Aortic root reconstruction represents one of the most complex areas of cardiac surgery as well as one of the most dynamic-major developments in understanding of the aortic root anatomy and physiology, improvements in imaging and surgical technique allowed for development and acceptance into clinical practice of several novel procedures over last couple of decades. From first aortic root replacement reported by Bentall and De Bono in 1968 to aortic root reimplantation (David procedure) and remodeling (Yacoub operation) with multiple contemporary modifications, aortic root reconstruction now is widely used in treatment of chronic aortic aneurysmal disease and acute aortic dissections alike. Basic principles of aortic root structure and function and critical operative strategies for aortic root surgery are reviewed in this chapter.

TY - JOUR. T1 - A quarter of a century of experience with aortic valve-sparing operations. AU - David, Tirone E.. AU - Feindel, Christopher M.. AU - David, Carolyn M.. AU - Manlhiot, Cedric. PY - 2014/1/1. Y1 - 2014/1/1. N2 - Objective To examine the late outcomes of aortic valve-sparing operations to treat patients with aortic root aneurysm with and without aortic insufficiency (AI) in a cohort of patients followed up prospectively since 1988. Methods A total of 371 consecutive patients had undergone aortic valve-sparing surgery (mean age, 47 ± 15 years; 78% men) from 1988 through 2010. In addition to the aortic root aneurysm, 47% had moderate or severe AI, 35.5% had Marfan syndrome, 12.1% had type A aortic dissection, 9.2% had bicuspid aortic valve, 8.4% had mitral insufficiency, 16.1% had aortic arch aneurysm, and 10.2% had coronary artery disease. Reimplantation of the aortic valve was used in 296 patients and remodeling of the aortic root in 75. Cusp repair by plication of the free margin ...

Minimally Invasive Modified Bentall Operation in a Young Chinese Male with Severe Aortic Regurgitation Secondary to Infective Endocarditis in the Backgrou

Background: Ascending aortic aneurysms (AA) are a common, though poorly understood medical condition.. Aims: To document the histological changes in a large series of human ascending AA, and to correlate these changes with clinical variables.. Methods: 111 ascending AA were excised at surgery over a 3 year period. Each aneurysm was received as a continuous ring of tissue. Sections were taken from the anterior, posterior, greater and lesser curvature of the aorta and graded in a semi-quantitative fashion for the degree of elastin fragmentation, elastin loss, smooth muscle cell (SMC) loss, intimal changes and inflammation.. Results: Mean patient age at surgery was 58.7 (15.6) years; there were 70 men and 41 women. 12 patients had Marfan syndrome, 34 (30.6%) had a bicuspid aortic valve (BAV), while 71 (64.0%) had a tricuspid aortic valve (TAV). Inflammatory cells were present in 28 cases (25.2%) and were confined to the adventitia. No particular region of the aortic circumference was more severely ...

Understanding the pathogenesis of aortic dissection requires consideration of the inciting event that causes the intimal-medial tear and the propagation of blood within the aortic media. Although various risk factors that predispose the aorta to dissection have been described well, the precise insult that leads to laceration of the intima and media remains unclear.. Historically, the primary causative event that leads to aortic dissection has been extremely controversial. Cystic medial necrosis associated with Marfan disease and other connective tissue disorders was once believed to contribute to aortic medial degeneration, leading to aortic dissection. Larson and Edwards,42 however, demonstrated that only a few of their 161 patients with known aortic dissection exhibited medial degeneration. They found that 158 of these patients had intimal aortic tears at autopsy, which supports the theory initially proposed by Murray and Edwards43 that the intimal tear is the primary event, allowing the blood ...

Dive into the research topics of Natural History of Ascending Aortic Aneurysms in the Setting of an Unreplaced Bicuspid Aortic Valve. Together they form a unique fingerprint. ...

I just returned from my first visit with the cardio/thoracic surgeon. He gave me good news that my ascending aortic aneurysm is 3.9 and technically not at the 4.0 stage for a true aneurysm. But I will get the echo cardio gram and another CAT scan in a year to see if it is stable. He assured me that there really is only a 3% chance of it rupturing at this level. And of course as the centimeters increase so does the chances. But they still do not do surgery until 6 cm because there is a greater risk of rupture than the surgery. So I am content to just get my yearly screenings and he said there is a great chance that I will never be operated on but you have to be vigilant with your check ups. And not lift over 30 pounds, but continue to do aerobic exercise !. ...

