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Acute aortic dissection

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https://www.readbyqxmd.com/read/29242940/clinics-in-diagnostic-imaging-182-acute-descending-aortic-dissection-with-aortic-root-retrograde-extension
#1
John Nathan Gifford, Angeline Choo Choo Poh
A 77-year-old man presented with acute-onset severe chest pain radiating to the back and elevated blood pressure. Multiphasic computed tomography of the aorta revealed an intimal tear in the descending thoracic aorta which extended both retrograde to the aortic root and antegrade to the infra-renal abdominal aorta. The initial impression, that the images showed a Stanford type B aortic dissection, was because the portion of the false lumen that extended beyond the aortic arch remained unopacified even on delayed phases, making it challenging to assess the extent of the dissection flap...
December 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/29241685/fenestrated-thoracic-endovascular-aortic-repair-using-physician-modified-stent-grafts-for-acute-type-b-aortic-dissection-with-unfavourable-landing-zone
#2
Jiechang Zhu, Lujing Zhao, Xiangchen Dai, Yudong Luo, Hailun Fan, Zhou Feng, Yiwei Zhang, Fanguo Hu
OBJECTIVES: The aim was to evaluate the early results of fenestrated thoracic endovascular aortic repair (fTEVAR) using physician modified stent grafts (PMSGs) to revascularise aortic branches for acute type B aortic dissection (ABAD) with unfavourable proximal landing zone. METHODS: Twenty consecutive patients who underwent fenestrated TEVAR using PMSGs between November 2015 and December 2016 were retrospectively reviewed. Pre-, intra-, and post-operative clinical data were recorded...
December 12, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29241182/serum-biomarker-identification-by-mass-spectrometry-in-acute-aortic-dissection
#3
Yong Ren, Qizhu Tang, Wenwei Liu, Yongqian Tang, Rui Zhu, Bin Li
BACKGROUND/AIMS: Aortic dissection (AD) is also known as intramural hematoma. This study aimed to screen peripheral blood biomarkers of small molecule metabolites for AD using high-performance liquid chromatography-mass spectrometry (HPLC-MS). METHODS: Sera from 25 healthy subjects, 25 patients with well-established AD, and 25 patients with well-established hypertension were investigated by HPLC-MS to detect metabolites, screen differentially expressed metabolites, and analyze metabolic pathways...
December 12, 2017: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/29240061/-hybrid-treatment-of-patients-with-aneurysms-and-dissections-of-the-aortic-arch-and-descending-portion-of-the-thoracic-aorta
#4
V V Shlomin, M L Gordeev, D A Zverev, E A Shloĭdo, V E Uspenskiĭ, E D Zvereva, P B Bondarenko, P D Puzdriak
The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29237361/hybrid-endovascular-aortic-arch-reconstruction-for-acute-aortic-dissection-an-endovascular-bridge-technique-for-complex-anatomy
#5
Michael P Rogers, Sophie M Reskin, Adam Ubert, Matthew C Black, Kendra J Grubb
Acute type A aortic dissections starting at the arch pose a challenge for cardiac surgeons. Open surgical repair requires deep hypothermic circulatory arrest for arch reconstruction and is associated with significant morbidity and mortality. Hybrid aortic repair techniques, with open arch debranching and thoracic endovascular aortic repair, have been employed in high-risk cases and challenging aortic pathology. Herein, we present a case of a 33-year-old African American male with a history of open thoracoabdominal aortic reconstruction and femoral-femoral artery bypass for a type B dissection who subsequently presented with new-onset chest pain and was found to have a retrograde type A dissection of a bovine arch with multiple dissection flaps and possible contrast extravasation on chest computed tomography...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29234731/endovascular-intimal-flap-septostomy-for-safe-landing-of-a-stent-graft-in-an-anastomotic-pseudoaneurysm-of-chronic-type-b-aortic-dissection
#6
Yoshiaki Saito, Kengo Tani, Satoshi Taniguchi, Ikuo Fukuda
Objective/Background: The purpose of this report is to demonstrate a novel endovascular technique for gaining and producing the maximal landing zone for a thoracic stent graft in a patient with a chronic type B aortic dissection. Methods: The patient was a 64 year old man with chronic type B aortic dissection. He had developed acute type B aortic dissection and undergone descending thoracic replacement (Zone 2-Th10) 12 years earlier. During follow-up, he developed an anastomotic false aneurysm distally...
2017: EJVES Short Reports
https://www.readbyqxmd.com/read/29234610/a-new-root-strengthening-technique-for-acute-aortic-dissection-with-a-weakened-aortic-root-the-neo-adventitia-technique
#7
Ji Yong Kim, In Ha Kim, Woon Heo, Ho-Ki Min, Do Kyun Kang, Youn-Ho Hwang, Hee Jae Jun
Background: Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the "neo-adventitia" technique to strengthen the weakened aortic root. Methods: From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique...
