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Patel K, Patel A, Ananthanarayanan C. Acute type A dissection, coarctation of aorta, and levoatriocardinal vein-A rare combination. J Card Surg 2021; 36:3867-3868. [PMID: 34297421 DOI: 10.1111/jocs.15832] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
Concomitant presence of acute type A dissection, coarctation of aorta and levoatriocardinal vein has not been described. We here present a case of aortic anuerysm complicated by type A dissection with coarctation of aorta and levoatriocardinal vein.
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Affiliation(s)
- Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Archit Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Chandrasekaran Ananthanarayanan
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
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Deplano V, Boufi M, Gariboldi V, Loundou AD, D'Journo XB, Cautela J, Djemli A, Alimi YS. Mechanical characterisation of human ascending aorta dissection. J Biomech 2019; 94:138-146. [PMID: 31400813 DOI: 10.1016/j.jbiomech.2019.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/11/2018] [Revised: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
Mechanical characteristics of both the healthy ascending aorta and acute type A aortic dissection were investigated using in vitro biaxial tensile tests, in vivo measurements via transoesophageal echocardiography and histological characterisations. This combination of analysis at tissular, structural and microstructural levels highlighted the following: (i) a linear mechanical response for the dissected intimomedial flap and, conversely, nonlinear behaviour for both healthy and dissected ascending aorta; all showed anisotropy; (ii) a stiffer mechanical response in the longitudinal than in the circumferential direction for the healthy ascending aorta, consistent with the histological quantification of collagen and elastin fibre density; (iii) a link between dissection and ascending aorta stiffening, as revealed by biaxial tensile tests. This result was corroborated by in vivo measurements with stiffness index, β, and Peterson modulus, Ep, higher for patients with dissection than for control patients. It was consistent with histological analysis on dissected samples showing elastin fibre dislocations, reduced elastin density and increased collagen density. To our knowledge, this is the first study to report biaxial tensile tests on the dissected intimomedial flap and in vivo stiffness measurements of acute type A dissection in humans.
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Affiliation(s)
- Valérie Deplano
- Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France.
| | - Mourad Boufi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France; Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, APHM, Timone Hospital, Department of Cardiac Surgery, Marseille, France
| | - Anderson D Loundou
- Aix Marseille Univ, SPMC EA3279, Department of Public Health, Marseille, France
| | - Xavier Benoit D'Journo
- Aix Marseille Univ, APHM, North Hospital, Department of Thoracic Surgery, Marseille, France
| | - Jennifer Cautela
- Aix Marseille Univ, APHM, North Hospital, Department of Cardiology, Marseille, France
| | - Amina Djemli
- Aix Marseille Univ, APHM, North Hospital, Department of Pathology, Marseille, France
| | - Yves S Alimi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France
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Watanabe T, Ito T, Sato H, Mikami T, Numaguchi R, Yasuda N, Nakazawa J, Kuroda Y, Harada R, Kawaharada N. Morphological predictor of remodelling of the descending thoracic aortic false lumen that remains patent after repair of acute type A dissection. Interact Cardiovasc Thorac Surg 2019; 28:629-634. [PMID: 30364942 DOI: 10.1093/icvts/ivy284] [Citation(s) in RCA: 2] [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: 03/09/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Some patients achieve complete recovery through false lumen remodelling in the descending aorta after surgery for acute type A aortic dissection. Our goal was to investigate the relationship between false lumen remodelling during later postoperative stages and quantitative analysis of the true lumen shape during the early postoperative stages. METHODS We examined 88 surgical patients between January 2007 and December 2016. Three points of the descending aorta were assessed from the 6th (T6), the 9th (T9) and the 11th (T11) vertebral levels. The shape of the true lumen was evaluated during the early postoperative stages, and false lumen remodelling 1 year after surgery was the end point. The parameters obtained by evaluating the shape of the true lumen comprised the first principal component analysis using elliptic Fourier analysis, the minor diameter ratio and the ratio of the area of the true lumen to that of the descending aorta, and the number of contact points on the true lumen wall during the early stages. RESULTS Using univariate analysis, we detected significant differences in the first principal components, the minor diameter ratio, the area ratio and the number of contact points at each thoracic vertebral level (P < 0.05). The cut-off value of the minor diameter ratio was 0.55, and the area ratio was 0.48 as determined by analysis of the receiver operating characteristic. Multivariable logistic analysis indicated that the first principal component was the most significant predictor from the proximal to the middle descending aorta. CONCLUSIONS Quantitative evaluation of shape of the true lumen in the early postoperative stages after surgery for acute type A dissection can serve as a viable predictor for false lumen remodelling in later stages. Furthermore, the first principal component could serve as a more astute predictor than other quantitative parameters according to multivariate analysis.
