Spontaneous rupture of the ascending aorta-size may not matter

Tamponade Hemopericardium due to Mitral Annulus Abscess Rupture

We present the case of a 71-year-old diabetic woman, suffering from chronic renal failure and with a history of hemodialysis for 6 years, who suddenly died. The autopsy showed a tamponade hemopericardium and a perforation of the left atrio-ventricular wall by an abscess of the mitral annulus. A severe picture of calcification of the mitral annulus calcification also emerged. Histology confirmed the abscess, highlighting the presence of peri-abscess endocarditis. Post-mortem microbiological investigations identified the presence of Staphylococcus epidermidis. The case was considered of interest, since the onset of an abscess of the mitral annulus is an infrequent occurrence and it is an even rarer event if it occurs on native heart valves and in the absence of associated finding of valve vegetation. Finally, the lethal evolution can also be considered rare since although theoretically the cardiac rupture from an abscess is a possible event that leads to death, to date no case has yet been reported.

Analysis of ascending aortic diameter and long-term prognosis in patients with ascending aortic dissection

OBJECTIVES

This study was designed to review the ascending aortic diameter of patients undergoing surgery for AAD in China and its influence on prognosis.

METHODS

In the period between January 2018 and January 2020, 265 patients eligible for analysis of ascending aorta were included in this study. The maximum diameter of the ascending aorta was assessed using preoperative computed tomography (CT) scan for patients.

RESULTS

The mean diameter of the ascending aorta of the reference population was 48.16 ± 9.37 mm, and the percentage of subjects with an aorta <55 mm was 80.38%. In this study, we found that BMI, hypertension, and bicuspid aortic valve are the main factors affecting the widening of the ascending aorta, and the diameter of the ascending aorta in patients with AAD is negatively correlated with the patient's long-term prognosis. However, there is no significant difference in survival rates among patients with different ascending aortic diameter.

CONCLUSIONS

Ascending aortas with smaller diameter are also prone to dissection, most of which occur at a lower surgical threshold than recommended by current guidelines. Therefore, the diameter of ascending aorta cannot be used as an independent risk factor for high-risk patients with aortic dissection, but it can be used as an important indicator to evaluate the long-term prognosis of patients.