December 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29229954/recent-evolution-in-use-and-effectiveness-in-mainland-china-of-thoracic-endovascular-aortic-repair-of-type-b-aortic-dissection
#8
Jiang Xiong, Chen Chen, Zhongyin Wu, Duanduan Chen, Wei Guo
A meta-analysis was performed on 175 studies selected among those published in mainland China between 2008 and 2015 on thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD). Most TEVAR were performed in Shanghai, Beijing, Hubei and Guangdong in patients with mean age of 53.9 years, and acute (70%) or chronic (30%) type B AD. Procedural success rate was 99.1 ± 0.8%. Major complication rate was 1.7 ± 2.3%, with paraplegia in 0.4 ± 0.0%. Overall in-hospital mortality rate was 1...
December 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29221734/aortic-annulus-does-not-dilate-over-time-after-aortic-root-remodeling-with-or-without-annuloplasty
#9
Takashi Kunihara, Satoshi Arimura, Fumihiro Sata, Christian Giebels, Ulrich Schneider, Hans-Joachim Schäfers
OBJECTIVE: The lack of annular stabilization is the drawback of aortic root remodeling, and recently the addition of annuloplasty has been proposed. Limited data, however, exist on late annular size after remodeling. We studied annular size over time. METHODS: In 241 patients (53 ± 16 years) annular size was determined preoperatively (T0), before discharge (T1), and at least 2 years after remodeling (T2, 54 ± 27 months) with (n = 52) or without external suture annuloplasty...
December 5, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29221269/cluster-analysis-of-acute-ascending-aortic-dissection-provides-novel-insight-into-mechanisms-of-distal-progression
#10
Jennifer L Philip, Nilto C De Oliveira, Shahab A Akhter, Brooks L Rademacher, Christopher B Goodavish, Paul D DiMusto, Paul C Tang
Background: Whether primary tear size impacts extent of type A dissection is unclear. Using statistical groupings based on dissection morphology, we examined its relationship to primary tear area. Methods: We retrospectively reviewed 108 patients who underwent acute ascending dissection repair from 2000-2016. Dissection morphology was characterized using 3-dimensional (3D) reconstructions of computed tomography (CT) scan images. Two-step cluster analysis was performed to group the dissections by examining the true lumen area as a fraction of the total aortic area at various levels...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29218798/high-risk-clinical-features-for-acute-aortic-dissection-a-case-control-study
#11
Robert Ohle, Justin Um, Omar Anjum, Helena Bleeker, Lindy Luo, George Wells, Jeffrey J Perry
BACKGROUND: Acute aortic dissection (AAD) is a rare condition with a high mortality that is often missed. The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and a low risk control group. METHODS: Historical matched case-control study: participants were adults >18 years old presenting to two tertiary care emergency departments (ED) or one regional cardiac referral center. CASES: new ED or in-hospital diagnosis of non-traumatic AAD confirmed by computed tomography or echocardiography...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29218111/the-diagnostic-value-of-microrna-4787-5p-and-microrna-4306-in-patients-with-acute-aortic-dissection
#12
Lei Wang, Shijie Zhang, Zhigao Xu, Jingjing Zhang, Li Li, Guoqiang Zhao
Acute aortic dissection (AAD) is a life-threatening cardiovascular disease with the high morbidity and mortality. Imaging modalities are the gold standard for the diagnosis of AAD; however, they are not always available in emergency department. Biomarker-assisted diagnosis is important for the early treatment of AAD. The aim of the present study was to identify potential microRNA (miRNA) biomarkers for AAD. Differentially expressed plasma miRNAs between AAD patients and age-matched healthy volunteers were analyzed by miRNA microarray...
2017: American Journal of Translational Research
https://www.readbyqxmd.com/read/29217443/analysis-of-aortic-growth-rates-in-uncomplicated-type-b-dissection
#13
Maen Aboul Hosn, Paolo Goffredo, Jeffrey Zavala, William J Sharp, Neelima Katragunta, Timothy Kresowik, Rachael Nicholson, Luigi Pascarella
OBJECTIVES: Uncomplicated type B dissections have historically been treated medically with hemodynamic control. Early progression of the disease and late aneurysmal dilation have been considered as indications for intervention. The aim of this study is to analyze growth rate patterns of type B dissections based on Computed Tomography measurements over time. METHODS: We conducted a retrospective review of patients with acute type B dissection from 2008 to 2014 who had at least two follow up CT scans...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29217246/acute-type-a-aortic-dissection-and-successful-surgical-repair-in-a-woman-at-21-weeks-gestational-pregnancy-with-maternal-and-fetal-survival-a-case-report
#14
Adam Barrus, Sam Afshar, Sara Sani, Troy G LaBounty, Cesar Padilla, Michaela K Farber, Andrew G Rudikoff, Antonio Hernandez Conte
No abstract text is available yet for this article.
