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1.
Medicine (Baltimore) ; 99(3): e18796, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011481

RESUMO

RATIONALE: Type A aortic dissection (TAAD) is a life-threatening disorder yet it is hard to diagnose. The dissection might extend to the coronary artery causing ST-segment elevation myocardial infarction (STEMI). Physicians might not recognize this particularly early in its presentation and patients proceed to receive the primary percutaneous coronary intervention. We present such a case and found that the marked pressure difference between the radial and ascending aortae could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. PATIENT CONCERNS: A 58-year-old male was presented to our emergency department for the complaint of left side chest pain that lasted for an hour with concomitant hypotension. STEMI was diagnosed at that time. DIAGNOSIS: The emergent primary percutaneous intervention was performed. When the diagnostic catheter was advanced to the ascending aorta, the systolic aorta pressure became 20 mm Hg higher than radial systolic pressure. Due to the abnormally large pressure differential between the peripheral radial artery and central ascending aorta, TAAD was suspected. INTERVENTIONS: After angiography and computer tomography confirmed the diagnosis of TAAD, the patient was sent for emergent surgery. OUTCOMES: The patient was died because of extensive dissection and shock. LESSONS: We present such a case and found that the marked pressure difference between the radial and ascending aortae during catheterization could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. This clue had hinted our speedy examination of the occluded coronary artery and dissection flap, and led to an early and accurate diagnosis.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Pressão Sanguínea , Cateteres , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
2.
Int Heart J ; 61(1): 169-173, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956146

RESUMO

We report the case of a 33-year-old woman with no history of coronary risk factors or chest pain who experienced intermittent chest pain at rest for several minutes from 2 PM. At 8 AM the next day, chest pain recurred and persisted for about 1 hour. She was transported to our hospital by ambulance, where electrocardiogram showed ST-elevation in the precordial leads, and blood tests showed elevation of cardiac markers. She was diagnosed with ST-elevation myocardial infarction. Because she was a young woman without any risk factors, coronary spastic angina was suspected. Coronary angiography without intracoronary nitrate administration revealed diffuse 75% stenosis in the proximal right coronary artery (RCA) and diffuse 90% stenosis in the left anterior descending artery (LAD). A coronary spasm provocation test elicited chest pain; coronary angiography showed 99% diffuse stenosis of LAD; and electrocardiogram showed precordial ST-segment elevation. Although intracoronary nitroglycerin injection attenuated the coronary spasm in the RCA and proximal LAD, 90% stenosis and coronary dissection were observed in the midportion of the LAD. When the imaging test that was carried out before the provocation test was reexamined, the dissection was recognized, and there was no clear dissection progress after the test. Intravascular ultrasound showed dissection of the LAD, as did angiography. We treated the patient using medical therapy instead of percutaneous coronary intervention.The patient did not suffer any anginal attack and improved sufficiently to be discharged. She remained free of attacks for about 10 years to the present time, and follow-up is continuing.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Angina Pectoris/diagnóstico por imagem , Vasoespasmo Coronário/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Adulto , Aneurisma Dissecante/complicações , Angina Pectoris/complicações , Dor no Peito/etiologia , Angiografia Coronária , Vasoespasmo Coronário/complicações , Gerenciamento Clínico , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
3.
Life Sci ; 241: 117144, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31830482

RESUMO

BACKGROUND: As an inflammation-related cytokine, interleukin (IL)-5 has been reported to be involved in the development of cardiovascular diseases, such as chronic heart failure and atherosclerosis. However, the role of IL-5 in acute aortic dissection (AAD) has barely been explored. METHODS: Aortic tissue samples from normal donors and patients with AAD were collected, and the expression and localization of IL-5 in aortic tissue were analyzed. In addition, a mouse AAD model was established by administering angiotensin II (Ang II) to ß-aminopropionitrile (BAPN)-treated mice. Morphological examinations and histopathologic analyses were performed to evaluate the effects of IL-5 overexpression on the occurrence of AAD. RESULTS: IL-5 expression was significantly decreased in aorta samples from AAD patients compared to those from donors, and macrophages were the main source of IL-5. In addition, IL-5 expression was decreased in plasma and aortic tissue samples from AAD mice. IL-5 overexpression markedly attenuated the occurrence of AAD in mice and produced corresponding decreases in the inflammatory response and cell apoptosis. In cocultures of macrophages and smooth muscle cells (SMCs), IL-5 overexpression in the macrophages significantly reduced Ang II-induced SMC apoptosis. CONCLUSION: IL-5 overexpression suppresses the development of AAD by reducing inflammation and SMC apoptosis. These results suggest that IL-5 is a potential therapeutic target in AAD.


