151
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Liu Y, Han L, Li J, Gong M, Zhang H, Guan X. Consumption coagulopathy in acute aortic dissection: principles of management. J Cardiothorac Surg 2017; 12:50. [PMID: 28606160 PMCID: PMC5468986 DOI: 10.1186/s13019-017-0613-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 12/31/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Yuyong Liu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China
| | - Lu Han
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China
| | - Jiachen Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China
| | - Xinliang Guan
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China.
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152
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Shono Y, Akahoshi T, Mezuki S, Momii K, Kaku N, Maki J, Tokuda K, Ago T, Kitazono T, Maehara Y. Clinical characteristics of type A acute aortic dissection with CNS symptom. Am J Emerg Med 2017. [PMID: 28633904 DOI: 10.1016/j.ajem.2017.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms. METHODS We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014. RESULTS We identified 59 TAAAD patients for the analysis (mean age, 67.3±10.5years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p<0.0001). Initial systolic and diastolic blood pressure were lower (p=0.003, and p=0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p<0.0001). CONCLUSION Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings.
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Affiliation(s)
- Yuji Shono
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Satomi Mezuki
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenta Momii
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Noriyuki Kaku
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Jun Maki
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kentaro Tokuda
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
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153
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Sekine Y, Nishina T, Ueda Y. Rare spinal cord infarction in a patient with acute type B aortic dissection. Interact Cardiovasc Thorac Surg 2017; 24:976-977. [PMID: 28329371 DOI: 10.1093/icvts/ivx034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/18/2017] [Indexed: 11/12/2022] Open
Abstract
A 69-year-old man was admitted to our hospital with acute epigastric discomfort and subsequent paraplegia. Computed tomography revealed acute type B aortic dissection with a thrombosed false lumen. Magnetic resonance imaging did not reveal spinal cord infarction. Paraplegia resolved completely within 1 h. However, on the following day, the patient developed motor impairment in the left leg, sensory disorder of the bilateral legs and urinary retention. The symptoms gradually improved with conservative medical therapy. Magnetic resonance imaging on hospitalization Day 20 revealed spinal cord infarction limited to the right posterior area at level T7/T8 and the conus medullaris. The patient was discharged 44 days after admission. The presented case is notable for its atypical presentation of spinal cord infarction resulting from acute aortic dissection. The aetiology of neurological symptoms, especially that of lower extremity monoplegia, remained undiagnosed.
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Affiliation(s)
- Yuji Sekine
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Takeshi Nishina
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yuichi Ueda
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
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154
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Bhatty TAN, Chaudhry QS, Khan Z, Bastawicy AN. Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East. Urol Ann 2017; 9:192-193. [PMID: 28479776 PMCID: PMC5405668 DOI: 10.4103/0974-7796.204177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aortic aneurysms are very rare in Middle East unlike Europe and America. Therefore, this pathology is very likely to be missed in acute presentation to the Emergency Medicine Department. We present a case of leaking abdominal aortic aneurysm mimicking right ureteric colic, which was missed in the initial assessment.
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Affiliation(s)
| | - Qamar Saeed Chaudhry
- Department of Urology, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Ziauddin Khan
- Department of Urology, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
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155
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Chen Z, Huang B, Lu H, Zhao Z, Hui R, Zhang S, Yang Y, Fan X. The effect of admission serum potassium levels on in-hospital and long-term mortality in type A acute aortic dissection. Clin Biochem 2017; 50:843-50. [PMID: 28499801 DOI: 10.1016/j.clinbiochem.2017.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Mild fluctuations in serum potassium (K+) levels are related to the prognosis of cardiovascular disease. This study aimed to determine the effect of admission serum potassium levels on in-hospital and long-term mortality in patients with Stanford type A acute aortic dissection (AAD). MATERIALS AND METHODS A total of 588 consecutive patients with type A AAD were enrolled, and they were grouped according to admission serum potassium level: <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0mmol/L. Clinical outcomes were in-hospital death and long-term all-cause mortality. RESULTS The in-hospital and long-term all-cause mortality rates were 10.7% and 16.3%, respectively. A U-shaped relationship was observed between admission serum potassium levels and both in-hospital death and long-term mortality. Univariate Cox regression identified potassium levels outside the interval of <3.5 to 4.5mmol/L to be a risk factor for both in-hospital and long-term death. After adjusting for age, gender, surgery and other risk factors, potassium levels outside the interval of <3.5 to 4.5mmol/L still had a significant association with long-term death [hazard ratio (HR)=1.72, 95% confidence interval (95% CI): 1.07-2.74, P=0.024]. Surgical intervention was the main protective factor associated with both in-hospital (HR=0.01, 95% CI 0.01-0.06, P<0.001) and long-term survival (HR=0.06, 95% CI 0.03-0.12, P<0.001). CONCLUSIONS Among patients with Stanford type A AAD, admission serum potassium levels other than 3.5 to 4.5mmol/L might be associated with an increased risk of in-hospital death and long-term mortality.
