell surface of the SMCs. 3. SMC contractile filaments that are linked to the focal adhesions on the inner side of the membrane. The genes that are altered to cause thoracic aortic aneurysms and aortic dissections encode proteins involved in the structure or function of the SMC elastin – contractile unit. Included in this gene list are the genes encoding protein that are structural components of elastin fibers and microfibrils, FBN1, MFAP5, ELN, and FBLN4. Also included are genes that are structural proteins in the SMC contractile unit, including ACTA2, which encodes SMC-specific α-actin and MYH11, which encodes SMC-specific myosin heavy chain, along with MYLK and PRKG1, which encode kinases that control SMC contraction. Finally, mutations in the gene encoding the protein linking integrin receptors to the contractile filaments, FLNA, also cause thoracic aortic disease. Thus, these data suggest that functional SMC elastin-contractile units are important for maintaining the structural integrity of the aorta. PMID:26724508

  2. Structure of the Elastin-Contractile Units in the Thoracic Aorta and How Genes That Cause Thoracic Aortic Aneurysms and Dissections Disrupt This Structure.

    PubMed

    Karimi, Ashkan; Milewicz, Dianna M

    2016-01-01

    The medial layer of the aorta confers elasticity and strength to the aortic wall and is composed of alternating layers of smooth muscle cells (SMCs) and elastic fibres. The SMC elastin-contractile unit is a structural unit that links the elastin fibres to the SMCs and is characterized by the following: (1) layers of elastin fibres that are surrounded by microfibrils; (2) microfibrils that bind to the integrin receptors in focal adhesions on the cell surface of the SMCs; and (3) SMC contractile filaments that are linked to the focal adhesions on the inner side of the membrane. The genes that are altered to cause thoracic aortic aneurysms and aortic dissections encode proteins involved in the structure or function of the SMC elastin-contractile unit. Included in this gene list are the genes encoding protein that are structural components of elastin fibres and microfibrils, FBN1, MFAP5, ELN, and FBLN4. Also included are genes that encode structural proteins in the SMC contractile unit, including ACTA2, which encodes SMC-specific α-actin and MYH11, which encodes SMC-specific myosin heavy chain, along with MYLK and PRKG1, which encode kinases that control SMC contraction. Finally, mutations in the gene encoding the protein linking integrin receptors to the contractile filaments, FLNA, also predispose to thoracic aortic disease. Thus, these data suggest that functional SMC elastin-contractile units are important for maintaining the structural integrity of the aorta.

  3. Disruption of mechanical stress in extracellular matrix is related to Stanford type A aortic dissection through down-regulation of Yes-associated protein.

    PubMed

    Jiang, Wen-Jian; Ren, Wei-Hong; Liu, Xu-Jie; Liu, Yan; Wu, Fu-Jian; Sun, Li-Zhong; Lan, Feng; Du, Jie; Zhang, Hong-Jia

    2016-09-05

    In this study, we assessed whether the down-regulation of Yes-associated protein (YAP) is involved in the pathogenesis of extracellular matrix (ECM) mechanical stress-induced Stanford type A aortic dissection (STAAD). Human aortic samples were obtained from heart transplantation donors as normal controls and from STAAD patients undergoing surgical replacement of the ascending aorta. Decreased maximum aortic wall velocity, ECM disorders, increased VSMC apoptosis, and YAP down-regulation were identified in STAAD samples. In a mouse model of STAAD, YAP was down-regulated over time during the development of ECM damage, and increased VSMC apoptosis was also observed. YAP knockdown induced VSMC apoptosis under static conditions in vitro, and the change in mechanical stress induced YAP down-regulation and VSMC apoptosis. This study provides evidence that YAP down-regulation caused by the disruption of mechanical stress is associated with the development of STAAD via the induction of apoptosis in aortic VSMCs. As STAAD is among the most elusive and life-threatening vascular diseases, better understanding of the molecular pathogenesis of STAAD is critical to improve clinical outcome.

