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Acute aortic dissection

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https://www.readbyqxmd.com/read/29445600/chronic-type-b-residual-after-type-a-what-i-would-do
#1
Martin Czerny, Maximilian Kreibich, Julia Morlock, Stoyan Kondov, Johannes Scheumann, Holger Schröfel, Fabian A Kari, Tim Berger, Matthias Siepe, Friedhelm Beyersdorf, Bartosz Rylski
" The major goal of surgery for acute type A aortic dissection is to have an alive patient. " This motto still remains the most important directive. However, also depending onto the extent of the underlying pathology and consecutively depending onto the extent of primary surgery, there is and will be need for additional classical surgical or interventional treatment sooner or later during follow-up in a substantial number of patients having had surgery for acute type A aortic dissection. This article shall guide the interested reader through the underlying mechanisms as well as treatment options in patients with chronic type B "residual" after type A repair and shall finally suggest preventive strategies to reduce the occurrence of this pathology to a minimum...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29444778/efficacy-and-safety-of-the-shexiang-baoxin-pill-for-the-treatment-of-coronary-artery-disease-not-amenable-to-revascularisation-study-protocol-for-a-randomised-placebo-controlled-double-blinded-trial
#2
Pan-Pan Tian, Jun Li, Jian Gao, Ying Li
INTRODUCTION: Coronary artery disease (CAD) not amenable to revascularisation indicates that the coronary arteries have severe diffuse lesions or calcifications, or that CAD is complicated with severe multiple-organ disease. Currently, Western medicines available for the treatment of CAD not amenable to revascularisation are limited. Shexiang Baoxin Pill (SBP), a type of Chinese patent medicine, has been widely used to treat CAD in China for many years. Previous studies have shown that long-term administration of SBP (1-2 pills three times daily, for at least 6 months) for treatment of CAD is effective and safe, with a significant, long-term effect...
February 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29428837/ascending-aortic-stenting-for-acute-supra-aortic-stenosis-from-graft-collapse
#3
Joshua M Lader, Deane E Smith, Cezar Staniloae, Arzhang Fallahi, Sohah N Iqbal, Aubrey C Galloway, Mathew R Williams
A 78 year-old man with remote type-A dissection presented with acute-onset dyspnea. Twenty-two years prior, treatment for his aortic disease required replacement of ascending and arch aneurysms with a Dacron graft using graft inclusion technique. He presented currently in cardiogenic shock. Echocardiography demonstrated new severe hypokinesis of all apical segments. Left-heart catheterization revealed a 120mmHg intra-graft gradient. CT arteriography was unrevealing, but intra-aortic ultrasound demonstrated critical intra-graft stenosis...
February 8, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29427478/from-ruling-out-to-ruling-in-putting-pocus-in-focus
#4
Arjun K Venkatesh, Charles D Scales, Marta E Heilbrun
Over the past twenty years, the Emergency Department (ED) has transformed from a location that managed patients with acute life-threatening illness or injury to an acute diagnostic center. The advent of rapid and accurate imaging, novel biomarkers, and other innovations concurrent with effects from financial and social forces has supported the development of an acute care system focused on "ruling out" low-frequency, high-mortality events such as acute myocardial infarction, stroke, pulmonary embolism, and aortic dissection...
February 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29422267/impact-of-a-negative-d-dimer-result-on-the-initial-assessment-of-acute-aortic-dissection
#5
Kenichi Nitta, Hiroshi Imamura, Yuichiro Kashima, Hiroshi Kamijo, Michitaro Ichikawa, Mayumi Okada, Katsunori Mochizuki, Hiroshi Takayama
BACKGROUND: D-dimer shows high sensitivity but low specificity for the diagnosis of acute aortic dissection (AAD). Previous reports indicated that negative D-dimer patients have shorter dissection length. However, whether patients with negative D-dimer results have a good prognosis is unknown. This study aimed to elucidate the clinical characteristics and implications of a negative D-dimer result on AAD diagnosis. METHODS: The study group comprised 126 patients (71 males, 55 females; mean age, 69 ± 11 years) with AAD admitted to our hospital between April 2009 and March 2015...
January 31, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29420730/clinical-differences-between-men-and-women-undergoing-surgery-for-acute-type-a-aortic-dissection
#6
Tomoaki Suzuki, Tohru Asai, Takeshi Kinoshita
OBJECTIVES: The differences in clinical features, surgical outcome and long-term prognosis between men and women who undergo surgery for Type A aortic dissection are not well known. METHODS: From January 2004 to December 2016, 303 patients, consisting of 147 women and 156 men, underwent surgery for acute Type A aortic dissection at our institution. We compared clinical outcomes between the 2 cohorts. RESULTS: Women were older than men (72...