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156
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Molteni M, De Chiara B, Casadei F, Botta L, Merlanti B, Russo CF, Giannattasio C, Moreo A. Late Echocardiographic Study of Aortic Valve and Aortic Root after Surgery for Type A Acute Aortic Dissection. J Cardiovasc Echogr 2017; 26:78-82. [PMID: 28465967 PMCID: PMC5224673 DOI: 10.4103/2211-4122.187948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR. Methods: From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53–72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed. Results: Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade <3; a non-negligible number of patients with acute significant AR (23% with grade ≥3) at the time of surgery underwent conservative aortic valve surgery. At a median echocardiographic follow-up of 50.5 months, we found no significant correlation between late recurrent AR and AR grade at the time of surgery and the aortic root diameter. Late recurrent AR grade was significantly higher in patients who underwent aortic commissures and cusps resuspension than those who underwent lone ascending aorta replacement (2.29 ± 1.05 vs. 1.58 ± 1.03, P = 0.028). Conclusions: Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
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Affiliation(s)
- Martina Molteni
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Francesca Casadei
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luca Botta
- Department of Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Bruno Merlanti
- Department of Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
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157
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Carino D, Nicolini F, Romano G, Ricci M, Gherli T. Early Coronary Thrombosis without ST-Segment Elevation Following Repair of Acute Aortic Dissection. Aorta (Stamford) 2017; 4:138-141. [PMID: 28097197 DOI: 10.12945/j.aorta.2016.16.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/21/2016] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Davide Carino
- General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy
| | - Francesco Nicolini
- General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy
| | - Giorgio Romano
- General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy
| | - Matteo Ricci
- General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy
| | - Tiziano Gherli
- General and Specialist Surgery Department, Cardiac Surgery Unit, Parma General Hospital, Parma, Italy
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158
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Abstract
OBJECTIVE To find out the association between serum total cholesterol (TC) on admission and in-hospital mortality in patients with acute aortic dissection (AAD). METHODS From January 2007 to January 2014, we enrolled 1492 consecutive AAD patients with serum TC measured immediately on admission. Baseline characteristics and in-hospital mortality were compared between the patients with serum TC above and below the median (4.00 mmol/L). Propensity score matching (PSM) was used to account for known confounders in the study. Cox proportional hazard model was performed to calculate the hazard ratio (HR) and 95% confidence interval (CI) for admission serum TC levels. RESULTS With the use of PSM, 521 matched pairs of patients with AAD were yielded in this analysis due to their similar propensity scores. Patients with admission serum TC < 4.00 mmol/L, as compared with those with admission serum TC ≥ 4.00 mmol/L, had higher in-hospital mortality (11.7% vs. 5.8%; HR, 2.06; 95% CI, 1.33-3.19, P = 0.001). Stratified analysis according to Stanford classification showed that the inverse association between admission serum TC and in-hospital mortality was observed in patients with Type-A AAD (24.0% vs. 11.3%; HR, 2.18; 95% CI, 1.33 - 3.57, P = 0.002) but not in those with Type-B AAD (3.8% vs. 2.2%; HR, 1.71; 95% CI, 0.67 - 4.34, P = 0.261). CONCLUSIONS Lower serum TC level on admission was strongly associated with higher in-hospital mortality in patients with Type-A AAD.
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Affiliation(s)
- Xintian Liu
- Xintian Liu, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Su
- Xi Su, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hesong Zeng
- Hesong Zeng, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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159
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Cerit L. Letter in response to the article entitled "High-sensitivity cardiac troponin T: A biomarker for the early risk stratification of type-A acute aortic dissection?" by Li et al. Arch Cardiovasc Dis 2016; 109:562. [PMID: 27595463 DOI: 10.1016/j.acvd.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/24/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Levent Cerit
- Near East University Hospital, Department of Cardiology, Near East Boulevard, 99138 Nicosa, Cyprus.
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160
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Abstract
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.
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Affiliation(s)
- Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
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161
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Conzelmann LO, Mehlhorn U, Czerny M, Weigang E. Reply to Morello et al. Eur J Cardiothorac Surg 2016; 50:586-7. [PMID: 27141098 DOI: 10.1093/ejcts/ezw098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Uwe Mehlhorn
- HELIOS Clinic for Cardiac Surgery, Karlsruhe, Germany
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162
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Inamasu J, Suzuki T, Wakako A, Sadato A, Hirose Y. Concurrence of Aneurysmal Subarachnoid Hemorrhage and Stanford Type A Acute Aortic Dissection. J Stroke Cerebrovasc Dis 2016; 25:e86-8. [PMID: 27083068 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022] Open
Abstract
We report a rare case of concurrent aneurysmal subarachnoid hemorrhage (SAH) and acute aortic dissection (AAD). A 38-year-old man visited our hospital complaining of severe headache, and brain computed tomography (CT) revealed the presence of SAH. Thoracic to neck computed tomography angiography (CTA), performed in addition to brain CTA, suggested a tear in the aortic arch, and subsequent CT aortography established the diagnosis of Stanford type A AAD. The AAD in our patient, who reported no episodes of chest or back pain, was detected incidentally by thoracic to neck CTA. The imaging study has rarely been indicated for SAH except that it provides additional anatomical information in patients for whom extracranial-intracranial bypass surgery or endovascular treatment is considered. Nevertheless, our experience may highlight additional diagnostic value of thoracic to neck CTA in SAH patients.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
| | - Takeya Suzuki
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Akira Wakako
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
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163
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Wu Z, Ruan Y, Chang J, Li B, Ren W. Angiotensin II is related to the acute aortic dissection complicated with lung injury through mediating the release of MMP9 from macrophages. Am J Transl Res 2016; 8:1426-1436. [PMID: 27186269 PMCID: PMC4859628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Acute aortic dissection (AAD) patients usually show concurrent lung injury mainly featured by hyoxemia. To date, no effective treatment method has been established for the AAD complicated with acute lung injury (ALI). Matrix metalloproteinases (MMPs), especially MMP2 and MMP9, have been considered to be closely related to the onset of aortic disease including AAD. To investigate the roles of MMP in the pathogenesis of AAD complicated with ALI, we determined the expression of MMP2 and MMP9 in serum and lung tissues of AAD patients. In addition, a new rat model of AAD complicated with ALI was established to investigate the pathogenesis of such complicated conditions. METHODS AND RESULTS Angiotensin II (Ang II) and MMP9 were up-regulated in the AAD complicated with ALI patients compared to those of the AAD without ALI patients, normal individuals and the patients with non-ruptured aneurysm. Besides, massive macrophages with MMP9 expression was noticed in the lung tissues in the AAD complicated with ALI patients. On this basis, AAD complicated with ALI rat model was established based on BAPN feeding and infusion of Ang II. Obvious lung injury was observed in the BAPN+Ang II group compared to that of the BAPN group, together with macrophage accumulation in lung tissues, as well as over-expression of MMP9 in lung tissues. After interference of MMP antagonist, a large number of macrophages were still accumulated in the lung tissues, but the lung injury was obviously attenuated. After the interference of AT1 receptor, the number of macrophages in the lung tissues was obviously decreased and the lung injury was obviously relieved. CONCLUSIONS Ang II is closely related to the lung injury at the early stage of AAD through mediating the release of MMP9 in the macrophages in the lung tissues.