  4. Disruption of mechanical stress in extracellular matrix is related to Stanford type A aortic dissection through down-regulation of Yes-associated protein

    PubMed Central

    Jiang, Wen-Jian; Ren, Wei-Hong; Liu, Xu-Jie; Liu, Yan; Wu, Fu-Jian; Sun, Li-Zhong; Lan, Feng; Du, Jie; Zhang, Hong-Jia

    2016-01-01

    In this study, we assessed whether the down-regulation of Yes-associated protein (YAP) is involved in the pathogenesis of extracellular matrix (ECM) mechanical stress-induced Stanford type A aortic dissection (STAAD). Human aortic samples were obtained from heart transplantation donors as normal controls and from STAAD patients undergoing surgical replacement of the ascending aorta. Decreased maximum aortic wall velocity, ECM disorders, increased VSMC apoptosis, and YAP down-regulation were identified in STAAD samples. In a mouse model of STAAD, YAP was down-regulated over time during the development of ECM damage, and increased VSMC apoptosis was also observed. YAP knockdown induced VSMC apoptosis under static conditions in vitro, and the change in mechanical stress induced YAP down-regulation and VSMC apoptosis. This study provides evidence that YAP down-regulation caused by the disruption of mechanical stress is associated with the development of STAAD via the induction of apoptosis in aortic VSMCs. As STAAD is among the most elusive and life-threatening vascular diseases, better understanding of the molecular pathogenesis of STAAD is critical to improve clinical outcome. PMID:27608489

  5. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    PubMed Central

    Im, Hyeongwoo; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-01-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  6. [Central cannulation of the aorta by Seldinger technique in DeBakey type I acute aortic dissection with malperfusion of internal organs].

    PubMed

    Barbukhatti, K O; Belash, S A; Kaleda, V I

    Described herein is a case report concerning the use of central cannulation of the aorta by Seldinger technique for DeBakey type I aortic dissection with the involvement of both femoral arteries and the brachiocephalic trunk, as well as with thrombosis of the false lumen from the level of the ascending aorta. This is followed by a brief review discussing the methods of instrumental control of the cannula position in the true lumen of the aorta, as well as peculiarities of using this technique of cannulation in various clinical situations.

  7. Inferior Mesenteric Artery Aneurysm Complicated With Occluded Celiac and Superior Mesenteric Artery After Replacement of Thoracoabdominal Aorta for Chronic Dissected Thoracoabdominal Aortic Aneurysm.

    PubMed

    Igarashi, Takashi; Yamamoto, Akihiro; Fujimiya, Tsuyoshi; Takase, Shinya; Satokawa, Hirono; Yokoyama, Hitoshi

    2017-10-01

    We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Asymptomatic aortic aneurysm causing right vocal cord palsy and hoarseness: A rare presentation.

    PubMed

    Rizvi, M M; Singh, Raj Bahadur; Jain, Anuj; Sarkar, Arindam

    2014-01-01

    Vocal cord palsy (VCP) presenting as hoarseness of voice can be the first symptom of very serious and sinister common pathologies. But vocal cord palsy resulting from aortic aneurysm is a rare entity and still rarer is the right cord palsy due to aortic aneurysm. We are reporting a rare case in which a 52-year old male smoking for last 30 years having asymptomatic aortic aneurysm presented to us with hoarseness of voice. On Panendoscopy, no local pathology was found and CECT from base of skull to T12 was advised. CECT showed a large aneurysm involving ascending aorta and extending upto abdominal aorta with compression of the bilateral bronchi. CTVS consultation was sought and they advised for regular follow-up only. We are reporting this case to warn both the anaesthetist and the surgeon about the catastrophic complications if they are not alert in handling such cases.

  9. Intramural hematoma of the thoracic aorta as a form of aortic dissection.

    PubMed

    Juszkat, Robert; Pukacki, Fryderyk; Oszkinis, Grzegorz; Zarzecka, Anna; Majewski, Wacław

    2007-01-01

    Intramural hematoma (IMH) of the thoracic aorta is a complication with unknown etiology and a poorly predictable prognosis. There is also considerable controversy about the management and prognosis of IMH as well as the treatment. We present two cases of endovascular treatment of IMH with stent-graft placement. On the basis of references, we discuss risks of progression of the given pathology and possible complications. Despite the lack of uniform opinion about the management of this disorder, we present our observations of and experiences with endovascular treatment of IMH of the thoracic aorta.

  10. Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups.