Results Total hospital (30-day) mortality was 4% (n = 2). 2(4%) patients required reoperation due to post-operative bleeding. Echocardiography showed none or trivial AI in 38%, mild AI in 54% and moderate AI in 8%. We revealed positive correlation between residual AI and size of aortic annulus, previous AI grade, and size of aortic prosthesis (optimal result in linear aortic graft size 3-5 mm exceeding aortic annulus size). Follow-up was 60% completed. Late mortality was 2% (1 patient). Echocardiography revealed none or trivial AI in 53%, mild AI in 20%, moderate AI in 17% and severe AI in 10% (3 patients). One patient required reoperation 3 years after TD-I operation, the AV replacement with mechanical prosthesis was performed. Another two patients with severe AI are under close surveillance due to normal LV size and NYHA class 1-2. We revealed positive correlation between late AI and residual AI grade, and aortic leaflets coaptation point (optimal result in cases with location of coaptation ...

TY - JOUR. T1 - The outcome after aortic valve-sparing (David) operation in 179 patients. T2 - A single-centre experience. AU - Leontyev, Sergey. AU - Trommer, Constanze. AU - Subramanian, Sreekumar -. AU - Lehmann, Sven. AU - Dmitrieva, Yaroslava. AU - Misfeld, Martin. AU - Mohr, Friedrich W.. AU - Borger, Michael A.. PY - 2012/8. Y1 - 2012/8. N2 - Objectives: The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root aneurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. Methods: Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5% (n = 42) were females. Marfan syndrome was present in 17.3% of patients (n = 31), and acute Type A aortic dissection in 15.6% (n = 28). Clinical follow-up was 100% complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. ...

I joined this group today. I am a 73 YO female and have a lot of heart issues that worry me: CAD, Valvular Disease (aortic and mitral), ascending aortic aneurysm (3.9 CM as measured on an echo). The CAD was diagnosed 11 years ago through a calcium scan and then I began treatment with a cardio and had all the usual tests. I guess I am most concerned about having a heart attack and not know what is happening as the female experience is so different from that of males. I am also worried that I will be in a situation where immediate treatment is not available, such as on a plane or while riding a bike on a trail. I am appreciating reading the experiences of others with similar diagnosiss.. ...

عنوان کنگره : هشتمین کنگره بین المللی قلب و عروق رضوی, ایران,مشهد,1395/05/06-1395/05/08 ...

Social media support group dedicated to questions & information for aortic dissection survivors & aortic aneurysm sufferers family & friends

Social media support group dedicated to questions & information for aortic dissection survivors & aortic aneurysm sufferers family & friends

Rogers AM, Hermann LK, Booher AM, Nienaber CA, Williams DM, Kazerooni EA, Froehlich JB, OGara PT, Montgomery DG, Cooper JV, Harris KM, Hutchison S, Evangelista A, Isselbacher EM, Eagle KA, IRAD Investigators (2011) Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation 123(20):2213-2218. https://doi.org/10.1161/CIRCULATIONAHA.110.988568 CrossRefPubMedGoogle Scholar ...

Medial degeneration associated with thoracic aortic aneurysm and acute aortic dissection was originally described by Erdheim as a noninflammatory lesion related to the loss of smooth muscle cells and elastic fibre fragmentation in the media. Recent evidences propose the strong role of a chronic immune/inflammatory process in aneurysm evocation and progression. The coexistence of inflammatory cells with markers of apoptotic vascular cell death in the media of ascending aorta with aneurysms and type A dissections raises the possibility that activated T cells and macrophages may contribute to the elimination of smooth muscle cells and degradation of the matrix ...

Medial degeneration was the most frequent diagnosis in this series of aortic specimens. Medial degeneration was equally common in patients above and below 65 years of age. However, in cases with acute type A aortic dissections, high grade atherosclerosis was the leading histopathological diagnosis in patients older than 65 years. Acute type A aortic dissections seem to have different underlying pathologies in different age groups.. This series represents a one-year volume of an aortic referral center. The intention of this analysis was to correlate histopathological to morphological findings from imaging as well as to raise our intraoperative macroscopic and subjective impressions to a microscopic and objective level.. According to the risk factors a height prevalence of hypertension was observed in all of the patient groups. Especially the TAD group ≥ 65 years of age showed a relatively high rate of hypertension with no clinical diagnosis of connective tissue disease in this group. Generally, ...

This is a 45 year old male patient previously healthy presented with severe abdominal pain, admitted through the ER as a case of AF and signs of acute coronary syndrome. The widened mediation seen in the initial chest x-ray in addition to the si...