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Affiliation(s)
- Zhiyong Wu
- Department of Cardiovascular Surgery, Wuhan University Renmin Hospital Wuhan 430060, China
| | - Yongle Ruan
- Department of Cardiovascular Surgery, Wuhan University Renmin Hospital Wuhan 430060, China
| | - Jinxing Chang
- Department of Cardiovascular Surgery, Wuhan University Renmin Hospital Wuhan 430060, China
| | - Bowen Li
- Department of Cardiovascular Surgery, Wuhan University Renmin Hospital Wuhan 430060, China
| | - Wei Ren
- Department of Cardiovascular Surgery, Wuhan University Renmin Hospital Wuhan 430060, China
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164
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Li G, Wu XW, Lu WH, Cheng J, Wu XY, Ai R, Zhou ZH, Tang ZZ, Liao YH. High-sensitivity cardiac troponin T: A biomarker for the early risk stratification of type-A acute aortic dissection? Arch Cardiovasc Dis 2016; 109:163-70. [PMID: 26916429 DOI: 10.1016/j.acvd.2015.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND High-sensitivity cardiac troponin is the most specific and sensitive biomarker of myocardial injury. However, no study has investigated whether the early concentration of high-sensitivity cardiac troponin is increased or is of value in predicting short-term prognosis in patients with type-A acute aortic dissection (AAD) in the emergency department. AIMS To measure the high-sensitivity cardiac troponin T (hs-TnT) concentration in patients with type-A AAD upon hospital admission, and to assess its value in predicting short-term prognosis. METHODS We enrolled consecutive patients with type-A AAD. Blood samples were collected on admission; hs-TnT concentrations were measured on the Elecsys 2010 system. High-sensitivity C-reactive protein (hs-CRP), D-dimer and other biochemical indicators were measured. Patients were divided into two groups according to hs-TnT concentration on admission (< or ≥0.014ng/mL). RESULTS More than half (61.2%) of the 103 included patients had an hs-TnT concentration ≥0.014ng/mL. hs-TnT concentrations were significantly higher in those who died compared with survivors (0.292±0.516 vs. 0.069±0.154ng/mL; P=0.003). Multivariable Cox regression analysis suggested that hs-TnT is an independent factor for predicting in-hospital mortality risk (odds ratio: 2.202, 95% confidence interval: 1.111-4.367; P=0.024). Kaplan-Meier curves revealed a significant increase in hospital mortality in the hs-TnT(+) group compared with the hs-TnT(-) group (P=0.021). When hs-TnT was ≥0.042ng/mL, the sensitivity and specificity in predicting hospital short-term mortality were 70.8% and 76.4%, respectively. CONCLUSIONS Our study suggests that hs-TnT concentration could be used as an early biomarker for the risk stratification of patients with type-A AAD in the emergency department; the relationship between hs-TnT concentration and long-term prognosis needs further investigation.
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165
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Tanaka Y, Kitamura T, Horai T, Miyaji K. Two-stage operation for Stanford type A acute aortic dissection originating from Kommerell's diverticulum. Interact Cardiovasc Thorac Surg 2016; 22:695-7. [PMID: 26869663 DOI: 10.1093/icvts/ivw011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/11/2016] [Indexed: 12/29/2022] Open
Abstract
We report a rare case of Stanford type A acute aortic dissection involving an aberrant right subclavian artery and originating from Kommerell's diverticulum in a 52-year old man. Initially, as an emergency measure, total arch replacement and right axillary artery reconstruction were performed. However, due to the subsequent enlargement of the false lumen, thoracic endovascular aortic repair and right subclavian artery coiling were performed successfully 5 months after the first operation. Herein, we describe surgical management approaches for the treatment of a Stanford type A acute aortic dissection with aberrant right subclavian artery.
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Affiliation(s)
- Yuki Tanaka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tetsuya Horai
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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166
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Wang XJ, Huang B, Yang YM, Zhang L, Su WJ, Tian L, Lu TY, Zhang S, Fan XH, Hui RT. Differential expression of microRNAs in aortic tissue and plasma in patients with acute aortic dissection. J Geriatr Cardiol 2015; 12:655-61. [PMID: 26788043 DOI: 10.11909/j.issn.1671-5411.2015.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Biomarker-assisted diagnosis of acute aortic dissection (AAD) is important for diagnosis and treatment. However, identification of biomarkers for AAD in blood is a challenging task. The aim of this study is to search for new potentially microRNA (miRNAs) biomarkers in AAD. Methods The miRNAs expression profiles in ascending aortic tissue and plasma were examined by microarray analysis in two sets or groups. The tissue group was composed of four patients with AAD and four controls of healthy male organ donors. The plasma group included 20 patients with AAD and 20 controls without cardiovascular disease. Bioinformatics was used to analyze the potential targets of the differentially expressed miRNAs. Results Our study revealed that in AAD patients, the aortic tissue had 30 differentially expressed miRNAs with 13 up-regulated and 17 down-regulated, and plasma had 93 differentially expressed miRNAs, of which 33 were up-regulated and 60 were down-regulated. Four miRNAs were found to be up-regulated in both aortic tissue and plasma in AAD patients. The predicted miRNA targets indicated the four dysregulated miRNAs mainly targeted genes that were associated with cell-cell adhesion, extracellular matrix metabolism, cytoskeleton organization, inflammation, and multiple signaling pathways related to cellular cycles. Conclusions Four miRNAs, which are up-regulated both in aortic tissue and in plasma in AAD patients, have been identified in this study. These miRNAs might be potential diagnostic biomarkers for AAD. Larger sample investigations are needed for further verification.
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167
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Xia L, Li JH, Zhao K, Wu HY. Incidence and in-hospital mortality of acute aortic dissection in China: analysis of China Health Insurance Research (CHIRA) Data 2011. J Geriatr Cardiol 2015; 12:502-6. [PMID: 26512241 PMCID: PMC4605945 DOI: 10.11909/j.issn.1671-5411.2015.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Acute aortic dissection (AAD) is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in Mainland China is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. METHODS We used the China Health Insurance Research Data (the CHIRA Data) 2011 which comprises all inpatient hospital records (300,886) during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries (1,718,500 men and 1,616,500 women) from 25 cities and counties in different economic-geographic regions of Mainland China. Patients with acute aortic dissection were identified according to International Classification of Disease 10(th) Revision (ICD-10) of I71.0. The estimated incidence of AAD was calculated using the equation: estimated incidence = 2.0 × (40% × hospital admission rate) + 60% × hospital admission rate. RESULTS The hospital admission rate was 2.0/100,000 (65/3,325,000, 95% CI: 1.2-2.8). The estimated annual incidence of AAD was 2.8/100,000 (95% CI: 1.9-3.6) and was higher in male than in female (3.7 vs. 1.5, P < 0.001). The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ± 6 days, the overall in-hospital mortality was 13.9% (9/65). CONCLUSIONS Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.