Assuntos
Aneurisma Dissecante/prevenção & controle , Apoptose , Modelos Animais de Doenças , Inflamação/prevenção & controle , Interleucina-5/metabolismo , Macrófagos/patologia , Miócitos de Músculo Liso/patologia , Aminopropionitrilo/toxicidade , Aneurisma Dissecante/induzido quimicamente , Aneurisma Dissecante/complicações , Aneurisma Dissecante/metabolismo , Angiotensina II/toxicidade , Animais , Aorta/metabolismo , Aorta/patologia , Estudos de Casos e Controles , Feminino , Humanos , Inflamação/etiologia , Inflamação/metabolismo , Inflamação/patologia , Interleucina-5/genética , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Miócitos de Músculo Liso/metabolismo , Prognóstico
4.
Int Heart J ; 60(6): 1373-1380, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666449

RESUMO

It has been shown in previous studies that Chinese patients with acute aortic dissection (AD) were approximately 10 years younger than patients from western countries. However, there is a lack of studies concerning the age-related differences in clinical characteristics and outcomes in Chinese patients with acute AD. A total of 1,061 patients with AD (570 type A and 491 type B AD) were enrolled between 2006 and 2008. The clinical characteristics were compared between the patients in our study and those in the International Registry of Acute Aortic Dissection (IRAD). Compared with patients in the IRAD, those in our study were relatively younger, comprised more males, and had a higher proportion of Marfan syndrome but received fewer surgical interventions. When stratified by 10-year age, younger patients were more likely to have type A AD, familial AD, and Marfan syndrome, whereas older patients tended to comprise more females and type B AD. As age increased, the proportion of surgical intervention gradually decreased regardless of the type of AD. During a median follow-up of 2.2 years, 147 patients died, of whom 94 (63.9%) had type A AD and 53 (36.1%) had type B AD. Long-term mortality increased with increasing age, especially in patients above 70 years old. Furthermore, the recurrence rate of AD was higher in both the young and the older patients. In conclusion, compared with western patients with AD, Chinese patients have distinct characteristics and more attention should be paid to the young and older patients because of their high long-term mortality and recurrence rate.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/terapia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/terapia , Grupo com Ancestrais do Continente Asiático , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , China , Feminino , Humanos , Masculino , Síndrome de Marfan/epidemiologia , Pessoa de Meia-Idade , Recidiva , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
J Cardiothorac Surg ; 14(1): 201, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771609

RESUMO

BACKGROUND: An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. CASE PRESENTATION: We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. CONCLUSION: Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Artéria Subclávia/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico , Angiografia por Tomografia Computadorizada , Humanos , Imagem Tridimensional , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/cirurgia
6.
J Cardiothorac Surg ; 14(1): 206, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775824

RESUMO

BACKGROUND: Acute type A aortic dissection complicated by malperfusion is a life - threatening emergency. The optimal management strategy for malperfusion remains controversial. CASE PRESENTATION: A 46-year-old man presented to another institution with acute type A aortic dissection with abdominal aorta occlusion. Motor and sensory grade of both lower extremities were zero. Immediate antegrade distal perfusion of both lower extremities was achieved, and total arch replacement with left axillo-bifemoral bypass was performed. At the time of discharge, motor and sensory grades of both lower extremities were 2 and 3, respectively. CONCLUSION: This case demonstrates many of the techniques in the management of acute type A aortic dissection with abdominal aorta occlusion. In this case, direct antegrade perfusion of both lower extremities and axillo-bifemoral bypass may be helpful for patients presenting with severe malperfusion of both lower extremities with acute type A aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Abdominal/cirurgia , Aneurisma Aórtico/cirurgia , Arteriopatias Oclusivas/etiologia , Derivação Axilofemoral , Extremidade Inferior/irrigação sanguínea , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Arteriopatias Oclusivas/cirurgia , Ponte Cardiopulmonar , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Pak Med Assoc ; 69(9): 1376-1379, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511729

RESUMO

Acute aortic dissection is a frequently fatal condition that rarely involves young individuals. It has an estimated worldwide prevalence of 0.5-2.95 per 100,000 persons per year, with a mean incidence at around age 60. Of all the aortic dissections, less than 10% involve patients younger than 40 years of age. We present the case of a forty-yearold male who presented in the emergency department with non-specific complaints of nausea and lightheadedness. The patient being hemodynamically and clinically stable was discharged after supportive treatment. However after 5 hours the patient presented again in the emergency department with a neck pain, hypotension and sweating. CT angiography revealed a massive aortic dissection involving ascending, arch and descending aorta up to the bifurcation of iliac arteries. The patient was immediately taken for surgery for the replacement of ascending aorta and resuspension of aortic valve. The patient tolerated surgery well and was discharged after being clinically and haemodynamically stable.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Vertigem/diagnóstico , Adulto , Aneurisma Dissecante/complicações , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Erros de Diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Humanos , Hipotensão/etiologia , Imagem Tridimensional , Masculino , Náusea/etiologia , Near Miss , Cervicalgia/etiologia
10.
J Radiol Case Rep ; 13(7): 21-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31558964