Your forearms and hands should be strengthened if you to handle the ball better. Tips For Improving Your NBA Live Mobile Skills Today NBA Live Mobile season tends to be an exciting time of year...

I WAS DIAGNOSED WITH AN ASCENDING AORTA ANEURYSM OF 4.5 cm about A YEAR AGO, I LOST 28 POUNDS AND DROPPED MY BLOOD PRESSURE TO 109/69 ON A DAILY BASIS...

130)僧帽弁置換手術後無症状にてDeBakey I型大動脈解離を呈した一例(日本循環器学会 第92回近畿地方会) （2002 ...

TY - JOUR. T1 - Outcome of medical and surgical treatment in patients with acute type B aortic dissection. AU - Hsu, Ron Bin. AU - Ho, Yi Lwun. AU - Chen, Robert J.. AU - Wang, Shoei Shen. AU - Lin, Fang Yue. AU - Chu, Shu Hsun. PY - 2005/1/1. Y1 - 2005/1/1. N2 - Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical ...

The optimal treatment for patients with type B aortic dissection remains a matter of debate. Each cardiologist or surgeon determines the surgical indications for type B aortic dissection according to his or her experience and the surgical results of the institution.. Recently, however, it was advocated that patients who had type B acute aortic dissection without complications, such as rupture or organ ischemia, be treated with hypotensive drugs during the acute phase, because the mortality rate with this treatment is reported to be equal to or slightly better than that for surgical treatment during the acute phase.4 5 12 13 14 15 16 17 Surgical treatment should be selected if the aortic diameter becomes enlarged during the chronic phase; careful observation of aortic enlargement in all patients treated during the chronic phase is very important but very difficult. Unfortunately, some patients who have successfully gone through the acute phase with medical hypotensive therapy suddenly die during ...

TY - JOUR. T1 - Acute aortic intramural hematoma. T2 - An analysis from the international registry of acute aortic dissection. AU - Harris, Kevin M.. AU - Braverman, Alan C.. AU - Eagle, Kim A.. AU - Woznicki, Elise M.. AU - Pyeritz, Reed E.. AU - Myrmel, Truls. AU - Peterson, Mark D.. AU - Voehringer, Matthias. AU - Fattori, Rossella. AU - Januzzi, James L.. AU - Gilon, Dan. AU - Montgomery, Daniel G.. AU - Nienaber, Christoph A.. AU - Trimarchi, Santi. AU - Isselbacher, Eric M.. AU - Evangelista, Arturo. PY - 2012/9/11. Y1 - 2012/9/11. N2 - Background-Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. Methods and Results-Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996-2011) were evaluated to examine differences between patients (based on the initial imaging test) with IMH or classic dissection (AD). Of 2830 patients, 178 had IMH (64 type A [42%], 90 type B ...

In this study, we provide a contemporary overview of clinical outcomes in patients with known MFS without prior aortic dissection. This represents one of the largest MFS studies to date using 3-dimensional imaging techniques. We found a type B aortic dissection rate of 9% during a median follow-up period of 6 years. Type B aortic dissections generally occurred in mildly dilated proximal descending aortas, especially in patients with prior prophylactic aortic surgery. From our data, we were able to develop a risk score to predict type B aortic dissection in patients with MFS, on the basis of history of prophylactic aortic root surgery and proximal descending aortic diameter.. The occurrence of type A aortic dissection has become a rare event in patients with known MFS in the era of aggressive prophylactic surgery. Although AoRR has improved life expectancy considerably, distal aortic disease may develop later in patients with MFS (14,15). Replacement of the aortic root or ascending aorta with a ...

In this study, we provide a contemporary overview of clinical outcomes in patients with known MFS without prior aortic dissection. This represents one of the largest MFS studies to date using 3-dimensional imaging techniques. We found a type B aortic dissection rate of 9% during a median follow-up period of 6 years. Type B aortic dissections generally occurred in mildly dilated proximal descending aortas, especially in patients with prior prophylactic aortic surgery. From our data, we were able to develop a risk score to predict type B aortic dissection in patients with MFS, on the basis of history of prophylactic aortic root surgery and proximal descending aortic diameter.. The occurrence of type A aortic dissection has become a rare event in patients with known MFS in the era of aggressive prophylactic surgery. Although AoRR has improved life expectancy considerably, distal aortic disease may develop later in patients with MFS (14,15). Replacement of the aortic root or ascending aorta with a ...