February 6, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29420717/surgical-outcomes-of-aortic-repair-via-transapical-cannulation-and-the-adventitial-inversion-technique-for-acute-type-a-aortic-dissection
#7
Junichi Shimamura, Shin Yamamoto, Susumu Oshima, Kensuke Ozaki, Takuya Fujikawa, Shigeru Sakurai, Yuki Hirai, Tomohiro Hirokami, Nobukazu Moriya, Soichiro Hase, Tassei Nakagawa, Motoshige Yamasaki, Wataru Takayama, Shiro Sasaguri
OBJECTIVES: To evaluate the surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection. METHODS: Between 2008 and 2015, a total of 300 patients with acute Type A aortic dissection underwent emergency surgery, consisting of 271 hemiarch repairs and 29 total aortic arch replacements, using transapical cannulation and the adventitial inversion technique at a distal anastomosis. The mean follow-up periods were 31...
February 6, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29416251/aortic-dissection-masquerading-as-a-bicuspid-aortic-valve
#8
Harendra Arora, Priya Ajit Kumar
A 37-year-old male presented to the Emergency Department with acute worsening of back pain and new onset dyspnea. Transthoracic echocardiography revealed moderate left ventricular dysfunction and a bicuspid aortic valve (BAV). In addition, he was noted to have a dilated thoracic aorta concerning for a dissection, severe aortic insufficiency (AI), and both a pericardial and pleural effusion. Magnetic resonance imaging revealed a Type A ascending aortic dissection. He was taken emergently to the operating room for repair...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29415372/one-stage-replacement-of-the-aorta-from-arch-to-thoracoabdominal-region
#9
Takashi Matsueda, Yuki Ikeno, Koki Yokawa, Yojiro Koda, Soichiro Henmi, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
OBJECTIVES: We present our experience with one-stage replacement of thoracic aneurysm from the ascending aorta to the thoracoabdominal aorta. PATIENTS AND METHODS: Fourteen patients (10 male and 4 female; mean age 53.6 ± 12.4 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was chronic aortic dissection in 13 patients and intraoperative retrograde aortic dissection in 1 patient. Five patients had Marfan syndrome...
February 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29410467/data-driven-modeling-of-hemodynamics-and-its-role-on-thrombus-size-and-shape-in-aortic-dissections
#10
Alireza Yazdani, He Li, Matthew R Bersi, Paolo Di Achille, Joseph Insley, Jay D Humphrey, George Em Karniadakis
Aortic dissection is a pathology that manifests due to microstructural defects in the aortic wall. Blood enters the damaged wall through an intimal tear, thereby creating a so-called false lumen and exposing the blood to thrombogenic intramural constituents such as collagen. The natural history of this acute vascular injury thus depends, in part, on thrombus formation, maturation, and possible healing within the false lumen. A key question is: Why do some false lumens thrombose completely while others thrombose partially or little at all? An ability to predict the location and extent of thrombus in subjects with dissection could contribute significantly to clinical decision-making, including interventional design...
February 6, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29404804/variation-in-emergency-department-use-of-computed-tomography-for-investigation-of-acute-aortic-dissection
#11
Robert Ohle, Omar Anjum, Helena Bleeker, George Wells, Jeffrey J Perry
INTRODUCTION: Acute aortic dissection (AAD) is a life-threatening condition making early diagnosis critical. Although 90% present with acute pain, the myriad of associated symptoms can make diagnosis a challenge. Our objective was to assess how we are using computed tomography to rule out acute aortic dissection specifically rate of ordering, diagnostic yield, and variation in practice. METHODS: We included consecutive adult patients presenting to two tertiary academic care emergency departments over one calendar year presenting with non-traumatic chest, back, abdominal, or flank pain...
February 5, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29398314/infrarenal-aortic-repair-with-or-without-false-lumen-intentional-placement-of-endografts-for-hybrid-management-of-complex-aortic-dissection
#12
William J Quinones-Baldrich, Taimur Saleem, Adam Oskowitz
OBJECTIVE: Aortic dissection (AD) often involves the infrarenal aorta. We review our experience with open infrarenal aortic repair with or without false lumen intentional placement (FLIP) of endografts in the proximal dissected aorta as part of a hybrid strategy to treat complex AD. METHODS: A prospectively maintained database of patients undergoing intervention for AD was reviewed. Data regarding diagnosis, imaging features, nature of the infrarenal repair (one- vs two-stage procedure), endoleaks, need for additional interventions, morbidity, and mortality were collected...
February 2, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29397965/short-term-outcomes-of-a-simple-and-effective-approach-to-aortic-root-and-arch-repair-in-acute-type-a-aortic-dissection
#13
Bo Yang, Aroosa Malik, Victoria Waidley, Xiaoting Wu, Elizabeth L Norton, David M Williams, Minhaj S Khaja, Whitney E Hornsby
OBJECTIVE: To evaluate short-term outcomes following direct aortic root and arch repair in patients with acute type A aortic dissection (ATAAD) without technical adjuncts. METHODS: Between 2012 and 2016, 94 consecutive patients with ATAAD underwent surgical repair, including aortic root repair (n = 45), root replacement (n = 39), or no root procedure (n = 10). Aortic root repair was achieved by running approximation of the dissected aortic wall circumferentially at the sinotubular junction and reinforcing the coronary ostia with 5-0 Prolene...