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Affiliation(s)
- Toshitaka Watanabe
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Hiroshi Sato
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Ryosuke Numaguchi
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Junji Nakazawa
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Hokkaido, Japan
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Kamata S, Funatsu T, Itou Y, Yagihara T. Conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement. J Cardiol Cases 2018; 17:36-9. [PMID: 30279850 DOI: 10.1016/j.jccase.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Coronary malperfusion associated with aortic dissection usually requires aggressive surgical treatment or catheter revascularization. Here, we report a case of conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement. An 81-year-old woman was rushed to our hospital in a state of circulatory shock after developing chest pain. She was severely hypotensive on admission, and the electrocardiogram (ECG) revealed anterior and lateral ST elevation. However, the initial fluid resuscitation increased her blood pressure to a normal level, and the ischemic ECG changes disappeared in about 20 min. ECG-gated cardiac multidetector computed tomography showed a type A aortic dissection complicated with left main trunk dissection. A primary entry tear was located 5 mm below the left coronary ostium. The patient successfully underwent composite graft replacement of the aortic root in a stable hemodynamic condition. <Learning objective: Emergency clinicians should be aware that coronary malperfusion associated with aortic dissection can be improved by conservative management in some cases. Electrocardiogram-gated cardiac multidetector computed tomography is a useful tool for the diagnosis and clinical management of this condition.>.
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Ikeno Y, Matsumori M, Yokawa K, Henmi S, Nakai H, Matsueda T, Yamanaka K, Inoue T, Tanaka H, Okita Y. A case of type A acute aortic dissection with a common carotid trunk. Gen Thorac Cardiovasc Surg 2018; 67:637-639. [PMID: 29869057 DOI: 10.1007/s11748-018-0953-7] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
We present a rare case of common carotid artery with acute type A aortic dissection. A 72-year-old woman underwent emergent aortic arch repair using Antegrade selective cerebral protection. Bottom-tapped cannulae were inserted into three orifices of arch vessels, however, regional cerebral oxygen saturation decreased after rewarming. We found that arch branches were in order from front to back, right subclavian artery, common carotid trunk, and left subcravian artery. The patient complicated stroke in the right middle cerebral artery.
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Affiliation(s)
- Yuki Ikeno
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan. .,Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan.
| | | | - Koki Yokawa
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Soichiro Henmi
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Hidekazu Nakai
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Takashi Matsueda
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | | | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
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Abstract
BACKGROUND Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. Western worlds. We examined the literature and our experience to report outcomes after repair of ATAIMH. METHODS We reviewed the hospital, follow-up clinic records and online mortality databases for all patients who presented to our center for open repair of ATAAD between 1999 and 2014. Preoperative characteristics, early and long-term outcomes were compared between classic ATAAD vs. ATAIMH. Survival was analyzed using Kaplan-Meier and log-rank statistics. RESULTS Of the 523 repaired ATAAD, 101 patients (19%) presented with IMH and 422 (81%) had classic dissection. ATAIMH were significantly older (64.8±12.9 vs. 56.8±14.6 years; P<0.001), more commonly females (39% vs. 26%; P=0.010), had poor baseline renal function (i.e., glomerular filtration rate) (P<0.017), more retrograde dissections (27% vs. 8.3%; P<0.001), and less distal malperfusion (5% vs. 15%; P<0.001). Age greater than 60 years, female sex, retrograde dissection, and Marfan syndrome were strongly correlated with ATAIMH. Time to repair for ATAIMH was longer (median, 55.3 vs. 9.8 hours; P<0.001) with one death in ATAIMH within three days of presentation (0.9% vs. 6%; P=0.040). In all, 30-day mortality in ATAIMH was not different from classic ATAAD (12% vs.16%; P=0.289). A significantly lower incidence of postoperative dialysis in ATAIMH was noted (10% vs. 19%; P=0.034). When adjusted for age and renal function, late survival was improved with IMH (P<0.039). CONCLUSIONS ATAIMH continues to be associated with significant morbidity and mortality, comparable to classic aortic dissection. A multidisciplinary management approach involving aggressive medical management and risk stratification for timely surgical intervention, along with genetic profiling, is recommended for optimal care. Long-term monitoring is mandatory to assess compliance to medical therapy and recognition of evolving complications.
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Affiliation(s)
- Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Charles C Miller
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Borojevic M, Safradin I, Vrljic D, Biocina B. Rewarming strategy and neuromonitoring are significant details in neurological outcome after surgical repair of type A aortic dissection. Eur J Cardiothorac Surg 2013; 44:402. [PMID: 23404688 DOI: 10.1093/ejcts/ezt047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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