TY - JOUR. T1 - Aortic root replacement in 271 Marfan patients. T2 - A 24-year experience. AU - Gott, Vincent L.. AU - Cameron, Duke E.. AU - Alejo, Diane E.. AU - Greene, Peter S.. AU - Shake, Jay G.. AU - Caparrelli, David J.. AU - Dietz, Harry C.. N1 - Funding Information: This study was supported in part by the Dana and Albert Cubby Broccoli Center for Aortic Diseases at the Johns Hopkins Medical Institutions, by National Institutes of Health Grant RO1-AR41135, by the Howard Hughes Medical Institute, and by the Smilow Family Foundation. Copyright: Copyright 2008 Elsevier B.V., All rights reserved.. PY - 2002. Y1 - 2002. N2 - Background. The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients. Methods. Between September 1976 and August 2000, 232 Marfan patients ...

The data presented here support the conclusion that heterozygous loss-of-function mutations in LOX, specifically variants that disrupt the catalytic activity or lead to haploinsufficiency, predispose to thoracic aortic aneurysms and acute aortic dissections. Overlapping syndromic features of Marfan syndrome, such as pectus deformities and striae, were reported in family members with LOX variants, but these features were not sufficient to meet diagnostic criteria for Marfan syndrome.13 Thoracic aortic aneurysms in these individuals are either aortic root aneurysms or fusiform aneurysms, involving both the aortic root and ascending aorta. Although mutation carriers died of ascending aortic dissections, there were no reports of aortic dissections with minimal enlargement of the ascending aorta. None of the affected individuals presented with descending thoracic aortic aneurysms or dissections. Interestingly, a bicuspid aortic valve was identified in 3 of 18 individuals with LOX mutations. It is ...

In patients with Marfans syndrome, AD with rupture has long been the main cause of death, even in younger patients. Modern surgical techniques of ascending aortic repair have been essential for improving patient prognoses. Bentall procedures or aortic root reconstruction are currently electively performed with acceptable morbidity and mortality rates.. Unlike in aortic root surgery, which is well codified and may be routinely performed on patients with Marfans syndrome, management of the dissected DTA is still challenging. This is especially true in cases involving aneurysmal dilatation (1,4,14). In contrast with the excellent surgical results of elective root replacement, both early and long-term results of repeat surgery for the descending aorta remain poor (15). De Olivera et al. (16) reported on 6 surgical repairs of the DTA after previous valve-sparing operations. In this series, 3 patients died after surgical repair of the descending aorta, 1 sustained post-operative paraplegia, and 2 ...

Aortic dissection, though rare, is an often fatal event.1 A recent population-based study from Oxford showed that women have higher mortality from aortic dissection and are more likely to die before hospital assessment,2 which was also shown by the worlds largest registry of aortic dissection.3 Importantly, most individuals with aortic dissection had inadequately controlled hypertension, suggesting that modifiable risk factors may play a role in prevention.2 Moreover, women have worse outcomes following surgery for aortic dissection,3 and the surgical risk is even higher during pregnancy.4 ,5 The majority of aortic dissections in women of childbearing age occur during pregnancy and have adverse consequences for the mother and the fetus.6 Data from the Swedish National Birth Registry in women ,40 years of age have shown that pregnancy is associated with a 25-fold increased risk of aortic dissection.6 The scientific literature regarding aortic dissection and pregnancy is largely made up of case ...

TY - JOUR. T1 - Plasma levels of metalloproteinases-9 and -2 in the acute and subacute phases of type A and type B aortic dissection. AU - Sangiorgi, Giuseppe. AU - Trimarchi, Santi. AU - Mauriello, Alessandro. AU - Righini, Paolo. AU - Bossone, Eduardo. AU - Suzuki, Toru. AU - Rampoldi, Vincenzo. AU - Eagle, Kim A.. PY - 2006/5. Y1 - 2006/5. N2 - OBJECTIVES: Aortic dissection is characterized by an acute phase of medial dissection and a subacute-chronic phase of vessel wall repair. Matrix metalloproteinases (MMPs), through degradation of extracellular matrix, may play an important role in these processes. Elevation of MMPs might represent an opportunity to diagnostically characterize acute or chronic aortic processes. We examined the potential diagnostic role of MMP-9 and MMP-2 in different phases of aortic dissection. METHODS: Plasma levels of MMPs were evaluated by enzyme-linked immunosorbent assay technique in 13 patients affected by acute aortic dissection (nine type A, four type B). Ten ...

