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Journal of Cardiothoracic Surgery Apr 2022Aortic dissection in pregnancy is a life-threatening event that is associated with high maternal and foetal mortality. Most cases occur during the third trimester of... (Review)
Review
BACKGROUND
Aortic dissection in pregnancy is a life-threatening event that is associated with high maternal and foetal mortality. Most cases occur during the third trimester of pregnancy, Herein, we describe a case of a pregnant woman with acute type A aortic dissection at 28 weeks of gestation.
CASE PRESENTATION
A previously healthy, 24-year-old gravida 2 para 1 woman was brought to the emergency department during at the 28 weeks of gestation and diagnosed with acute type A aortic dissection. Cesarean section was performed with the cardiac surgical team on standby for cardiopulmonary bypass and the patient delivered a baby weighing 1000 g. After the operation, we performed the Beatall procedure and total arch replacement with FET using the deep hypothermic circulatory arrest technique. Both the mother and child survived and recovered well. A review of the literature on antepartum acute aortic dissection during pregnancy is also presented.
CONCLUSION
Women should have a comprehensive, systematic physical examination before getting pregnant. Women at high risks of aortic dissection must undergo multidisciplinary evaluation and be counseled before pregnancy, once they become pregnant, their consistent aortic root diameter should be consistently monitored, and their blood pressure strictly controlled.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Cardiac Surgical Procedures; Cesarean Section; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Third; Young Adult
PubMed: 35414028
DOI: 10.1186/s13019-022-01817-7 -
The Journal of Thoracic and... Oct 2021
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans; Judgment
PubMed: 32417051
DOI: 10.1016/j.jtcvs.2020.03.024 -
Vascular and Endovascular Surgery Aug 2022New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection...
INTRODUCTION
New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection repair. Nevertheless, initial successful treatment of an aortic dissection does not fully eliminate the risk of later adverse aortic events like anastomotic pseudoaneurysm. Pseudoaneurysm of the anastomosis between the ascending and the arch graft could initiate complications like peripheral embolization, dysphagia or compression of mediastinum organs. Re-operation via re-sternotomy bears enormous morbidity and mortality for these patients. There is a high unmet need for percutaneous therapeutic options to treat pseudoaneurysms.
CASE PRESENTATION
A 59-year-old-man treated 15 years ago for type A aortic dissection, was hospitalized due to intermittent abdominal pain. A detailed examination revealed 2 pseudoaneurysms: 1 symptomatic at the level of the reimplanted celiac trunk and 1 asymptomatic at the anastomosis between the brachiocephalic trunk and the aortic arch graft. Due to multiple co-morbidities and previous operations, the risk for surgery was considered too high. Both pseudoaneurysm were treated percutaneously, the symptomatic 1 with covered stent and the asymptomatic with Amplatzer™ septal-occluder.
DISCUSSION
We present an alternative percutaneous therapy approach for treatment of pseudoaneurysm using a septal-occluder. A follow-up computed tomography 3 months later showed successfully excluded pseudoaneurysm.
Topics: Aortic Dissection; Aneurysm, False; Humans; Middle Aged; Septal Occluder Device; Stents; Treatment Outcome
PubMed: 35466833
DOI: 10.1177/15385744221095922 -
Journal of Vascular Surgery Apr 2015Spontaneous celiac artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation...
OBJECTIVE
Spontaneous celiac artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation and management of this condition.
METHODS
During the last 8 years, 19 patients (14 men, five women) presented with the diagnosis of spontaneous celiac artery dissection. Each patient's clinical course was retrospectively reviewed, and patients were contacted for assessment of current symptoms.
RESULTS
All patients had computed tomography scans documenting a celiac artery dissection without concomitant aortic dissection. Ages ranged from 39 to 76 years. Seven patients presented with abdominal pain, and 12 were diagnosed incidentally. All patients were initially treated with observation because none had threatened end organs. Patients presenting with aspirin or clopidogrel therapy were continued on these medications, but no patients were prescribed any medications due to their dissection. Three patients continued to have abdominal pain and eventually underwent celiac artery stenting. Pain improved after the intervention in all three. One patient with aneurysmal degeneration of the celiac artery underwent surgical repair. No other patients required intervention. Eighteen patients had follow-up within a year of data collection in the clinic or over the phone. The average time from the initial diagnosis to follow-up for the entire cohort was 46 months. None had abdominal or back pain related to the celiac dissection, had lost weight, or had to change their eating habits.
CONCLUSIONS
Celiac artery dissection can be safely managed initially with observation. If abdominal pain is persistent, endovascular stenting may stabilize or improve the pain, and surgical reconstruction can be done for aneurysmal degeneration or occlusion, both unusual events. Long-term anticoagulation does not appear necessary in these patients.