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Affiliation(s)
- Lei Xia
- The Administrating Office, Chinese PLA General Hospital, Beijing, China
| | - Jing-Hu Li
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Zhao
- China Health Insurance Research Association, Beijing, China
| | - Hai-Yun Wu
- Brainpower Phama Consulting Co., Ltd., Beijing, China
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Ren HM, Wang X, Hu CY, Que B, Ai H, Wang CM, Sun LZ, Nie SP. Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection. J Geriatr Cardiol 2015; 12:232-8. [PMID: 26089846 DOI: 10.11909/j.issn.1671-5411.2015.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/26/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022]
Abstract
Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. However, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain unclear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Methods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease: improving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0% vs. 4.2%, respectively; P < 0.001), including acute renal failure (21.4% vs. 0, respectively; P < 0.001), and they increased with severity of AKI (P < 0.001). The maximum levels of body temperature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR: 1.023; 95% CI: 1.003–1.044; P = 0.0238) and bilateral renal artery involvement (OR: 19.076; 95% CI: 1.914–190.164; P = 0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently occurred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.
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Sansone F, Morgante A, Ceresa F, Salamone G, Patanè F. Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection. Aorta (Stamford) 2015; 3:91-7. [PMID: 27069938 PMCID: PMC4820344 DOI: 10.12945/j.aorta.2015.14.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 02/12/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND "Type A" acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD. METHODS From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees. RESULTS The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury. CONCLUSIONS The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia. The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.
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Affiliation(s)
- Fabrizio Sansone
- Corresponding Author: Fabrizio Sansone, MD, Division of Cardiac Surgery, Papardo Piemonte Hospital, Contrada Sperone, 98158 Messina, Italy. Tel: +39 090 3993315, Fax: +39 090 3993309, E-Mail:
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170
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Yu HC, Wang ZQ, Hao YY, An FP, Hu YC, Deng RB, Yu P, Cui GB, Li H. An extensive DeBakey type IIIb aortic dissection with massive right pleural effusion presenting as abdominal pain and acute anemia: particular case report. J Geriatr Cardiol 2015; 12:319-22. [PMID: 26089858 DOI: 10.11909/j.issn.1671-5411.2015.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/29/2015] [Accepted: 03/10/2015] [Indexed: 12/03/2022] Open
Abstract
We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography angiography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta starting immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a 'rule-out' test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation.
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171
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He X, Liu X, Liu W, Gao B, Zeng H. Acute Stanford type B aortic dissection occurred simultaneously with acute myocardial infarction. Int J Cardiol 2015; 189:56-8. [PMID: 25885872 DOI: 10.1016/j.ijcard.2015.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Gao
- Department of Cardiology, Central Hospital of Suizhou City, Suizhou, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Russo CF, Mariscalco G, Colli A, Santè P, Nicolini F, Miceli A, De Chiara B, Beghi C, Gerosa G, Glauber M, Gherli T, Nappi G, Murzi M, Molardi A, Merlanti B, Vizzardi E, Bonadei I, Coletti G, Carrozzini M, Gelsomino S, Caiazzo A, Lorusso R. Italian multicentre study on type A acute aortic dissection: a 33-year follow-up†. Eur J Cardiothorac Surg 2015; 49:125-31. [PMID: 25721818 DOI: 10.1093/ejcts/ezv048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/14/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD. METHODS We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated. RESULTS The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was identified in 10% of the patients. During surgery, the native aortic valve was preserved in 72% of the cases, including leaflet resuspension in 23% and David operation in 1.2%. Considering aortic valve replacement (AVR: 28%), bioprosthesis implantation was performed in 14.7% of the subjects. Neurological impairment at discharge was shown in 23% of the cases among which 21% of patients had new neurological impairment versus preoperative conditions. The overall 30-day mortality rate was 25.7%. All risk profiles remained independently associated with in-hospital mortality. During the available follow-up of hospital survivors (median: 70 months, interquartile range: 34-113, maximum: 396), cardiac-related death occurred in 7.9% of the subjects. The cumulative survival rate for cardiac death was 95.3% at 5 years, 92.8% at 10 years and 52.8% at 20 years. Severe aortic regurgitation (AR) (grade 3-4) at the time of surgery showed to be a significant risk factor for reintervention during the follow-up (P < 0.001). Among risk profiles, only the preadmission risk was independently associated with late mortality after multivariate analysis. Unexpectedly, there was no difference in freedom from cardiac death between patients with and without AVR. CONCLUSIONS Although surgery for type A has remained challenging over more than three decades, there is a positive trend in terms of hospital mortality and long-term follow-up. About 90% of patients were free from reoperation in the long term, although late AR remains a critical issue, suggesting that a thorough debate on surgical options, assessment and results of a conservative approach should be considered.
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Affiliation(s)
- Claudio F Russo
- Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | - Giovanni Mariscalco
- Department of Heart and Vessels, Cardiac Surgery Unit-Ospedale di Circolo, Varese, Italy
| | - Andrea Colli
- Cardiac Surgery, Università of Padova Medical School, Padova, Italy
| | - Pasquale Santè
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
| | | | | | | | - Cesare Beghi
- Department of Heart and Vessels, Cardiac Surgery Unit-Ospedale di Circolo, Varese, Italy
| | - Gino Gerosa
- Cardiac Surgery, Università of Padova Medical School, Padova, Italy
| | | | - Tiziano Gherli
- Cardiac Surgery, Università of Parma Medical School, Parma, Italy
| | - Gianantonio Nappi
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
| | | | - Alberto Molardi
- Cardiac Surgery, Università of Parma Medical School, Parma, Italy
| | - Bruno Merlanti
- Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | | | | | | | | | | | - Antonio Caiazzo
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
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173
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Peng W, Peng Z, Chai X, Zhu Q, Yang G, Zhao Q, Zhou S. Potential biomarkers for early diagnosis of acute aortic dissection. Heart Lung 2015; 44:205-8. [PMID: 25686518 DOI: 10.1016/j.hrtlng.2015.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to identify biological markers for early diagnosis of acute aortic dissection (AAD). METHODS 76 patients presented to the emergency room with acute chest pain within 6 h of occurrence were recruited for this study, and AAD diagnosed by aortic CTA. Biomarkers were measured by ELISA. ROC curve and Pearson correlation analysis were used to evaluate the sensitivity and specificity to diagnosis of AAD. RESULTS The serum levels of α-SMA, smMHC, sELAF, PC1 and D-dimer were significantly higher in AAD patients than in other groups (P < 0.05). Significant correlations between smMHC, sELAF, PC1, and D-dimer level were observed in AAD. Any combination of two markers showed good sensitivity (94.29%) and specificity (85.37%). CONCLUSION smMHC, sELAF, PC1, or D-dimer alone is a biomarker for early diagnosis of AAD, but the combination of these markers has significantly higher diagnostic value.