AbstractBackground:Aortic root aneurysms combined with lesions of the mitral valve requires synchronous operations. The conventional approach is to treat the two lesions through separate aortic and atrial incisions.Methods:From May 2009 to August 2012, 28 transaortic mitral valve operations were per

Introduction : Acute aortic type III dissection is one of the most catastrophic events, with in-hospital mortality ranging between 10% and 12%. The majority of patients are treated medically, but complicated dissections, which represent 15% to 20% of cases, require surgical or thoracic...

Doctors for acute aortic dissection in Singapore, find doctors near you. Book Doctors Appointment Online, View Cost for acute aortic dissection in Singapore | Practo

TY - JOUR. T1 - Replacement of infected aortic prosthetic graft with aortic homograft after heart transplantation. T2 - 13-year follow-up. AU - Macedo, Francisco Igor B. AU - Salerno, Tomas. AU - Pham, Si M.. PY - 2013/5/1. Y1 - 2013/5/1. N2 - Acute ascending aortic dissection (AAAD) is a rare complication after orthotopic heart transplantation. We report a patient with AAAD after heart transplantation in whom repair was complicated by infection of the ascending aortic prosthetic graft. This was successfully managed by re-do replacement with two cryopreserved aortic homografts. Despite extensive calcification in the wall, the homografts show no aneurysm or dilation after 10 years.. AB - Acute ascending aortic dissection (AAAD) is a rare complication after orthotopic heart transplantation. We report a patient with AAAD after heart transplantation in whom repair was complicated by infection of the ascending aortic prosthetic graft. This was successfully managed by re-do replacement with two ...

OBJECTIVES The purpose of this study is to delineate changes in aortic geometry and diameter due to dissection. BACKGROUND Aortic diameter is the major criterion for elective ascending aortic replacement for dilated ascending aortas to prevent aortic dissection. However, recommendations are made on the basis of clinical experience and observation of diameters of previously dissected aortas. METHODS Six tertiary centers on 2 continents reviewed their acute aortic dissection type A databases, which contained 1,821 patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography ,2 years before and within 12 h after aortic dissection onset. Aortic geometry before and after dissection onset were compared. RESULTS Altogether, 63 patients were included (27 spontaneous and 36 retrograde dissections, median age 68 [57; 77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was ,55 mm before aortic dissection ...

Abdominal aortic aneurysm is an aneurysmal dilatation of the abdominal aorta, usually defined as an aneurysm whose diameter increases by more than 50%. Abdominal aortic aneurysms are predominant in elderly males, with a male-to-female ratio of 10:3. Smoking significantly increases the risk of aneurysm rupture. Most abdominal aortic aneurysms are lesions below the renal artery level. Common causes include atherosclerosis, and other rare causes include cystic degeneration of the middle layer of the artery, syphilis, congenital dysplasia, trauma, infection, connective tissue disease, etc. Common risk factors for abdominal aortic aneurysm include smoking, hypertension, old age, male, etc. Most patients are asymptomatic and are often found by chance by physical examination for other reasons. A typical abdominal aortic aneurysm is an expansive mass pulsating laterally and anteroposterior. Half of the patients are accompanied by vascular murmurs. A few patients have symptoms of compression. Abdominal ...

As initial stabilization and initial resuscitation take place, a focused clinical examination should simultaneously be performed. The physician should assess for signs of shock (e.g., cold extremities, delayed capillary refill, weak, thready pulse.) and aim to determine the etiology of hypotension if present. The physician should always consider bedside ultrasonography (RUSH protocol) to facilitate diagnosis as soon as possible. Assess for pulse deficits. Pulse deficits are diminished or absent pulses caused by compression of the true lumen by the false lumen. Blood pressure difference between the left and right arm suggests aortic dissection. BP difference ,20 mmHg between the two limbs is significant. Data analysis from the International Registry of Acute Aortic Dissection (IRAD) revealed that fewer than 20% of patients with proven acute aortic dissection had reported pulse deficits. The cardiopulmonary examination should focus on signs of cardiac ischemia, aortic insufficiency, cardiac ...