September 14, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29217087/evolution-of-simplified-frozen-elephant-trunk-repair-for-acute-debakey-type-i-dissection-midterm-outcomes
#15
Eric E Roselli, Jay J Idrees, Faisal G Bakaeen, Michael Z Tong, Edward G Soltesz, Stephanie Mick, Douglas R Johnston, Mathew J Eagleton, Venu Menon, Lars G Svensson
BACKGROUND: A modified technique for frozen elephant trunk (FET) repair of acute DeBakey type I dissection has evolved. Procedural modifications are described and midterm outcomes evaluated. METHODS: From 2009 to 2016, 72 patients with DeBakey type I dissection underwent emergency simplified FET. Mean age was 59 ± 15 years. Presentation included malperfusion (n = 22, 31%), rupture (n = 12, 16%), and aortic insufficiency (n = 42, 58%). Concomitant procedures included valve replacement (n = 9), root replacement (n = 11; valve sparing n = 6), cusp repair (n = 11), and valve resuspension (n = 21)...
December 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29216679/the-role-of-extracorporeal-membrane-oxygenator-therapy-in-the-setting-of-type-a-aortic-dissection
#16
Ibrahim Sultan, Andreas Habertheuer, Tyler Wallen, Mary Siki, Wilson Szeto, Joseph E Bavaria, Matthew Williams, Prashanth Vallabhajosyula
BACKGROUND AND AIM: Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post-cardiotomy shock. We sought to determine the utility of ECMO implementation post-TAAD repair. METHODS: The Pennsylvania Health Care Cost Containment Council (PHC4) database, maintained by an independently functioning state agency, was retrospectively reviewed from 2004 to 2014...
December 7, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29203969/cardiovascular-disease-in-ageing-an-overview-on-thoracic-aortic-aneurysm-as-an-emerging-inflammatory-disease
#17
REVIEW
Calogera Pisano, Carmela Rita Balistreri, Alessandro Ricasoli, Giovanni Ruvolo
Medial degeneration associated with thoracic aortic aneurysm and acute aortic dissection was originally described by Erdheim as a noninflammatory lesion related to the loss of smooth muscle cells and elastic fibre fragmentation in the media. Recent evidences propose the strong role of a chronic immune/inflammatory process in aneurysm evocation and progression. The coexistence of inflammatory cells with markers of apoptotic vascular cell death in the media of ascending aorta with aneurysms and type A dissections raises the possibility that activated T cells and macrophages may contribute to the elimination of smooth muscle cells and degradation of the matrix...
2017: Mediators of Inflammation
https://www.readbyqxmd.com/read/29197601/ectopic-expression-of-pcsk9-by-smooth-muscle-cells-contributes-to-aortic-dissection
#18
Yasunori Iida, Hiroki Tanaka, Hideto Sano, Yuko Suzuki, Hideyuki Shimizu, Tetsumei Urano
BACKGROUND: Acute aortic dissection (AAD) is a common disease among the elderly. Although several risk factors of AAD have been reported, the molecular mechanism underlying AAD development remains to be elucidated. Proprotein convertase subtilisin/kexin type 9 (PCSK9) increases LDL-cholesterol levels in blood by preventing its clearance. Therefore, PCSK9 inhibition is a promising therapeutic approach to treating cardiovascular diseases. The objective of this study was to elucidate the role of PCSK9 in the pathogenesis of AAD...
November 29, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29195573/complications-after-self-expanding-transcatheter-or-surgical-aortic-valve-replacement
#19
John V Conte, James Hermiller, Jon R Resar, G Michael Deeb, Thomas G Gleason, David H Adams, Jeffrey J Popma, Steven J Yakubov, Daniel Watson, Jia Guo, George L Zorn, Michael J Reardon
Procedural complications following transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are usually reported as retrospective analyses. We report the first comparison of complications following SAVR or self-expanding TAVR from a prospectively randomized study of high-risk SAVR patients. Three hundred ninety-five TAVR and 402 SAVR patients were prospectively enrolled and randomized 1:1 to TAVR with a CoreValve bioprosthesis or a surgical bioprosthetic valve. The rates of major procedural and vascular complications occurring (periprocedurally (0-3 days) and early (4-30 days)) were compared for TAVR vs SAVR patients...
2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29187218/open-stent-graft-repair-with-upper-half-sternotomy-for-blunt-thoracic-aortic-injury-a-case-report
#20
Toshinori Komatsu, Tamaki Takano, Hiromu Kehara, Megumi Fuke, Takamitsu Terasaki, Masayuki Sakaguchi
BACKGROUND: Thoracic endovascular aortic repair is now widely applied to the treatment of blunt aortic injury. However, its long-term outcomes remain unclear. Endoleakage and migration might occur in the long term, especially when younger patients undergo endovascular aortic repair. In open stent grafting, the proximal end of the open stent graft is directly sutured to the native aorta, which may reduce the risk of endoleakage and migration. We applied open stent grafting to the treatment of blunt aortic injury in the subacute phase and herein report the patient's clinical course...
November 29, 2017: Journal of Cardiothoracic Surgery
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