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Affiliation(s)
- Wen Peng
- Department of Emergency, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Zhenyu Peng
- Department of Emergency, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Xiangping Chai
- Department of Emergency, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, China.
| | - Qingyi Zhu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Qin Zhao
- Department of Emergency, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
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174
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Shrestha M. Re: Distal aortic reintervention after surgery for acute DeBakey type I or II aortic dissection: open versus endovascular repair. Eur J Cardiothorac Surg 2015; 48:264-5. [PMID: 25656403 DOI: 10.1093/ejcts/ezu555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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175
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Abstract
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.
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Affiliation(s)
- Noemi Cifani
- a Department of Clinical and Molecular Medicine , Faculty of Medicine and Psychology, Internal Medicine Unit, Sant' Andrea Hospital, Sapienza University of Rome , Rome , Italy.,b Department of Biology and Biotechnology' Charles Darwin' , Sapienza University of Rome , Rome , Italy
| | - Maria Proietta
- a Department of Clinical and Molecular Medicine , Faculty of Medicine and Psychology, Internal Medicine Unit, Sant' Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Luigi Tritapepe
- c Department of Anaesthesiology , Critical Medicine and PainTreatment, Faculty of Medicine and Odontology, Policlinico Umberto Primo, Sapienza University of Rome , Rome , Italy
| | - Cira Di Gioia
- d Department of Radiology , Oncology, and Anatomy& Pathology, Faculty of Medicine and Odontology, Policlinico Umberto Primo, Sapienza University of Rome , Rome , Italy
| | - Livia Ferri
- a Department of Clinical and Molecular Medicine , Faculty of Medicine and Psychology, Internal Medicine Unit, Sant' Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Maurizio Taurino
- e Department of Clinical and Molecular Medicine,Faculty of Medicine and Psychology , Vascular Surgery Unit, Sant' Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Flavia Del Porto
- a Department of Clinical and Molecular Medicine , Faculty of Medicine and Psychology, Internal Medicine Unit, Sant' Andrea Hospital, Sapienza University of Rome , Rome , Italy
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Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
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Della Corte A. The conundrum of aortic dissection in patients with bicuspid aortic valve: the tissue, the mechanics and the mathematics. Eur J Cardiothorac Surg 2014; 48:150-1. [PMID: 25352661 DOI: 10.1093/ejcts/ezu418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, V Monaldi Hospital, Naples, Italy
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178
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Etz CD, von Aspern K, Hoyer A, Girrbach FF, Leontyev S, Bakhtiary F, Misfeld M, Mohr FW. Acute type A aortic dissection: characteristics and outcomes comparing patients with bicuspid versus tricuspid aortic valve. Eur J Cardiothorac Surg 2014; 48:142-50. [PMID: 25319128 DOI: 10.1093/ejcts/ezu388] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/09/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of this study is to investigate the clinical characteristics and postoperative outcome of patients with a bicuspid aortic valve (BAV) suffering acute dissection in comparison with their tricuspid peers. METHODS Between 1995 and 2011, 460 consecutive patients underwent emergency repair for acute type A aortic dissection. In 379 patients without connective tissue disease, the aortic valve morphology could clearly be specified (91.6% tricuspid and 8.4% bicuspid). RESULTS At the time of dissection, patients with a bicuspid valve were younger (46.7 ± 13 vs 61.6 ± 12 years, P < 0.001) with the entry tear more often located in the root compared with those with a tricuspid valve (bicuspid: 31.3% vs tricuspid: 6.3%, P < 0.001). Consequently, surgical repair warranted root replacement in 93.8% of bicuspid vs 28.8% of tricuspid valve patients (P < 0.001). The leading pathology was medial necrosis/degeneration in bicuspid and atherosclerosis in tricuspid patients (P = 0.166). Hospital mortality was 20.3% and not significantly different between the two valve morphologies, even despite the younger age of bicuspid patients: 28.1% among bicuspids vs 19.6% among tricuspids (P = 0.255). Survival after discharge was 63.3% at 10 years for all patients. BAV patients had a significantly better survival with 100% at 10 years compared with 60.2% in tricuspid valve patients (P = 0.011). Mean follow-up among survivors was comparable for bicuspid and tricuspid patients (3.7 and 4.1 years, respectively). CONCLUSIONS Patients with BAV have a distinctive dissection pattern with the entry tear frequently located in the aortic root and-despite their younger age-are subject to substantial hospital mortality. For bicuspid patients suffering from dissection, composite root replacement yields an excellent outcome equal to an age- and gender-matched normal population.
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Affiliation(s)
- Christian D Etz
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Konstantin von Aspern
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Alexandro Hoyer
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Felix F Girrbach
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
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Dean JH, Woznicki EM, O'Gara P, Montgomery DG, Trimarchi S, Myrmel T, Pyeritz RE, Harris KM, Suzuki T, Braverman AC, Hughes GC, Kline-Rogers E, Nienaber CA, Isselbacher EM, Eagle KA, Bossone E. Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. Am J Med 2014; 127:878-85. [PMID: 24835037 DOI: 10.1016/j.amjmed.2014.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts. METHODS Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus non cocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection. RESULTS C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P < .001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients. CONCLUSIONS Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.