    PubMed

    Xu, Huanming; Li, Zhenfeng; Dong, Huiwu; Zhang, Yilun; Wei, Jianyong; Watton, Paul N; Guo, Wei; Chen, Duanduan; Xiong, Jiang

    2017-09-07

    Thoracic endovascular aortic repair (TEVAR) is commonly applied in type-B aortic dissection. For patients with dissection affects descending aorta and extends downward to involve abdominal aorta and possibly iliac arteries, false lumen (FL) expansion might occur post-TEVAR. Predictions of dissection development may assist in medical decision on re-intervention or surgery. In this study, two patients are selected with similar morphological features at initial presentation but with different long-term FL development post-TEVAR (stable and enlarged FL). Patient-specific models are established for each of the follow-ups. Flow boundaries and computational validations are obtained from Doppler ultrasound velocimetry. By analyzing the hemodynamic parameters, the false-to-true luminal pressure difference (PDiff) and particle relative residence time (RRT) are found related to FL remodeling. It is found that (i) the position of the first FL flow entry is the watershed of negative-and-positive PDiff and, in long-term follow-ups, and the position of largest PDiff is consistent with that of the greatest increase of FL width; (ii) high RRT occurs at the FL proximal tip and similar magnitude of RRT is found in both stable and enlarged cases; (iii) comparing to the RRT at 7days post-TEVAR, an increase of RRT afterwards in short-term is found in the stable case while a slight decrease of this parameter is found in the enlarged case, indicating that the variation of RRT in short-term post-TEVAR might be potential to predict long-term FL remodeling. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  11. Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study

    PubMed Central

    Chen, Zhaoran; Huang, Bi; Yang, Yanmin; Hui, Rutai; Lu, Haisong; Zhao, Zhenhua; Lu, Zhinan; Zhang, Shu; Fan, Xiaohan

    2017-01-01

    Objectives To evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD). Design A single-centre, observational retrospective study. Setting The study was conducted in Fuwai Hospital, the National Centre for Cardiovascular Disease, Beijing, China. Participants From 2008 to 2010, a set of consecutive patients with type A AAD, confirmed by CT scanning, were enrolled and divided into four groups according to onset season: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November). The primary end points were in-hospital death and all-cause mortality during follow-up. Results Of the 492 cases in this study, 129 occurred in winter (26.2%), 147 in spring (29.9%), 92 in summer (18.7%), and 124 in autumn (25.2%). After a median follow-up of 20.4 months (IQR 9.7–38.9), the in-hospital mortality in cases occurring in autumn was higher than in the other three seasons (23.4% vs 8.4%, p<0.01). Long-term mortality was comparable among the four seasonal groups (p=0.63). After adjustment for age, gender and other risk factors, onset in autumn was still an independent factor associated with increased risk of in-hospital mortality (HR 2.05; 95% CI 1.15 to 3.64, p=0.02) in addition to surgical treatment. Further analysis showed that the seasonal effect on in-hospital mortality (autumn vs other seasons: 57.4% vs 27.3%, p<0.01) was only significant in patients who did not receive surgical treatment. No seasonal effect on long-term clinical outcomes was found in this cohort. Conclusions Onset in autumn may be a factor that increases the risk of in-hospital death from type A AAD, especially in patients who receive conservative treatment. Immediate surgery improves the short-term and long-term outcomes regardless of onset season. PMID:28242769

  12. Unusual presentation of silently growing abdominal aortic aneurysm causing biliary obstruction.

    PubMed

    Changal, Khalid Hamid; Lim, Francis; Sunkara, Tejasvi; Hamdani, Syed Uzair

    2017-09-25

    Biliary obstruction is a rare presentation of abdominal aortic aneurysm (AAA). The most common symptoms of AAA are abdominal or back pain and limb ischaemia from thromboembolism. We report a case of a 67-year-old male who was diagnosed with obstructive jaundice secondary to an AAA. CT angiogram revealed compression of the common bile duct by the large AAA, causing diffuse intrahepatic and extrahepatic ductal dilatation. Surgical repair of the aortic aneurysm was successful, and patient's symptoms improved. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Exome Sequencing Identifies SMAD3 Mutations as a Cause of Familial Thoracic Aortic Aneurysm and Dissection with Intracranial and Other Arterial Aneurysms

    PubMed Central

    Regalado, Ellen S.; Guo, Dong-chuan; Villamizar, Carlos; Avidan, Nili; Gilchrist, Dawna; McGillivray, Barbara; Clarke, Lorne; Bernier, Francois; Santos-Cortez, Regie L.; Leal, Suzanne M.; Bertoli-Avella, Aida M.; Shendure, Jay; Rieder, Mark J.; Nickerson, Deborah A; Milewicz, Dianna M.

