Spontaneous aortic dissection and cystic medial degeneration. Report of a sudden death case and literature review

Abstract

A 32 years old woman collapsed during work, after complaining for several minutes of intense diffuse abdominal pains. An emergency team arrived on the spot succeded in reconverting a ventricular fibrillation and rushed the patient to an Emergency unit. Upon admission the patient was in shock (pulse 110/min, blood pressure 60/40 mmHg), extremely anxious, and continued to complain of intense epigastrial pains. A plain X ray and abdominal echography were irrelevant. Although the ECG suggested an acute myocardial infarction, the enzymatic markers of acute myocardial ischemia were uncharacteristic. The patient died 2 hours after admission, with the presumed diagnostic: "Acute myocardial infarction TOPOL I, possibly with spontaneous reperfusion. Cardiac arrest on ventilatory support". The autopsy revealed an almost circumferential aortic dissection initiated at the ostia of the left coronary artery, extending down to right common iliac artery. Microscopic examination revealed a myxoid degeneration between the disrupted elastic lamellae of the aortic media. The paper reviews the incidence of aortic spontaneous dissection, the pathogeny and associated genetic anomalies of aortic media degeneration.

Cystic Medionecrosis of Pulmonary Arterial Trunk as a Probable Cause of Thrombosis of Its Branches

“…Кистозный медионекроз характеризуется свое-образной дегенерацией эластических и мышечных во-локон медиального слоя артерии с формированием очагов некроза, кист, расслоением, аневризматиче-ским расширением и спонтанным разрывом сосуди-стой стенки [1]. Локализация кистозного медионек-роза типична для аорты и крайне редка для сосудов иной (подвздошных, подключичных, коронарных, сонных) анатомической локализации [1][2][3][4][5].…”

“…Локализация кистозного медионек-роза типична для аорты и крайне редка для сосудов иной (подвздошных, подключичных, коронарных, сонных) анатомической локализации [1][2][3][4][5]. Первое клиническое описание кистозного медионекроза (1928) принадлежит швейцарскому терапевту Gsell O.…”

Postmortem Aortic Dissection: An Artifact of the Embalming Process

“…Risk factors for aortic dissection include male sex, age in the 60′s and 70′s, hypertension, prior cardiac surgery, bicuspid aortic valve, and a history of connective tissue disorder (Marfan syndrome, Ehlers‐Danlos syndrome) . Another morphologic change of the aorta that increases an individual's risk for AD (and other aortic pathology) is cystic medial degeneration (CMD) . Aside from these risk factors, there are cases of aortic dissections in the literature that are iatrogenic, following cannular placement in the subclavian artery or as a complication of aortic side clamping .…”