Pre and postoperative computer tomography findings of a patient with a type a aortic dissection extending (original) (raw)
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An uncommon presentation of acute type A aortic dissection
Journal of Cardiovascular Medicine, 2012
Introduction: Although aortic dissection is not common but its outcome is frequently fatal, and many patients with aortic dissection die before getting to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar myocardial ischemia, and physical findings in the physical examination of aortic dissection may be absent. Case presentation: A 59 years old male referred to our hospital with right shoulder pain from 3 days before for evaluation of acute coronary syndrome. He had a history of Coronary artery bypass grafting 3 years before and hypertension from 20 years before. On presentation to our hospital he had stable vital signs. In electrocardiography he had T inversion in leads I, avL and v4-v6 which were new changes with respect to his previous electrocardiography. On physical examination he had an early to mid-diastolic murmur in the right sternal border. On transthoracic echocardiography suspicious flap of dissection was seen in the ascending aorta and CT angiography was done for the patient which confirmed the diagnosis. Discussion: In the case presented a catastrophic condition with high mortality has been presented to our hospital with an unusual symptom of the disease and further evaluation with regards to our physical examination has led us to find the diagnosis and have prompt treatment for the patient. Conclusion: It is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with predisposing factors.
BMC Cardiovascular Disorders
Background Type A aortic dissection is a very dangerous, fatal, and emergency condition for surgery. Acute aortic dissection is a rare condition, such that many patients will not survive without reconstructive surgery. Case presentation We present a case 24-year-old male who came with symptoms of shortness of breath and cough. The patient underwent ECG, chest radiology, and ultrasound, where the patient was found to have right pleural effusion while his ECG was normal. In the history taken from the patient, he had no underlying disease, no history of heart diseases in his family. For a better diagnosis, ETT and aortic CT angiography was performed on the patient which confirmed the evidence of dissection. Immediately after the diagnosis, necessary arrangements were made for open heart surgery and the patient was prepared for surgery. The patient was admitted in the cardiac surgery ICU for 5 days and his medication was carefully administered. After the conditions were stabilized, the ...
European Journal of Radiology, 2001
Objecti6e: In a time when diagnostic methods and above all, surgical as well as interventional radiological treatment for aortic aneurysms and aortic dissections have reached a point nobody could think of a few years back, the present authors feel that it is worth while to remind oneself of the natural course of disease in these conditions. Taking into consideration the high morbidity and mortality rate in surgically treated patients with aortic dissection, and the high complication rate per-and postoperatively, it also seems right to ask if a more expectative and conservative approach to the condition sometimes perhaps may be justified. Methods and material: Two case reports are given. One was a 15-year-old boy with Stanford (Daily) type B dissection who statistically ought to have a good prognosis, but who died within 2 h after onset of symptoms. The other patient, a middle-aged woman with Stanford type A dissection, survived for 25 years without operation. Conclusion: These two cases, though not unique viewed separately, we consider to represent the extremes of the condition and also a natural course of disease, while none of them was operated on.
Cureus
Type A aortic dissection (AD) is a devastating cardiovascular emergency requiring emergent surgical intervention. Most patients with AD have several risk factors for the disease including longstanding hypertension, smoking history, atherosclerosis, and old age. Younger patients may also present with AD if a genetic disorder affecting the integrity of the aorta is present. This case presents an otherwise healthy 36year-old male with no known significant family history who presented with an atypical presentation of aortic dissection. He described a five-day history of chest pressure made worse with exertion followed by progressive dyspnea which prompted him to seek medical attention. His initial laboratory workup revealed an elevated troponin I level which prompted a cardiology consultation in the emergency department. Transthoracic echocardiography revealed dilatation of the aortic root and aortic regurgitation. CT angiography of the chest was performed revealing a type A dissection beginning at the aortic root and terminating proximal to the right brachiocephalic artery. Involvement of the coronary arteries was suspected due to the elevated troponin I. He was taken to the operating room and underwent aortic grafting, right coronary artery bypass, and repair of the left main artery. Unfortunately, at the end of the operation, the patient went into refractory ventricular fibrillation, which progressed to asystole. He was unable to be revived.
Surgical results in acute type A aortic dissection
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2005
Currently international registry data present the patient mortality with acute type A aortic dissection managed non-surgically to be 58%, and managed surgically to be 26%. Many articles consistently report the hospital mortality exceeding 20% in western countries. Many factors, such as cardiac tamponade and dissection-related organ malperfusion, contribute to hospital mortality and morbidity. In Japan, the number of patients enrolled in the annual reports has been increasing and the surgical results have been improving year by year. In-hospital mortality has decreased to less than 20% since 1999. Since the beginning of our aortic program, a total of 98 patients underwent emergency operations, and the operative mortality and in-hospital mortality were 5.1% and 6.1%, respectively. In a recent series since 2001, the operative and in-hospital mortalities were remarkably low; 2.8% and 3.2% respectively. We were able to benefit greatly by various innovative technologies which include open...
The many faces of aortic dissections: beware of unusual presentations
Clinical Imaging, 2008
Aortic dissection is gaining recognition in Western societies, and it is being diagnosed with increasing frequency. New diagnostic imaging modalities, longer life expectancy, as well as the increase in the number patients suffering from hypertension have all contributed to the growing awareness of aortic dissection. Nevertheless, as many as 30% of patients ultimately diagnosed with acute dissection are first thought to be suffering from something else. The increased availability and use of multidetector computed tomography has led to the incidental discovery of aortic dissection in very different settings. This article focuses on unusual presentations of painless aortic dissection. It is important for radiologists to remember that aortic dissections may present in different ways, not only as an acute, critical fatality but also with subtle, unusual signs and symptoms, which apparently do not seem to be strictly related to aortic diseases.
Spontaneous healing of life-threatening iatrogenic type A aortic dissection
International Journal of Cardiology, 2014
To the editor Acute Stanford type A aortic dissection is a life threatening disease associated with a 1 to 4% hourly death rate if left untreated . Although relatively rare, aortic dissection may be caused by left cardiac catheterization. Usually such iatrogenic dissection of the ascending aorta occurs as a consequence of retrograde extension of coronary artery dissection. Here is reported the favourable outcome with medical management of a patient with catheter-induced acute aortic dissection originating from the abdominal aorta and extending to the right coronary artery.
Acute type A aortic dissection - a case beyond the guidelines
Srpski arhiv za celokupno lekarstvo, 2020
Introduction. There are not many cases among acute type-A aortic dissection survivors who get to be called ?incredible.? Here we present such a case followed-up for more than five years. Case outline. A 48-year-old male with acute type A aortic dissection, complicated with cardiac tamponade and severe aortic valve regurgitation, was submitted to emergent surgical treatment. Distal reconstruction was performed by complete aortic arch replacement with ?elephant trunk? extension and separate arch branch bypasses, while the proximal reconstruction was done with Bentall procedure. Total of 11 anastomoses was necessary to complete this procedure. Straight profound hypothermic (18o C) circulatory arrest, with a saturation of the venous blood from the jugular bulb of 97%, lasted 133 minutes. The patient was discharged stable without any neuro-cognitive deficit. Two years later, he was admitted with late prosthetic valve endocarditis and subvalvular abscess. Good response on treatment with e...