7/11|br />18:50-21:10 Aortic Dissections/ Transection/ Trauma|br />Πρόεδροι: E. Brountzos,M. Khoury,F. Sigala,A. Trikas|br />18:50-19:00 Single stage hybrid repair for De Bakey type I aortic dissection|br /> . Tzilalis|br />19:00-19:10 Innominate artery dissection mimicking saccular aortic rupture|br />C. Kotoulas|br />19:10-19:20 Treatment of a type II post dissection TAAA with one renal artery originating from false lumen|br />T. Bisdas|br />19:20-19:30 Right axillary and left femoral artery perfusion for repair of posttraumatic aortic arch disruption|br />T. Karaiskos|br />19:30-19:40 Endovascular treatment of subacute type B thoracic dissection in a young patient|br />T. Kratimenos |br />19:40-19:50 Urgent endovascular repair of suprarenal aortic perforation during TAVI|br />S. Kalliafas|br />19:50-20:00 Valve sparing procedure (DAVID) in acute Type I Dissection|br />D. Iliopoulos|br />20:00-20:10 Left Carotid Cannulation for acute aortic dissection|br />V. Patris|br />20:10-20:20 Treatment

A 59-year-old man with a history of hypertension who suddenly developed back pain and apoplexy was transferred to our hospital 20 min after the clinical onset. Physical examination showed right conjugate deviation of the eyes and left paralysis, suggesting disorder of the right cerebral hemisphere. Enhance computed tomography showed an aortic dissection from the ascending aorta to bilateral iliac arteries, and the right common cranial artery was compressed by a false lumen. Acute type A aortic dissection complicated with cerebral malperfusion was diagnosed, and an emergency operation was performed 2.5h after the onset. Cardiopulmonary bypass was established with right femoral artery inflow and bicaval venous drainage. We found the dissection entry at the ascending aorta using the distal open technique, and performed hemiarch graft replacement with selective cerebral perfusion. The postoperative course was uneventful without deterioration of neurological function. Postoperative computed ...

PubMed Central Canada (PMC Canada) provides free access to a stable and permanent online digital archive of full-text, peer-reviewed health and life sciences research publications. It builds on PubMed Central (PMC), the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature and is a member of the broader PMC International (PMCI) network of e-repositories.

Objectives At the conclusion of this educational activity, participants should be able to: Define aortic dissection Describe epidemiology of acute aortic dissection State common and uncommon presentations of acute aortic dissection Appreciate that a normal chest radiograph should not be used to rule out acute aortic dissection List three factors leading to a missed diagnosis of aortic dissection List key pitfalls in the management of acute aortic dissection 3

Management of an adult patient with aortic coarctation and an associated cardiac pathology poses a great surgical challenge since there are no standard guidelines for the therapy of such complex pathology. Debate exists not only on which lesion should be corrected first, but also upon the type and timing of the procedure. Surgery can be one- or two-staged. Both of these strategies are accomplice with elevate morbidity and mortality. In the face of such an extended surgical approach, balloon dilatation seems preferable for treatment of severe aortic coarctation. We present an adult male patient with aortic coarctation combined with ascending aorta aneurysm and concomitant aortic valve regurgitation. The aortic coarctation was corrected first, using percutaneous balloon dilatation; and in a second stage the aortic regurgitation and ascending aorta aneurysm was treated by Bentall procedure. The patients postoperative period was uneventful. Three years after the operation he continues to do well.

Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18-75 years old) presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfans syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT), transthoracic echocardiography (TTE) and coronary angiography. Initial misdiagnosis occurred in fifteen patients (31%) later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and

METHODS: Between 2000 and 2011, 109 consecutive patients underwent surgical repair for acute type A aortic dissection with circulatory arrest and ASCP and MH in our institution. Mean patient age was 67±11 years old. Total arch replacement was performed in 85 patients (78%). Thirty (27%) patients had shock status preoperatively. The patients were divided into two different subsets, which is group A (circulatory arrest at less than 27.9 °C, N.=70), and group B (at more than 28 °C, N.=39 ...

A 60-year-old man with a history of indigestion and untreated hypertension presented with sudden-onset central chest pain which radiated to his back. Acute coronary syndrome was initially suspected but excluded in the emergency department before the patient was discharged. The pain subsequently abated to mild intermittent episodes and was misdiagnosed as indigestion. A week later the patient developed new shortness of breath and flu-like symptoms with a positive d-dimer test. CT angiography revealed a Stanford type B aortic dissection which was causing hypoperfusion of the right kidney, resulting in an acute kidney injury. Due to uncontrolled hypertension despite rigorous antihypertensive medication and his failing renal function, the patient underwent endovascular repair and made a good recovery postoperatively. ...

Marfan Syndrome: A Primer For Clinicians And Scientists. Peter Nicholas Robinson, Maurice Godfrey eds. Chapter 5: Duke E. Cameron and Vincent L. Gott. Surgical Management of the Marfan Patient at The Johns Hopkins Hospital. ...

