Superior Vena Cava Obstruction and Dissecting Aortic Aneurysm

Spitzer, Stanley

doi:10.1001/jama.1975.03260020050025

Cited by 27 publications

(2 citation statements)

References 10 publications

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“…The literature review also failed to identify the predominance of a specific aortic valve prosthesis in postsurgical cases of dissection (Table 4). 1,2,7,9,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Dissections at clamping or cannulation sites are usually observed at the time or soon after surgery. 39 Thus, we think that dissections late after AVR are usually not related to specific operative features or techniques.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…9,[12][13][14][15][16] A lethal outcome is reported in 50% of such dissections occurring within 1 month to 16 years after AVR. 1,2,7,9,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Combining AVR with prophylactic replacement of the ascending aorta is a treatment that may prevent aortic dissection; criteria for prophylactic aortic surgery at AVR, however, are established exclusively for Marfan patients. 8,12,29,32 This retrospective study was performed to assess clinical and pathoanatomical characteristics of non-Marfan patients developing type I aortic dissection late after routine AVR.…”

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confidence: 99%

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Predictors of Proximal Aortic Dissection at the Time of Aortic Valve Replacement

et al. 1999

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Background-Type I aortic dissection develops in 0.6% of patients late after aortic valve replacement (AVR), and 13% of patients with type I aortic dissections have a history of AVR. Predictors of aortic dissection at AVR, however, have not been characterized. Methods and Results-A study group of 33 patients with type I aortic dissection had aortic surgery 49Ϯ55 months after routine AVR. A group of 101 controls, who did not have morphological progression of aortic diameters Ն6 years after AVR, was used to identify predictors of postsurgical dissection. Multivariate analysis identified aortic regurgitation (PϽ0.002) and fragility (PϽ0.001) or thinning of the aortic wall (PϽ0.007) at AVR as predictors, associated with a 14%, 22%, and 7% probability of late aortic dissection, respectively. Clamping times, types of valve prostheses, concomitant coronary artery bypass grafting, and mean ascending aortic diameters of 43Ϯ10 mm at AVR did not predict late dissection. A separate analysis of 29 nondissecting aneurysms of the ascending aorta developing 104Ϯ64 months after routine AVR revealed younger age at AVR (PϽ0.003) and congenitally bicuspid aortic valves (PϽ0.03) as predictors of late aneurysm formation. Conclusions-Aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation may reflect aortic root disease, with a high risk for postsurgical aortic sequelae if it is treated incompletely by isolated valve replacement. (Circulation. 1999;100[suppl II]:II-287-II-294.

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