RESUMO

A previously well 81-year-old Chinese male presented with hoarseness and low back pain for one month. Chest radiography at presentation revealed widening of the mediastinal silhouette. Nasopharyngoscopy detected left vocal cord paralysis. CT aortogram revealed a large saccular aortic arch aneurysm with a dissection flap extending distally down to the aortic bifurcation. The combination of clinical and imaging findings was consistent with cardiovocal syndrome. In view of good premorbid function, surgical repair was offered, and the patient underwent surgical repair and recovered well with no further back pain. A review of cases of cardiovocal syndrome suggest that prognosis of recurrent laryngeal nerve paralysis is dependent on the degree and duration of compression, and usually persists despite treatment of the underlying aneurysm.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dor nas Costas/etiologia , Rouquidão/etiologia , Idoso de 80 Anos ou mais , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Síndrome , Tomografia Computadorizada por Raios X/métodos , Paralisia das Pregas Vocais/etiologia
11.
Am J Case Rep ; 20: 1235-1240, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31431606

RESUMO

BACKGROUND Dissections occur when the intima is injured and an intramural hematoma develops between the intima and the media. There are a multitude of factors which contribute to arterial aneurysms and dissections, that could be infectious, genetic, traumatic, or environmental, but there are still cases for which the etiology is not determined. CASE REPORT We describe a patient who presented with arterial aneurysms and dissections that involved multiple vessels over the course of 10 years. We also reviewed the literature on possible risk factors, triggers, and genetic disorders that may predispose patients to developing arterial aneurysms and dissections. CONCLUSIONS To the best of our knowledge, this is the first report of this unusual pattern of presentation for idiopathic vasculopathy causing multiple dissections and aneurysms in a young patient. Idiopathic vasculopathy resulting in aneurysm and dissection is not an entirely uncommon entity; most cases of disparate dissection are not linked with a causal mechanism, although genetic influence is often heavily suspected, but it unfortunately often cannot be proven. We reviewed the available literature for a better understanding of pathologic, radiologic, and cytogenetic investigations of arteriopathy of unknown cause.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma/complicações , Doenças das Artérias Carótidas/complicações , Aneurisma Ilíaco/complicações , Artéria Mesentérica Superior/diagnóstico por imagem , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma Dissecante/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino
12.
J Invasive Cardiol ; 31(7): E233, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31257223

RESUMO

Coronary angiography in a 44-year-old woman shows chronic dissection of the left sinus of Valsalva, totally obscuring the LMCA, with good collaterals supplying the left coronary system from the right coronary artery.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Aórtico/complicações , Oclusão Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Seio Aórtico , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/diagnóstico , Doença Crônica , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Oclusão Coronária/diagnóstico , Feminino , Humanos
13.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289149

RESUMO

Acute aortic dissection presenting neurological symptoms is rare and entails significant diagnostic challenges. We present a case of 45-year-old woman with a medical history of essential hypertension and smoking, admitted with lobar pneumonia. During her inpatient treatment, she developed severe back pain and numbness below the level of the umbilicus. Due to her presenting symptoms considered differential diagnoses were paravertebral abscess and acute stroke. CT scan of the head did not reveal any ischaemic changes. Further investigation with MRI (with and without contrast) raised concerns for possible aortic dissection. CT angiography of thorax, abdomen and pelvis displayed extensive aortic dissection extending from aortic root to left iliac artery limiting flow to right carotid artery causing stenosis. The patient was diagnosed with Stanford type A aortic dissection. The patient was referred to the cardiothoracic surgery team for surgical repair. The patient made a good recovery after a prolonged course of hospitalisation, followed by cardiac rehabilitation and physical therapy.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Paraplegia/etiologia , Doença Aguda , Aneurisma Dissecante/classificação , Aneurisma Dissecante/patologia , Aorta/diagnóstico por imagem , Aorta/patologia , Artérias Carótidas/patologia , Angiografia por Tomografia Computadorizada/métodos , Constrição Patológica , Diagnóstico Diferencial , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Resultado do Tratamento
14.
Cir Cir ; 87(4): 466-469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264980

RESUMO

Background: Anterior spinal artery syndrome, usually resulting in flaccid paraplegia, is a rare but disastrous complication that can occur after surgery of aortic aneurysms and aortic dissections. Spinal cord infarct as the initial clinical presentation of aortic dissection is a very rare finding. Case report: A 42-year-old male patient who comes to the emergency department due to severe chest pain associated with presyncope and paraplegia of the lower limbs in the context of type A aortic dissection. Conclusions: Recognizing this atypical clinical presentation of aortic dissection and knowing how to approach it is critical for an early diagnosis and to minimize the risk of spinal cord ischemia during surgery.