December 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29395207/direct-repair-of-the-aortic-root-and-arch-in-acute-type-a-dissection-is-outcome-related-to-technique-patient-selection-or-experience
#14
EDITORIAL
Leonard N Girardi
No abstract text is available yet for this article.
January 4, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29395197/zone-zero-thoracic-endovascular-aortic-repair-a-proposed-modification-to-the-classification-of-landing-zones
#15
Eric E Roselli, Jay J Idrees, Douglas R Johnston, Matthew J Eagleton, Milind Y Desai, Lars G Svensson
OBJECTIVE: Endovascular stent-grafting provides an alternative treatment option for high-risk patients with ascending aortic disease. The feasibility of this approach has been demonstrated before. We assess the updated experience with ascending thoracic endovascular aortic repair and propose a modification of the landing zone classification based on the outcomes. METHODS: From 2006 to 2016, 39 patients deemed very high risk for open replacement underwent endovascular repair of ascending aorta for acute type A dissection (12, 31%), intramural hematoma (2, 5%), pseudoaneurysm (22, 56%), and chronic dissection suture line entry tear (3, 8%)...
November 22, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29390466/iatrogenic-acute-aortic-dissection-induced-by-off-pump-coronary-artery-bypass-grifting-a-case-report-and-review-of-the-literature
#16
Jiachen Li, Xinliang Guan, Ming Gong, Xiaolong Wang, Hongjia Zhang
RATIONALE: Iatrogenic acute aortic dissection (IAAD) induced by cardiac surgery is a fatal complication, with 0.04% of therapeutic procedures and worse outcomes than spontaneous aortic dissection. PATIENTS CONCERNS: A 64-year-old male complaining of intermittent chest tightness for 4 years received an off-pump coronary artery bypass grifting (OPCABG) and IAAD was found during surgery. DIAGNOSIS: Unstable angina, coronary artery triple vessel lesion, IAAD...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29385431/surgery-for-acute-type-i-aortic-dissection-without-resection-of-supra-aortic-entry-sites-leads-to-unfavourable-aortic-remodelling
#17
Woon Heo, Suk-Won Song, Kwang-Hun Lee, Shin-Young Lee, Tae-Hoon Kim, Min-Young Baek, Kyung-Jong Yoo
OBJECTIVES: This study aimed to evaluate the impact of remnant re-entries in arch branches on postoperative change in the aortic arch and descending aortic diameters and the rate of major adverse aortic events. METHODS: Between January 2010 and December 2016, 249 patients underwent surgery for acute Type I aortic dissection. Patients who underwent total arch replacement, had Marfan syndrome or had intramural haematoma were excluded. Seventy-two patients with predischarge and follow-up computed tomography scans were enrolled...
January 29, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29385426/outcomes-of-valve-sparing-root-replacement-in-acute-type-a-aortic-dissection
#18
Hiroshi Tanaka, Yuki Ikeno, Noriyuki Abe, Hiroaki Takahashi, Takeshi Inoue, Yutaka Okita
OBJECTIVES: To investigate the long-term durability of aortic valves, we reviewed the outcomes of patients who underwent valve-sparing root replacement with acute Type A aortic dissection. METHODS: We included patients who underwent emergent aortic repair for acute Type A aortic dissection at our university hospital between 2000 and 2016. We identified patients who underwent valve-sparing root replacement from the included cohort and assessed their survival and long-term valve durability...
January 29, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29375232/acute-myocardial-infarction-and-concomitant-stroke-as-the-manifestations-in-a-patient-with-type-a-aortic-dissection-a-case-report-with-three-years-of-follow-up
#19
Po-Jung Yuan, Wai-Kin Wong
A 55-year-old male patient presented with repeated acute retrosternal chest pain. Twelve-lead electrocardiogram and cardiac enzymes revealed non-ST elevation myocardial infarction. He was treated as non-ST elevation myocardial infarction at first. The symptoms of left-sided hemiparesis and aphasia occurred later on after admission. The results of emergent brain computed tomography and magnetic resonance imagining demonstrated acute stroke. The unusual presentation warned us of the possibility of aortic dissection...
January 2018: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29369147/target-home-morning-sbp-be-below-125%C3%A2-mmhg-in-type-2-diabetes-patients
#20
Kazuo Eguchi, Satoshi Hoshide, Kazuomi Kario
BACKGROUND: It is not established to what extent self-monitoring of home BP be lowered in patients with type 2 diabetes. We tested the hypothesis that the appropriate home morning SBP cutoff value is 125 mmHg in our stratification of cardiovascular risk in type 2 diabetes. METHOD: Clinic and home BP monitoring were performed in 4308 individuals (1057 people with diabetes and 3251, nondiabetes), and we tested two cutoff values of home morning SBP (MSBP): 135 and 125 mmHg...
January 23, 2018: Journal of Hypertension
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