Perspective: Left ventricle-right atrium (LV-RA) communication is mostly congenital and extremely rare (,1% of all congenital heart disease) finding. This was first classified by Gerbode et al. in 1958(1,2). Acquired LV-RA communications can be secondary to endocarditis, trauma, myocardial infarction (1) or valve replacement (1,3). This defect was likely a postoperative complication of the Ross procedure. Cardiac MR imaging was able to show the type and location of the defect, and to help quantify the degree of shunt across the defect (4). References:. 1. Cheema OM, Patel AA, Chang SM, Dipan JS. Gerbode Ventricular Septal Defect Diagnosed at Cardiac MR Imaging: Case Report. Radiology. 2009; 252:50-52.. 2. Ramasubbu K., Coselli J, Zoghbi WA. Unusual complication of aortic root reconstruction with sparing of the aortic valve: left ventricular outflow tract to right atrial fistula. J Am Soc Echocardiogr 2006; 19(4): 469.e5-469.e9.. 3. Wasserman SM, Fann JI, Atwood JE, Burdon TA, Fadel BM. Acquired ...

Friday, March 23, 2018 Herberman Conference Center at UPMC Cancer Pavilion, UPMC Shadyside Pittsburgh, Pa. 1 to 8 p.m.* *Times are Tentative Program Goal To provide oncology health care professionals with the knowledge and skills needed to promote evidence-based care to oncology patients and their families throughout the survivorship continuum. Who Should ...

Ascending aortic aneurysm - stl file processedHave embodi3D 3D print this model for you. This file was created with democratiz3D. Automatically create 3D printable models from CT scans. thorax, chest, .stl, 3d, model, printable, bone, sternum, manubrium, ribs, clavicle, scapula, coracoid, process...

Learn more about Aortic Root Surgery medical procedure, risk, preparation, definitions, what to expect after and results at FindaTopDoc.

Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases this is associated with a sudden onset of severe chest or back pain, often described as tearing in character. Also, vomiting, sweating, and lightheadedness may occur. Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta. Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk. The diagnosis is suspected based ...

Purpose To assess the efficacy of deep convolutional neural networks (DCNNs ) in differentiating acute aortic dissections from non-dissected aortas on thoracic CT.

The aorta is the large artery that carries blood away from the heart. Aortic aneurysms and dissections, which often have symptoms similar to a heart attack, cause more than 10,000 deaths annually in the U.S., according to the Centers for Disease Control. Certain types of dissections (Type A), if left untreated, kill 33% of patients within the first 24 hours, and 50% of patients within 48 hours, according to research by the International Registry of Acute Aortic Dissections (IRAD). The research from Shriners Hospital for Children and Oregon Health & Science University, Portland, and Baylor College of Medicine and the Texas Heart Institute in Houston, which was published online today by Circulation Research, found that high blood levels of fibrillin-1, a protein essential to the make-up of the bodys connective tissue and blood vessels, are about twice as common in people with thoracic aortic aneurysm than in people with other types of aortic aneurysms. The high fibrillin-1 levels most likely are ...

BACKGROUND: Over the past two decades elective valve-sparing aortic root replacement (V-SARR) has become more common in the treatment of patients with aortic root and ascending aortic aneurysms. Currently there are little data available to predict complications in the post-operative population. The study goal was to determine if altered flow patterns in the thoracic aorta, as measured by MRI, are associated with complications after V-SARR. METHODS: Time-resolved three-dimensional phase-contrast MRI (4D flow) was used to image 12 patients with Marfan syndrome after V-SARR. The patients were followed up for an average of 5.8years after imaging and 8.2years after surgery. Additionally 5 volunteers were imaged for comparison. Flow profiles were visualized during peak systole using streamlines. Wall shear stress estimates and normalized flow displacement were evaluated at multiple planes in the thoracic aorta. RESULTS: During the follow-up period, a single patient developed a Stanford Type B aortic ...

Methods In 11 patients with Stanford B aortic dissection, TEE and TTE were used to determine the parameters for pre-surgery diagnosis and selection of a coated stent. During surgery, TEE and TTE provided real-time and dynamic monitoring and guiding for precise implantation of the coated stent to effectively seal the tear of the aortic dissection. After surgery, clinical efficacy and potential side effects of the implantation of the coated stent were evaluated.. ...