Topics: Abdominal Pain; Adult; Aged; Aortic Dissection; Anticoagulants; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Celiac Artery; Endovascular Procedures; Female; Humans; Incidental Findings; Male; Michigan; Middle Aged; Platelet Aggregation Inhibitors; Retrospective Studies; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Watchful Waiting
PubMed: 25601505
DOI: 10.1016/j.jvs.2014.10.108 -
Clinical Cardiology Sep 2006Acute aortic dissection in childhood and adolescence is a rare but life-threatening condition with many known risk factors, most of which are heritable. The importance... (Review)
Review
Acute aortic dissection in childhood and adolescence is a rare but life-threatening condition with many known risk factors, most of which are heritable. The importance of determining the presence of any predisposing disorders is stressed, since all close relatives can then be screened for any such inherited trait that would make them at risk for a similar catastrophic event. Even with no obvious predisposing disorder, it may still be prudent to evaluate close kin for the presence of aortic root dilatation, since some genetic disorders have no manifestation other than acute aortic dissection secondary to aortic medial pathology. Close monitoring for at-risk family members, including the index patient, may need to be a life-long process.
Topics: Acute Disease; Adolescent; Aortic Dissection; Aortic Aneurysm; Child; Genetic Testing; Humans; Medical History Taking; Risk Factors
PubMed: 17007168
DOI: 10.1002/clc.4960290903 -
The Journal of Thoracic and... Feb 2015Type B dissection accounts for 25% to 40% of all aortic dissections. The current brief review presents an update on this disease, focusing on new data and insights that... (Review)
Review
OBJECTIVES
Type B dissection accounts for 25% to 40% of all aortic dissections. The current brief review presents an update on this disease, focusing on new data and insights that have come to light in the past 2 years since the topic was last reviewed at the 2012 AATS Aortic Symposium.
METHODS
A literature search using PubMed (www.ncbi.nih.gov/pubmed) was performed with the search terms "acute type B aortic dissection" and "ADSORB trial," and all English-language articles published in print or available online between 2011 and March 2014 were carefully reviewed. Articles were selected for inclusion on the basis of perceived novel important insights into the pathophysiology and management of acute type B dissection. Data from the ADSORB (Acute Dissection: Stent graft OR Best medical therapy) trial were graciously provided by the ADSORB investigators prior to trial publication.
RESULTS
Important new findings regarding acute type B aortic dissection include data on differences between blacks and whites with acute aortic dissection, proposed changes to the current classification system, anatomic predictors of late outcomes, long-term results with thoracic endovascular aortic repair, as well as additional insights into the uncommon but potentially deadly complication of retrograde type A dissection after endovascular repair. Further, early results from the ADSORB trial suggest a benefit for thoracic endovascular repair plus best medical therapy over medical therapy alone for aortic remodeling outcomes 1 year post dissection.
CONCLUSIONS
A great deal of important information on acute type B aortic dissection has become available in the past 2 years since the 2012 AATS Aortic Symposium, some of which is summarized in this brief review. Further, it is clear that much additional investigation is needed so we in the aortic disease management community may continue to gain "new insights into an old disease."
Topics: Acute Disease; Aortic Dissection; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25306065
DOI: 10.1016/j.jtcvs.2014.08.083 -
European Journal of Vascular and... Oct 2018
Topics: Aortic Dissection; Aortic Diseases; Endovascular Procedures; Humans; Reoperation; Vascular Surgical Procedures
PubMed: 30064714
DOI: 10.1016/j.ejvs.2018.07.006 -
Kardiologia Polska 2021
Topics: Aortic Dissection; Aortic Valve; Aortic Valve Insufficiency; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Retrospective Studies; Treatment Outcome
PubMed: 33885271
DOI: 10.33963/KP.15957 -
Brazilian Journal of Cardiovascular... Oct 2021Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery. (Review)
Review
INTRODUCTION
Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery.
METHODS
The purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion.
RESULTS
We found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that the incidence of IAAD could increase in the future; we think that using all the precaution - such a strict monitoring of perfusion pressure throughout the intervention, avoiding extremely high jet pressures using vasodilators, repositioning of arterial cannula, or splitting perfusion in both femoral arteries -, this complication can be extremely reduced. Finally, we describe a very singular case occurring during mitral valve replacement followed by spontaneous dissection of left anterior descending artery one month later.
CONCLUSION
The present article adds to the literature a more detailed clinical picture of this entity, including patients' characteristics, the mechanism, timing, and localization of the tear, and mortality details.
Topics: Aortic Dissection; Cardiac Surgical Procedures; Humans; Iatrogenic Disease; Minimally Invasive Surgical Procedures; Mitral Valve
PubMed: 34787991
DOI: 10.21470/1678-9741-2020-0561 -
Canadian Family Physician Medecin de... Feb 2015
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Male
PubMed: 25676643
DOI: No ID Found