Surgical Management of Aortic Dissection During a 30-Year Period

Fann, James I.; Smith, Julian A.; Miller, D. Craig; Mitchell, R. Scott; Moore, Kathleen A.; Grunkemeier, Gary L.; Stinson, Edward B.; Oyer, Philip E.; Reitz, Bruce A.; Shumway, Norman E.

doi:10.1161/01.cir.92.9.113

Cited by 388 publications

(275 citation statements)

References 18 publications

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“…The states of the diseased aorta and cardiovascular system are important causes of late death. 25 The predominating signs in the dog in the present study were severe weakness, ascites, and dyspnea, caused by right-sided heart failure, and diffuse petechiation of the skin and oral mucous membranes, caused by severe thrombocytopenia.…”

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confidence: 46%

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

et al. 2007

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A 3-year-old male, castrated, miniature pinscher weighing 9 kg was presented to the University of Zurich Veterinary Teaching Hospital Cardiology Service for evaluation of lethargy, a newly recognized cardiac murmur, and labored breathing. For the previous 3 days, the dog had been progressively reluctant to move and breathing had become labored. Before the current presentation, the dog had always been in excellent health.On admission, the dog was in sternal recumbency, profoundly lethargic, and showed expiratory dyspnea. Diffuse petechiation was visible on the skin and mucous membranes. Heart and pulse rate were 160 beats per minute and irregular, pulse quality was weak, and rectal temperature was 37.1uC (98.8uF). On auscultation, no respiratory or cardiac sounds were heard on the left side and muffled sounds were heard on the right side with a continuous heart murmur, grade 3/6. The jugular veins were distended and abdominal palpation disclosed hepatomegaly and ascites.Laboratory abnormalities on presentation included severe thrombocytopenia (11,000/mL; reference range, 130,000-394,000/mL), hypoproteinemia (43 g/L, reference range: 56-71 g/L), hypoalbuminemia (22 g/L, reference range: 29-37 g/L), hyponatremia (136 mmol/ L; reference range, 152-159 mmol/L), and hyperkalemia (5.4 mmol/L; reference range, 4.3-5.3 mmol/L). A coagulation profile was normal.An ECG indicated sinus tachycardia with single ventricular premature complexes and non-sustained ventricular tachycardia with a left bundle branch block pattern. The QRS complexes during sinus tachycardia were consistent with right ventricular enlargement and the ST segments were depressed in leads I, II, and aVF and increased in lead aVR.Thoracic radiographs revealed marked pleural effusion, moderate right heart enlargement, diminished pulmonary vasculature, engorged caudal vena cava, hepatomegaly, and ascites. Analysis of abdominal and pleural fluids indicated that they were modified transudates.On 2-dimensional and M-mode transthoracic echocardiography, a the right ventricle (RVDd, 2.45 cm) and right atrium (RA, 4 cm) appeared markedly dilated with flattening of the interventricular septum. The left ventricle was hypovolemic (LVDd, 1.4 cm). In the main pulmonary artery, a membranous structure that originated laterally slightly above the pulmonary valve annulus was bulging into the lumen (Fig 1a). An echodense structure suggestive of a thrombus at the site of the pulmonary artery bifurcation completely occluded the left pulmonary artery. Color Doppler echocardiography indicated moderate tricuspid insufficiency (TI), mild pulmonic insufficiency (PI), and continuous turbulent flow from the descending aorta to the main pulmonary artery through a patent ductus arteriosus (PDA). Furthermore, the systolic outflow signal above the pulmonary valve was only a narrow turbulent jet that passed medially to the described membrane. Behind the membrane, there was no systolic flow but only diastolic blood flow in the main pulmonary artery towards the pulmonary valve (Fig 1b). Sp...

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Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

et al. 2007

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“…The true lumen was collapsed by the false lumen at the eighth thoracic vertebra (Figure 2) and was responsible for the high blood pressure and intestinal ischemia because of poor distal perfusion (malperfusion syndrome). This syndrome complicates aortic dissections in 31% or fewer patients (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Aortic dissection after open repair of an infrarenal aortic aneurysm

Lorenzo

Villegas²,

Mestre³

et al. 2009

Int J Angiol

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“…15) This condition leads to major organ malperfusion and subsequent organ failure, paralysis, or severe ischemic peripheral vascular symptoms. Hemodynamic instability represented as hypotension or shock, and often associated with pericardial tamponade is found in as many as 60% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Their mean age was 72.7 compared to 64.0 for the survivors of surgery. Fann, et al 15) report that determinants of early death related to operation were earlier operative date, hypertension, cardiac tamponade, renal dysfunction, and advanced age. Surgery in type B is less well established.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning type B patients, identification of high-risk patients and their optimal management is still controversial. 15,26) Crawford, et al 12) report that operative mortality in acute aortic dissection cases was 33% before 1986, compared to less than 5% after 1986. These results were attributed to improvements in surgical technique and surgeon experience.…”

Section: Discussionmentioning

confidence: 99%

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<b>Newly Diagnosed Acute Aortic Dissection</b>

et al. 2005

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SUMMARYThe objective of the present study was to examine cases of acute aortic dissection in order to analyze the clinical and diagnostic findings, and to summarize their treatment modalities, as well as their hospital outcomes.Between July 1998 and June 1999, we prospectively studied patients who were newly diagnosed as having acute aortic dissection at 25 hospitals in Mie prefecture. These cases were examined for their demographics, the characteristics of the clinical findings, diagnostic methods, treatment modalities according to the type of aortic dissection, and the early morbidity and mortality of the hospital outcomes.Of 66 newly diagnosed aortic dissections (43 males), 30 were type A and 36 were type B. Seventy-six percent of the cases arrived at a medical facility within 6 hours from the onset of symptoms. Frequent initial symptoms and clinical findings were pain in 95.5%, cardiac arrest and/or hypotension in 21%, pericardial effusion in 29%, pleural effusion in 25%, and neurological signs in 30%. Twenty-one patients underwent surgical repair, 36 were treated medically, and 5 underwent endovascular stenting. Overall early mortality was 12.1%, which included 2 DOA. Fifty percent of these deaths occurred within 48 hours, and 63% by 72 hours of the initial event.In spite of the relatively rare incidence of acute aortic dissection in our study, the calculated incidence was 4.0/100,000/year. The overall mortality rate was relatively low compared to the figures reported in the literature, suggesting the earliest possible diagnosis and timely intervention are critically important to attain successful outcomes. (Int Heart J 2005; 46: 1083-1098

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Surgical Management of Aortic Dissection During a 30-Year Period

Cited by 388 publications

References 18 publications

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

Aortic dissection after open repair of an infrarenal aortic aneurysm

<b>Newly Diagnosed Acute Aortic Dissection</b>

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