Management of ruptured abdominal aortic aneurysms. The latest evidence on the best way to manage a ruptured aneurysm will be presented including the one-year results of the IMPROVE trial and the IPD 3 trial. In the same session, the controversy as to whether many patients with ruptured abdominal aortic aneurysms are denied intervention will be discussed. Greenhalgh comments: Perhaps doctors are becoming more concerned about operating for fear of having poor mortality figures. We need to find evidence whether indeed patients are denied intervention.. Janet Powell (Imperial College, London, UK), member of the CX Programme Organising Board, considers that a few patients are offered repair of ruptured aortic aneurysm because perhaps not all centres have an endovascular team and facilities available at all times; additionally, there are financial stringencies on healthcare systems and many of these patients may need intervention out of hours. Holden adds that many questions on this subject remain ...

A Bentall procedure is a type of surgical operation usually done in open heart surgeries that concerns the aorta, the largest artery of the heart.This can involve replacing some defective parts of the aorta, such as the valve or the upper part called the ascending aorta, with a graft.Some patients with Marfan syndrome may especially have to undergo a Bentall procedure, as the condition causes .... https://www.wisegeek.com/what-is-a-bentall-procedure.htm DA: 16 PA: 32 MOZ Rank: 48 ...

We present a successful case of catheter-directed infusion into the SMA for a patient with NOMI complicated with traumatic type B AD involving the SMA. Vasodilator infusion via arterial catheter has been reported as an effective treatment for NOMI and many reports suggested efficacy of this strategies [4-7]. In 1977, Boley et al. decreased mortality rate from about 70-80% to 40% performing catheter intra-arterial infusion of papaverine [8]. Other recent study revealed vasodilator administration from SMA achieved successful treatment in 64% patients of NOMI after open heart surgery with nonsurgical treatment [7]. The strategy and management of NOMI with type B AD involving the SMA have not yet been established, and research is limited [1]. Thus, there are two overwhelming difficulties: risk from the catheterization of the dissected aorta and the accurate and prompt evaluation of NOMI.. First, the catheterization of and arterial infusion for the dissected aorta are essential, and more safety ...

A team of investigators has developed an innovative blood test that may provide a faster, simpler way for emergency room doctors and others to diagnose and monitor potentially deadly aortic aneurysms and aortic dissections (a tear in the wall of the aorta) for which early diagnosis is critical for survival. The aorta is the large…

The 52 in 52 Review: The International Registry of Acute Aortic Dissection (IRAD) New Insights Into an Old Disease. Article Citation: Hagan PG et al. The International Registry of Acute Aortic Dissection (IRAD)New Insights Into an Old Disease. JAMA. 2000;283(7):897-903. doi:10.1001/jama.283.7.897 What We Already Know About the Topic: Aortic dissection has challenged physicians since itRead more. ...

Type B aortic dissection (AoD) is a disease connected to high blood load on the aortic wall and to a reduced aortic wall resistance. Nowadays, prognosis on type B AoD results to be particularly difficult with an high incidence of patients treated with medical therapy which manifest complication connected with dissection and which should have been treated with surgical repair immediately. This work aims to study those haemodynamical and morphological proprieties of dissected aorta, which can influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on twenty-five patients with type B AoD, whose nine presented an aneurysm evolution and sixteen presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow was less homogeneous with a consequent recirculating path. We found that entry point zone proximal to the aortic arch showed both high blood velocity ...

Objective: To report on the technical eligibility of patients previously treated for Stanford type A aorta dissection (AAD) for endovascular aortic arch repair based on contemporary anatomical criteria for an arch inner-branched stentgraft (AIBS). Methods: All patients treated for AAD from 2004-2015 at a single aortic centre were identified. Extent of repair and use of circulatory arrest were reported. Survival and reoperation were assessed using Kaplan Meier and competing risk models. Anatomic assessment was performed using 3-dimensional CT-imaging software. Primary outcome was survival ≥ 1 year and fulfilment of the AIBS anatomical criteria. Results: A total of 198 patients were included (158 Debakey I, 32 Debakey II, and 8 Intramural hematoma). Mortality was 30-days: 16.2%, 1-year: 19.2%, 10-years: 45.0%. There were 129 patients with imaging beyond 1 year (mean, 47.8 months), while 89 (69.0%) were AIBS eligible. During follow-up, 19 (14.7%) patients met the threshold criteria for aortic ...

Offering highly specialized care for aortic disease in San Diego, Scripps uses the latest in treating aortic aneurysm and aortic dissection.

Spontaneous abdominal aortic dissection (AAD) with retrograde thoracic extension is an extremely rare occurrence with a high mortality. Abdominal aortic dissection can be associated with an abdominal aortic aneurysm (AAA) and the presence of an AAD w