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Affiliation(s)
- Joshua H Dean
- Cardiovascular Center, University of Michigan, Ann Arbor
| | | | - Patrick O'Gara
- Cardiology Department, Brigham & Women's Hospital, Boston, Mass
| | | | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway
| | - Reed E Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kevin M Harris
- Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minn
| | - Toru Suzuki
- Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Alan C Braverman
- Cardiovascular Division, Washington University School of Medicine, St Louis, Mo
| | - G Chad Hughes
- Division of Thoracic Cardiovascular Surgery, Duke University Medical Center, Durham, NC
| | | | - Christoph A Nienaber
- Division of Cardiology and Vascular Medicine, University of Rostock, Rostock, Germany
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor
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180
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Komi M, Sugaya A, Akutsu H, Sato H, Kaminishi Y, Misawa Y. A worn Björk-Shiley prosthetic valve without valve dysfunction observed during ascending aortic replacement. Clin Case Rep 2014; 2:180-2. [PMID: 25614806 PMCID: PMC4302620 DOI: 10.1002/ccr3.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/24/2014] [Accepted: 04/15/2014] [Indexed: 11/15/2022] Open
Abstract
Key Clinical Message The implanted first-generation Björk–Shiley valve in our patient was functioning well before aortic surgery, but we replaced the valve because we confirmed disc erosion 39 years after implantation during the surgery. We judged that the implanted valve was no longer capable of maintaining the patient's life.
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Affiliation(s)
- Misao Komi
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
| | - Akira Sugaya
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
| | - Hirohiko Akutsu
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
| | - Hirotaka Sato
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
| | - Yuichiro Kaminishi
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
| | - Yoshio Misawa
- Division of Cardiovascular Surgery, Jichi Medical University Shimotsuke, Tochigi, Japan
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181
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Okazaki T, Yamamoto Y, Yoda K, Nagahiro S. The ratio of D-dimer to brain natriuretic peptide may help to differentiate between cerebral infarction with and without acute aortic dissection. J Neurol Sci 2014; 340:133-8. [PMID: 24655734 DOI: 10.1016/j.jns.2014.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies reported that the plasma d-dimer level reflects the activity of thrombus formation in the left atrium of patients with acute cerebral infarction and acute aortic dissection (AAD). Brain natriuretic peptide (BNP) is considered to be a marker of chronic heart failure. The differential diagnosis in the emergency room between stroke due to cardioembolism and AAD is difficult but important for early treatment especially in patients requiring intravenous thrombolysis with a recombinant tissue-type plasminogen activator. We aimed to investigate the association between the plasma d-dimer and BNP levels in patients with cerebral infarction and AAD. METHODS We identified 115 consecutive patients with ischemic stroke who were admitted within 72 h of symptom onset and 15 consecutive patients with AAD and measured the level of plasma d-dimer and BNP and the d-dimer:BNP ratio. RESULTS In patients with AAD the d-dimer level was significantly higher than that in patients with any other stroke subtypes and their BNP level was significantly lower than that in patients with cardioembolic stroke. The d-dimer:BNP ratio was significantly higher in patients with AAD than in those with any other stroke subtype. Compared to patients with a cardioembolic stroke subtype they manifested significantly higher d-dimer levels and d-dimer:BNP ratios suggesting that this ratio may help to diagnose cerebral infarction due to AAD (sensitivity 80%, specificity 93.5%, cut-off 0.074). When the population was limited to patients within 6h of onset, the ratio had higher sensitivity and specificity at the same cut-off value (sensitivity 81.8%, specificity 96.4%). CONCLUSION We found that the d-dimer:BNP ratio may be helpful in distinguishing between cerebral infarction with and without AAD.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan.
| | - Yoko Yamamoto
- Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan
| | - Keishi Yoda
- Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, The University of Tokushima Graduate School, Japan
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182
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Chien TM, Chen CW, Yu CP, Chen HM, Chen YF. Letter in response to "acute coronary involvement in acute type A aortic dissection: a subgroup analysis of bicuspid aortic valve and Marfan syndrome". Int J Cardiol 2014; 172:222-3. [PMID: 24467980 DOI: 10.1016/j.ijcard.2013.12.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/28/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tsu-Ming Chien
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Wei Chen
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cai-Pei Yu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Huai-Min Chen
- Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Fu Chen
- Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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183
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Ito T, Kuroda Y, Watanabe T, Koyanagi T, Higami T. Esophago-Pleural Fistula Caused by Compression Necrosis In a Patient With Acute Type B Aortic Dissection. Aorta (Stamford) 2013; 1:283-5. [PMID: 26798707 DOI: 10.12945/j.aorta.2013.13-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/06/2013] [Indexed: 11/18/2022]
Abstract
Esophago-pleural fistula associated with thoracic aortic aneurysm is a rare and lethal complication. We report the case of a 62-year-old male who suffered from esophago-pleural fistula 56 days after thoracoabdominal aortic surgery. Contrasted CT showed that the fistula occurred at the level of the esophagus compressed by rapid dilatation of thoracic aorta and endoscopy revealed no ischemic signs on esophageal mucosa, demonstrating that the cause of esophago-pleural fistula was compression necrosis due to rapid dilatation of the thoracoabdominal aortic aneurysm.
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Affiliation(s)
- Toshiro Ito
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Yohsuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Toshitaka Watanabe
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Tetsuya Koyanagi
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Tetsuya Higami
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Japan
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184
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Wang Y, Wu B, Dong L, Wang C, Shu X. Acute coronary involvement in acute type A aortic dissection: a subgroup analysis of bicuspid aortic valve and Marfan syndrome. Int J Cardiol 2013; 169:e82-3. [PMID: 24182903 DOI: 10.1016/j.ijcard.2013.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/07/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Yongshi Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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185
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Sekine Y, Yamamoto S, Fujikawa T, Oshima S, Ono M, Sasaguri S. Haemolytic anaemia resulting from the surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2013; 18:230-3. [PMID: 24203981 DOI: 10.1093/icvts/ivt481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Haemolytic anaemia after acute aortic dissection surgery is extremely rare. We report 4 cases of haemolytic anaemia with different aetiologies. METHODS Four patients underwent emergency operation for acute type A aortic dissection and subsequently developed haemolytic anaemia. RESULTS Case 1: a 41-year old man underwent hemiarch replacement. We performed total arch replacement 3 years postoperatively, which revealed that haemolytic anaemia was induced by proximal anastomotic stenosis caused by inverted internal felt strip. Case 2: a 28-year old man diagnosed with Marfan syndrome underwent total arch replacement. Five months postoperatively, we noted severe stenosis at the previous distal anastomotic site, which caused the haemolytic anaemia, and performed descending thoracic aortic replacement for a residual dissecting aneurysm. Case 3: a 49-year old man underwent hemiarch replacement. Three years postoperatively, we performed total arch replacement for a residual dissecting aortic arch aneurysm and repaired a kinked graft responsible for haemolytic anaemia. Case 4: a 42-year old man underwent total arch replacement. Eighteen months later, we performed descending thoracic aortic replacement. We repaired a portion of the ascending aorta as haemolityc anaemia was induced by kinking of a total arch replacement redundant graft. CONCLUSIONS All the haemolityc anaemia patients were successfully released after surgical reintervention.