    2014-01-01

    Rationale Thoracic aortic aneurysms leading to acute aortic dissections (TAAD) can be inherited in families in an autosomal dominant manner. As part of the spectrum of clinical heterogeneity of familial TAAD, we recently described families with multiple members that had TAAD and intracranial aneurysms or TAAD and intracranial and abdominal aortic aneurysms inherited in an autosomal dominant manner. Objective To identify the causative mutation in a large family with autosomal dominant inheritance of TAAD with intracranial and abdominal aortic aneurysms by performing exome sequencing of two distantly related individuals with TAAD and identifying shared rare variants. Methods and Results A novel frame shift mutation, p. N218fs (c.652delA), was identified in the SMAD3 gene and segregated with the vascular diseases in this family with a LOD score of 2.52. Sequencing of 181 probands with familial TAAD identified three additional SMAD3 mutations in 4 families, p.R279K (c.836G>A), p.E239K (c.715G>A), and p.A112V (c.235C>T) resulting in a combined LOD score of 5.21. These four mutations were notably absent in 2300 control exomes. SMAD3 mutations were recently described in patients with Aneurysms Osteoarthritis Syndrome and some of the features of this syndrome were identified in individuals in our cohort, but these features were notably absent in many SMAD3 mutation carriers. Conclusions SMAD3 mutations are responsible for 2% of familial TAAD. Mutations are found in families with TAAD alone, along with families with TAAD, intracranial aneurysms, aortic and bilateral iliac aneurysms segregating in an autosomal dominant manner. PMID:21778426

  14. Three-Dimensional Visualization and Imaging of the Entry Tear and Intimal Flap of Aortic Dissection Using CT Virtual Intravascular Endoscopy

    PubMed Central

    Li, Gang; Ma, Xiangxing; Wang, Qing; Yu, Dexin

    2016-01-01

    Aims Conventional computed tomography (CT) approaches provides limited visualization of the entire endoluminal changes of aortic dissection (AD), which is essential for its treatment. As an important supplement, three-dimensional CT virtual intravascular endoscopy (VIE) can show relevant details. This study aims to determine the value of VIE in displaying the entry tear and intimal flap of AD. Methods and Results Among 127 consecutive symptomatic patients with suspected AD who underwent CT angiography (CTA), 84 subjects were confirmed to have AD and were included in the study. Conventional CT and VIE images were observed and evaluated. From the 92 entry tears revealed via conventional CT, 88 (95.7%) tears appeared on VIE with round (n = 26), slit-shaped (n = 9), or irregular (n = 53) shapes, whereas the intimal flaps were sheetlike (n = 34), tubular (n = 34), wavelike (n = 13), or irregular (n = 7) in shape. The VIE also showed the spatial relationship between the torn flap and adjacent structures. Among 58 entry tears with multiple-line type flap shown on conventional CT, 41 (70.7%) appeared with an irregular shape on VIE, whereas among 30 tears with single-line type flap, 17 (56.7%) appeared as round or slit-shaped on VIE. These results demonstrated a significant difference (P < 0.05). The poor display of tears on VIE was related to the low CT attenuation values in lumen or in neighboring artifacts (P < 0.01). Conclusion CT VIE presents the complete configurations and details of the intimal tears and flaps of AD better than conventional CT approaches. Accordingly, it should be recommended as a necessary assessment tool for endovascular therapy and as part of strategy planning in pre-surgical patients. PMID:27760170

  15. Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection

    PubMed Central

    Chen, Zhao-Ran; Huang, Bi; Lu, Hai-Song; Zhao, Zhen-Hua; Hui, Ru-Tai; Yang, Yan-Min; Fan, Xiao-Han

    2017-01-01

    Objectives Inflammation has been shown to be related with acute aortic dissection (AAD). The present study aimed to evaluate the association of white blood cell counts (WBCc) on admission with both in-hospital and long-term all-cause mortality in patients with uncomplicated Stanford type B AAD. Methods From 2008 to 2010, a total of 377 consecutive patients with uncomplicated type B AAD were enrolled and then followed up. Clinical data and WBCc on admission were collected. The primary end points were in-hospital death and long-term all-cause death. Results The in-hospital death rate was 4.2%, and the long-term all-cause mortality rate was 6.9% during a median follow-up of 18.9 months. WBCc on admission was identified as a risk factor for in-hospital death by univariate Cox regression analysis as both a continuous variable and a categorical variable using a cut off of 11.0 × 109 cell/L (all P < 0.05). After adjusting for age, sex and other risk factors, elevated admission WBCc was still a significant predictor for in-hospital death as both a continuous variable [hazard ratio (HR): 1.052, 95% CI: 1.024–1.336, P = 0.002] and a categorical variable using a cut off of 11.0 × 109 cell/L (HR: 2.056, 95% CI: 1.673–5.253, P = 0.034). No relationship was observed between WBCc on admission and long-term all-cause death. Conclusions Our results indicate that elevated WBCc upon admission might be used as a predictor for increased risk of in-hospital death in uncomplicated type B AAD. There might be no predictive value of WBCc for the long-term survival of type B AAD. PMID:28270842

  16. Cocaine-induced relaxation of isolated rat aortic rings and mechanisms of action: possible relation to cocaine-induced aortic dissection and hypotension.

