Ascending aorta replacement and local repair of tear site in type a aortic dissection with arch tear

Park, Kay-Hyun; Sung, Kiick; Kim, Kwhanmien; Jun, Gyuchan Thomas; Lee, Young Tak; Park, Pyo Won

doi:10.1016/s0003-4975(03)00170-x

Cited by 7 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Miller 26 earlier, and von Segesser 12 , Baumgartner 27 and Ehrlich 28 later, have been proponents of repair of entry tears in the arch with ascending aortic replacement in selected cases of type A dissection with intimal tear in the arch of aorta. Park et al 29 reported that intimal tears were not present in the ascending aorta in 20-30% patients. In this large study, 28 (27.2%) patients out of 103 had arch tears in the greater curvature of the aortic arch compared with 12 patients with tears in the lesser curvature.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta - a case review

Kaul

2011

Perfusion

View full text Add to dashboard Cite

A 56-year-old man with sudden onset chest pain, absent right lower limb pulses and ECG changes suggestive of inferior ST elevation MI underwent coronary angiogram through the right radial artery with a view to primary percutaneous coronary intervention (PCI). The left coronary angiogram demonstrated severe proximal stenotic disease in the left anterior descending and circumflex coronary arteries, but the right coronary artery could not be selectively cannulated. An ascending aortogram to visualise the right coronary artery not only failed to demonstrate it, but revealed, instead, a dissection flap in the ascending aorta, arch and descending thoracic aorta, with moderately severe aortic regurgitation. At operation, the patient was found to have an acute dissection of the ascending aorta, arch and descending aorta with an entry tear in the descending aorta below the left subclavian artery origin. Triple coronary artery bypass grafting with re-suspension of the aortic valve, supracoronary replacement of the ascending aorta and hemiarch and transaortic repair of the descending aortic tear was performed. The patient made an uncomplicated recovery, with the re-appearance of right limb pulses. A postoperative magnetic resonance (MR) scan revealed complete thrombosis of the false channel in the residual arch and a considerably shrunken false channel in the descending aorta and no aortic regurgitation. Retrograde dissection of the ascending aorta from the descending aorta has been reported infrequently in the past. We believe the scale of the problem has been underestimated because of the failure to adopt open distal anastomosis routinely in the past and, hence, failure to inspect the arch and the descending aorta routinely, particularly when the intimal tear was not identified in the ascending aorta. Retrograde dissection of the ascending aorta from an intimal tear in the descending aorta, when identified as such, has been managed, either on the principle of exclusion of the tear in the descending aorta by various elephant trunk procedures and their variants or, alternatively, on the principle of excision of the tear by extended one-stage aortic replacement, usually combined with an elephant trunk procedure. Neither of these procedures is widely adopted, owing to procedural, institutional and outcome considerations. We describe a transaortic repair of the intimal tear in the descending aorta with supracoronary interposition graft replacement of the ascending aorta and hemiarch with excellent clinical and radiological result. We also review the diagnostic and therapeutic approaches to this incompletely understood lethal disease.

show abstract

Section: Discussionmentioning

confidence: 98%

“…All patients had follow-up CT scans -9 (69%) had complete thrombosis of the false descending thoracic aortic lumen while 4 had patent lumens. Intimal tear repair was done transaortically, using only intima and media or externally using full thickness interrupted mattress sutures after dissecting out the adventitia overlying the tear 29 .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta - a case review

Kaul

2011

Perfusion

View full text Add to dashboard Cite

show abstract

“…The anastomotic position of the artificial vessel depended on the location of the intimal tears and the scope of the true and false lumen. [26,27] For patients with intimal tears located in the aortic arch, although the treatment is still controversial, we still recommend that total arch replacement can result in better long-term prognosis. [28,29] …”

Section: Discussionmentioning

confidence: 99%

Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

et al. 2016

View full text Add to dashboard Cite

The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation.MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information.

show abstract

Aortenbogenrekonstruktion, Iokal

Tipps Und Tricks

View full text Add to dashboard Cite

show abstract

Ascending aorta replacement and local repair of tear site in type a aortic dissection with arch tear

Cited by 7 publications

References 14 publications

Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta - a case review

Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta - a case review

Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

Aortenbogenrekonstruktion, Iokal

Contact Info

Product

Resources

About