Assuntos
Aneurisma Dissecante/complicações , Síndrome da Artéria Espinal Anterior/etiologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Torácica/complicações , Paraplegia/etiologia , Adulto , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dor no Peito/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Medicine (Baltimore) ; 98(28): e16442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305471

RESUMO

RATIONALE: Visceral arterial pseudoaneurysms are rare but important vascular entities because of their inclination to cause life-threatening hemorrhage. They were commonly reported to be associated with trauma, infection, inflammatory disease, or occurred as postoperative complication. To date, there has been no published report of a superior mesenteric artery (SMA) branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection. PATIENT CONCERNS: The patient's medical history, clinical information, imaging findings including follow-up computed tomography angiography (CTA), and treatment are reported. A 51-year-old male presenting with epigastric pain and fever was found to have an enlarged pancreatic head and obscure fatty space around it on abdominal nonenhanced CT. He has medical history of anaphylactoid purpura and uncontrolled hypertension. His serum lipase and amylase were both within normal limits. Thoracoabdominal CTA following a sudden blood pressure drop attributed to the accurate diagnosis. DIAGNOSES: He was diagnosed with acute type B aortic dissection involving SMA and retroperitoneal hemorrhage secondary to SMA branch pseudoaneurysm rupture. INTERVENTIONS: The patient was successfully treated by thoracic endovascular aortic repair without additional branch intervention. OUTCOMES: Follow-up CTA at 3 months later demonstrated that the endoprothesis is well positioned with no endoleaks, and SMA branch pseudoaneurysm disappeared. LESSONS: We report a rare and complicated case presenting with SMA branch pseudoaneurysm rupture and acute type B aortic dissection. CTA is vital in the diagnosis of such vessel pathology. We must inspect carefully to ensure that no small lesions are missed.


Assuntos
Aneurisma Dissecante/diagnóstico , Falso Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Aórtico/diagnóstico , Artéria Mesentérica Superior , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Falso Aneurisma/complicações , Falso Aneurisma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Pancreatite/diagnóstico
16.
Interact Cardiovasc Thorac Surg ; 29(3): 331-338, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220275

RESUMO

In the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5-19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49-3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88-1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79-1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0-0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18-2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.


Assuntos
Aneurisma Dissecante/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Aneurisma Dissecante/complicações , Insuficiência da Valva Aórtica/etiologia , Humanos , Medidas de Resultados Relatados pelo Paciente , Reoperação
17.
Tex Heart Inst J ; 46(2): 130-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236079

RESUMO

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Perfusão/métodos , Traumatismo por Reperfusão/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/diagnóstico , Isquemia/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Ann Vasc Surg ; 60: 474.e11-474.e13, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200044

RESUMO

The authors report a case of a 69-year-old man with a 5-year history of medically treated type B aortic dissection, who presented a new retrograde type A aortic dissection (RTAD) of the aortic arch and the ascending aorta. Clinical presentation was suggestive of pulmonary embolism. Computed tomographic angiography revealed a contained rupture of the dissected aortic arch, confined to the connective tissue plane between the arch and the pulmonary arteries. Extrinsic compression of both pulmonary arteries caused right heart failure. The patient was successfully operated with replacement of the dissected aortic arch, decompressing the pulmonary arteries. The combination of a secondary new RTAD after a chronic type B aortic dissection and a compression of the pulmonary arteries by a contained rupture of the dissected aortic arch have not been reported previously in literature.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma da Aorta Torácica/complicações , Ruptura Aórtica/complicações , Artéria Pulmonar , Estenose de Artéria Pulmonar/etiologia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Doença Crônica , Descompressão Cirúrgica , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/diagnóstico por imagem , Resultado do Tratamento
20.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164384

RESUMO

A 61-year-old woman with no prior medical illness presented with acute onset stroke symptoms. She had no chest pain at the time of presentation. However, CT angiogram showed an extensive aortic dissection, resulting in hypoperfusion of the right cerebral hemisphere and thus causing stroke symptoms. Due to this finding, tissue plasminogen activator was not given and a negative outcome was avoided.


Assuntos
Aneurisma Dissecante/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Administração Intravenosa , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêutico
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