    PubMed

    Li, Wenyan; Su, Jialin; Sehgal, Swati; Altura, Bella T; Altura, Burton M

    2004-08-02

    Cocaine HCl is well known for its toxic effects on the cardiovascular system, but little is known about its effects on different regional blood vessels. We designed experiments to determine if cocaine HCl could influence the tension of isolated aortic rings, i.e., induce contraction or relaxation. Surprisingly, cocaine HCl (1 x 10(-5) to 6 x 10(-3) M) relaxed isolated aortic rings precontracted by phenylephrine in a concentration-dependent manner. No significant differences were found between intact or denuded isolated aortic rings (P>0.05). The maximal % relaxations of intact vs. denuded isolated aortic rings were 108.9+/-24.3% vs. 99.5+/-8.3% (P>0.05). Cocaine HCl, 2 x 10(-3) M, was found to inhibit contractions by phenylephrine; EC50s were increased (P<0.01) and Emax's were decreased (51.3+/-16.4% vs. 89.8+/-10.6%, P<0.01). A variety of amine antagonists could not inhibit the relaxant effects of cocaine HCl (P>0.05). The cyclooxygenase-1 inhibitor, indomethacin, also failed to inhibit relaxations induced by cocaine HCl (P>0.05). Neither L-arginine, NG-monomethyl-L-arginine (L-NMMA), nor methylene blue could inhibit the relaxations induced by cocaine HCl (P>0.05), suggesting cocaine HCl does not relax isolated aortic rings by inducing the synthesis or release of nitric oxide (NO) or prostanoids from either endothelial or vascular muscle cells. Inhibitors of cAMP, cGMP and protein kinase G (PKG) also failed to inhibit cocaine-induced relaxations. Cocaine HCl (1 x 10(-5) to 6 x 10(-3) M) could also relax isolated aortic rings precontracted by phenylephrine in high K+ depolarizing buffer. Surprisingly, calyculin A, an inhibitor of myosin light chain (MLC) phosphatase, inhibited cocaine-induced relaxations in a concentration-dependent manner, suggesting the probable importance of cocaine-induced MLC phosphatase activation in rat aortic smooth muscle cells. It was also found that cocaine HCl could dose-dependently inhibit Ca2+-induced contractions of isolated aortic

  17. Aortic dimensions in Turner syndrome.

    PubMed

    Quezada, Emilio; Lapidus, Jodi; Shaughnessy, Robin; Chen, Zunqiu; Silberbach, Michael

    2015-11-01

    In Turner syndrome, linear growth is less than the general population. Consequently, to assess stature in Turner syndrome, condition-specific comparators have been employed. Similar reference curves for cardiac structures in Turner syndrome are currently unavailable. Accurate assessment of the aorta is particularly critical in Turner syndrome because aortic dissection and rupture occur more frequently than in the general population. Furthermore, comparisons to references calculated from the taller general population with the shorter Turner syndrome population can lead to over-estimation of aortic size causing stigmatization, medicalization, and potentially over-treatment. We used echocardiography to measure aortic diameters at eight levels of the thoracic aorta in 481 healthy girls and women with Turner syndrome who ranged in age from two to seventy years. Univariate and multivariate linear regression analyses were performed to assess the influence of karyotype, age, body mass index, bicuspid aortic valve, blood pressure, history of renal disease, thyroid disease, or growth hormone therapy. Because only bicuspid aortic valve was found to independently affect aortic size, subjects with bicuspid aortic valve were excluded from the analysis. Regression equations for aortic diameters were calculated and Z-scores corresponding to 1, 2, and 3 standard deviations from the mean were plotted against body surface area. The information presented here will allow clinicians and other caregivers to calculate aortic Z-scores using a Turner-based reference population. © 2015 Wiley Periodicals, Inc.

  18. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain.

    PubMed

    Nakamizo, Tomoki; Koide, Takashi; Miyazaki, Hiromichi

    2015-01-01

    Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN.

  19. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain

    PubMed Central

    Nakamizo, Tomoki; Koide, Takashi; Miyazaki, Hiromichi

    2015-01-01

    Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This