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Affiliation(s)
- Yuji Sekine
- Department of Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
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186
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Peng W, Zhu QY, Zhou XH, Chai XP. A Simple Emergency Prediction Tool for Acute Aortic Dissection. Iran J Public Health 2013; 42:1085-91. [PMID: 26060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A simple emergency risk prediction tool should be developed for clinicians to quickly identify the prognosis of patients with acute aortic dissection. METHODS We enrolled 280 patients with acute aortic dissection admitted to emergency department between May 2010 and February 2013. Multivariate logistic regression analysis was performed to identify independent predictors of in-hospital death. RESULTS The in-hospital mortality of our patients with acute aortic dissection was 32.5%, in-hospital deaths with surgery less than the survived (34.1% VS 54.5%). Multivariate analysis identified that age (≥65 years old), Type A, blood pressure (mean systolic blood pressure ≤ 90 mmHg), neutrophil percentage (≥ 80%) and serum D-dimer (≥ 5.0 mg/L) were significant predictors of death. With the simple emergency risk prediction tool, scores of all in-hospital deaths were ≥ 3, whereas almost all of the survivors (97.9%) had scores < 15. A score of 10 offered the best threshold value, with the highest sensitivity (81.3%) and specificity (86.8%). CONCLUSIONS The in-hospital mortality rate of patients with acute aortic dissection is high and can be predicted. Early surgery would be beneficial for in-hospital survive. This tool should be available for clinicians in the emergency department to quickly identify the prognosis of patients with acute aortic dissection.
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187
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Nishioka N, Morimoto N, Yoshida M, Mukohara N. Intimointimal intussusception in both the proximal and distal ascending aorta: a rare clinical form of acute type A aortic dissection. Eur J Cardiothorac Surg 2013; 45:947. [PMID: 24080281 DOI: 10.1093/ejcts/ezt464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naritomo Nishioka
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan
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188
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Shimura S, Cho Y, Aki A, Ueda T. Successful reversal of immediate paraplegia associated with repair of acute Type A aortic dissection using cerebrospinal fluid drainage. Interact Cardiovasc Thorac Surg 2013; 17:1051-3. [PMID: 24014618 DOI: 10.1093/icvts/ivt389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Shinichiro Shimura
- Department of Cardiovascular Surgery, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
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189
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Semiz-Oysu A, Okur A, Sahin S. Pulmonary multislice computed tomography findings in acute aortic dissection. J Thorac Dis 2013; 4:485-9. [PMID: 23050112 DOI: 10.3978/j.issn.2072-1439.2012.07.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/01/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To document the type and incidence of pulmonary multislice computed tomography (CT) findings at presentation in patients with acute aortic dissection. MATERIALS AND METHODS Multidetector CT scans of 36 patients with a diagnosis of acute aortic dissection or intramural hematoma were retrospectively reviewed. RESULTS Pleural effusion, dependent stasis, mosaic attenuation, interlobular septal thickening, thickening of the peribronchovascular interstitium, vascular enlargement, compression atelectasis were common findings. Additionally air trapping, emphysema, consolidation, nodules, bronchiectasis or scarring were also noted. CONCLUSIONS Various pulmonary imaging findings may accompany acute aortic dissection. These findings and their clinical significance should be further investigated.
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Affiliation(s)
- Aslihan Semiz-Oysu
- Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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190
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191
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192
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Uchida K, Imoto K, Karube N, Minami T, Cho T, Goda M, Suzuki SI, Masuda M. Intramural haematoma should be referred to as thrombosed-type aortic dissection. Eur J Cardiothorac Surg 2013; 44:366-9; discussion 369. [PMID: 23515169 DOI: 10.1093/ejcts/ezt040] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intramural haematoma is defined pathologically as aortic dissection without an intimal tear. We therefore believe that this term is inappropriate as an acute clinical diagnosis, and instead, use the term 'thrombosed-type acute aortic dissection'. We compared the features of thrombosed-type acute aortic dissection with those of classic dissection. METHODS Thrombosed type was defined as aortic dissection without flow in the false lumen of the aorta on contrast-enhanced computed tomography. Surgery was indicated for all cases of type A acute aortic dissection, and central repair operations were performed in 509 patients. We retrospectively studied these patients' surgical records. RESULTS Three hundred and forty-four patients (68%) had classic dissection, and 165 (32%) had thrombosed type. Thrombosed type was associated with a significantly higher mean age (69 vs 60 years, P < 0.01), a higher incidence of cardiac tamponade (45 vs 28%, P < 0.01) and a lower incidence of malperfusion (6 vs 35%, P < 0.01) than classic dissection. Entry tears were located in the ascending aorta and the arch in 74 patients (45%) with thrombosed type. Since 2007, an intimal tear has been confirmed intraoperatively or on computed tomography in 39 (78%) of 50 patients with thrombosed-type aortic dissection. Mortality was significantly lower in patients with thrombosed-type dissection (6%) than in those with classic dissection (13%, P = 0.02). CONCLUSIONS Most cases of intramural haematoma are acute aortic dissections with an intimal tear without re-entry. Intramural haematoma should be referred to as thrombosed-type acute aortic dissection. Thrombosed type can be easily diagnosed on contrast-enhanced computed tomography and has features distinct from those of classic dissection. Our classification may be useful for the diagnosis of these types of aortic dissection.
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Affiliation(s)
- Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
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193
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Imoto K, Uchida K, Karube N, Yasutsune T, Cho T, Kimura K, Masuda M, Morita S. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg 2013; 44:419-24; discussion 424-5. [PMID: 23504116 DOI: 10.1093/ejcts/ezt060] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To identify the risk factors for mortality and establish improved treatment strategies in patients who have acute type A aortic dissection with coronary artery dissection. METHODS From January 1994 through December 2011, we performed surgery in 516 patients with acute type A aortic dissection. We studied 75 (15%) of these patients who had coronary artery dissection. Myocardial ischaemia was present in 48 (64%) of the 75 patients. The culprit coronary artery was the right coronary artery (RCA) in 26 patients, the left coronary artery (LCA) in 19 and the RCA + LCA in 3. For coronary artery reconstruction, preoperative coronary stent placement was done in 7 patients (RCA, 4 and LCA, 3), aortic root replacement in 14, coronary artery bypass grafting in 23 and biological glue application in 28. The relationships of preoperative risk factors and coronary artery reconstruction procedure with in-hospital death and postoperative low cardiac output syndrome (LOS) were analysed using Fisher's exact test. RESULTS Hospital death was 18/75 patients (24%), 16/48 (33%) among patients with ischaemia and 2/27 (7.4%) without ischaemia. The culprit lesion involved the RCA in 4/26 patients (15%), the LCA in 9/19 (47%) and the RCA + LCA in 3/3 (100%). Factors related to operative mortality were ischaemia (P = 0.019), LCA territory ischaemia (P = 0.003) and preoperative cardiopulmonary arrest (CPA) (P = 0.013). Postoperative LOS was less common in patients with coronary stent placement (P = 0.042). CONCLUSIONS In patients who undergo surgery for acute type A dissection with coronary artery dissection, preoperative CPA and myocardial ischaemia (particularly LCA territory ischaemia) negatively affect survival outcomes. Early revascularization by coronary stent placement is effective in preventing postoperative LOS.
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Affiliation(s)
- Kiyotaka Imoto
- Department of Cardiovascular Surgery, Yokohama City University, Medical Center, Yokohama, Japan.
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194
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Nagamine H, Ueno Y, Ueda H, Saito D, Tanaka N, Miyazaki M, Hara H, Kawase Y. A new classification system for branch artery perfusion patterns in acute aortic dissection for examining the effects of central aortic repair. Eur J Cardiothorac Surg 2012; 44:146-53. [PMID: 23242985 DOI: 10.1093/ejcts/ezs631] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We developed a new classification system for branch perfusion patterns in acute aortic dissection and used it to retrospectively evaluate the perfusion status of whole aortic branches and to examine the effects of central aortic repair. METHODS Thirty-four consecutive patients with acute type A aortic dissection underwent emergent surgery at our institution between August 2008 and December 2011. A retrospective review of pre- and postoperative computed tomographic angiography was performed. Branch perfusion patterns were categorized into three classes: Class I, dissection involving but not extending into the branch; Class II, dissection extending into the branch and Class III, dissection causing ostial avulsion. RESULTS In cervical branches (total 169 branches), 70 branches (41%) presented with Class I patterns, 58 (34%) with Class II and none with Class III. In abdominal branches (total 135 branches), 76 branches (56%) presented with Class I patterns, 12 (9%) with Class II and 18 (13%) with Class III. In common iliac arteries (total 68 arteries), 14 arteries (21%) presented with Class I patterns, 24 (35%) with Class II and none with Class III. After repair, among 21 high-risk cervical branches, 14 branches (67%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch false lumen and 4 (19%) showed no improvement in high-risk perfusion pattern or worsened. Among 22 high-risk abdominal branches, 18 branches (82%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch or aortic false lumen and 1 (5%) showed no improvement in high-risk perfusion pattern. CONCLUSIONS To overcome malperfusion syndromes associated with acute aortic dissection, recognition of diverse branch perfusion patterns through a universal classification system is imperative.
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Affiliation(s)
- Hiroshi Nagamine
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
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195
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Okamoto M, Amano T, Matsuoka S, Hirai H, Masuda K, Nakajima K, Sueyoshi A. A Case of Acute Myocardial Infarction due to Left Main Trunk Occlusion Complicated With Aortic Dissection as Diagnosed by Intravascular Ultrasound. Cardiol Res 2012; 3:232-235. [PMID: 28348693 PMCID: PMC5358137 DOI: 10.4021/cr212w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Masashi Okamoto
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Tomonori Amano
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Shunzo Matsuoka
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Hideki Hirai
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Kazunori Masuda
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Kanta Nakajima
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Atsushi Sueyoshi
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
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196
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Aziz F, Penupolu S, Alok A, Doddi S, Abed M. Peripartum acute aortic dissection: A case report & review of literature. J Thorac Dis 2012; 3:65-7. [PMID: 22263062 DOI: 10.3978/j.issn.2072-1439.2010.11.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/20/2010] [Indexed: 11/14/2022]
Abstract
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. We present here, a case of a 30 year old pregnant female with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome.
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Affiliation(s)
- Fahad Aziz
- Resident Internal Medicine, MSSM-Jersey City Campus, NJ, USA
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197
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Yunoki K, Naruko T, Itoh A, Furukawa A, Abe Y, Nakagawa E, Komatsu R, Haze K. Stenting of right coronary ostial occlusion due to thrombosed type A aortic dissection: One-year follow-up results. J Cardiol Cases 2010; 1:e166-e170. [PMID: 30524530 DOI: 10.1016/j.jccase.2009.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old man experienced acute chest pain and was transferred to our hospital. An electrocardiogram showed ST-segment elevation in leads II, III, aVf, and V1 through V3. The diagnosis at the emergency room was inferior acute myocardial infarction (AMI), and emergent coronary angiography (CAG) was performed. While CAG showed subtotal occlusion of the right coronary artery (RCA) ostium, aortic dissection was suspected due to staining of the contrast agent distal to the occluded site of RCA. Intravascular ultrasound showed compression of the RCA ostium due to aortic dissection. We performed bare metal stent implantation, and contrast-enhanced computed tomography (CT) after stenting showed a thrombosed type A aortic dissection. The patient received medical treatment along with repeated CT and echocardiographic examinations, and was discharged without any events one month after admission. CAG six months after stenting and 64-multislice CT angiography one year later showed a patent RCA. Contrast-enhanced CT at six months showed complete resorption of the ascending aortic intramural hematoma, and 64-multislice CT at one year showed a descending aortic intramural hematoma. The patient is doing well one year after the onset. This is a rare case of successful medical treatment for acute type A aortic dissection complicated with AMI.
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Affiliation(s)
- Kei Yunoki
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Akira Itoh
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Atsuko Furukawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Eiichiro Nakagawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Ryushi Komatsu
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kazuo Haze
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
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