1
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Wang JW, Wang XJ, Qiu X. A case of painless aortic dissection with neurological symptoms. Asian J Surg 2024; 47:2417-2418. [PMID: 38242796 DOI: 10.1016/j.asjsur.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Affiliation(s)
- Jin-Wei Wang
- Department of Imaging, Shandong Linglong Yingcheng Hospital, Zhaoyuan, Yantai, China
| | - Xiao-Juan Wang
- Department of Imaging, Shandong Linglong Yingcheng Hospital, Zhaoyuan, Yantai, China
| | - Xuan Qiu
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106.
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2
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Smedberg C, Hultgren R, Olsson C, Steuer J. Incidence, presentation and outcome of acute aortic dissection: results from a population-based study. Open Heart 2024; 11:e002595. [PMID: 38485121 PMCID: PMC10941176 DOI: 10.1136/openhrt-2023-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To describe the incidence of acute aortic dissection in a clearly defined population, to assess onset symptoms and admission biochemical marker levels and to analyse variables potentially associated to mortality. METHODS Medical records and CT angiograms of all patients hospitalised for acute aortic dissection in the Stockholm County during the 5-year period 2012-2016 were reviewed. The patients were followed until date of death or until 31 December 2020. The annual incidence was determined. Associations between clinical and biochemical variables and 30-day mortality, respectively, were analysed using multivariable logistic regression models. RESULTS A total of 344 patients were included. The mean annual incidence of acute aortic dissection was 4.1 per 100 000. Median age was 67 years (range 24-91) and 34% (n=118) were women. Type A dissection was predominant; 220 patients (64%) had type A and 124 (36%) had type B. Painless dissection was more common in type A than in type B (18% vs 15%, p=0.003). Type A dissection patients also more commonly had elevated plasma troponin T (44% vs 21%, p<0.001) and thrombocytopenia (26% vs 15%, p=0.010) than type B dissection patients on admission. Overall, 30-day mortality was 28% in type A and 11% in type B (p<0.001). Both painless dissection (OR 4.30, 95% CI 1.80 to 10.28, p=0.001) and elevated troponin T (OR 3.78, 95% CI 2.01 to 7.12, p<0.001), respectively, were associated with increased 30-day mortality in all acute aortic dissection patients. Thrombocytopenia was associated with elevated 30-day mortality only in patients with type A (OR 3.09, 95% CI 1.53 to 6.21, p=0.002). CONCLUSIONS Nearly two-thirds of acute aortic dissection patients had type A. Levels of troponin T and platelets, respectively, paired with presence or absence of typical symptoms may become useful adjuncts in risk stratification of patients with acute aortic dissection.
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Affiliation(s)
- Christian Smedberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Johnny Steuer
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
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3
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Mohsenian L, Noroozi Z, Farahmand F. A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine. Angiology 2024:33197241232619. [PMID: 38308612 DOI: 10.1177/00033197241232619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Aortic dissection, a potentially fatal event, usually presents with acute intense chest or back pain. Painless aortic dissections constitute about 10% of all cases. High blood pressure is a common finding in both painless and painful aortic dissections. During the coronavirus disease (COVID-19) pandemic, various anti-COVID vaccines have been massively used. Although these vaccines are generally safe, there is a small risk of adverse effects which are mostly mild and transient, but sometimes they could be life-threatening. We report a case of painless aortic dissection that occurred within minutes of receiving the COVID-19 inactivated vaccine. A 65-year-old woman with chronic controlled systemic hypertension developed slurred speech, decreased level of consciousness, generalized weakness, and dyspnea without chest, back, or abdominal pain a few minutes after receiving the second dose of inactivated COVID-19 vaccine; she had a systolic blood pressure of 220 mmHg and left-sided pleural effusion. Drainage of the pleural effusion revealed gross blood and a spiral chest and mediastinum CT with intravenous contrast showed a penetrating atherosclerotic ulcer in the descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was carried out, and the patient was discharged in satisfactory condition after 3 days.
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Affiliation(s)
- Leila Mohsenian
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Noroozi
- General Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faramarz Farahmand
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Yin J, Meng Y, Zhang D, Wang W, Wei Y. A painful lesson: painless aortic dissection misdiagnosed as acute stroke was treated with intravenous thrombolysis. Acta Neurol Belg 2023; 123:2009-2011. [PMID: 36029438 DOI: 10.1007/s13760-022-02075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Juntao Yin
- Department of Neurology, Xingtai Third Hospital, Gangtie Street 108#, Xingtai, 054000, China
| | - Yan Meng
- Department of Neurology, Xingtai Third Hospital, Gangtie Street 108#, Xingtai, 054000, China
| | - Daihui Zhang
- Department of CT/MR, Xingtai Third Hospital, Gangtie Street 108#, Xingtai, 054000, China
| | - Wan Wang
- Department of Neurology, Xingtai People's Hospital, Xiangdu Road 818#, Xingtai, 054000, China
| | - Yuqing Wei
- Department of Neurology, Xingtai Third Hospital, Gangtie Street 108#, Xingtai, 054000, China.
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5
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Jolobe OMP. Atypical aortic dissection as the differential diagnosis of hypertension with flash pulmonary edema. Am J Emerg Med 2023; 66:157-158. [PMID: 36641241 DOI: 10.1016/j.ajem.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Affiliation(s)
- Oscar M P Jolobe
- British Medical Association, BMA House, Tavistock Square, London, WC 1H 9JP, United Kingdom.
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6
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Yuan X, Mitsis A, Nienaber CA. Current Understanding of Aortic Dissection. Life (Basel) 2022; 12:1606. [PMID: 36295040 PMCID: PMC9605578 DOI: 10.3390/life12101606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Strovolos 2029, Cyprus
| | - Christoph A. Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
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7
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Wei L, Meng Y, Zhang G, Qin H. Endovascular Repair of the Thoracic Aorta Combined with Drug Therapy in Acute Uncomplicated Type B Aortic Dissection. DISEASE MARKERS 2022; 2022:3021599. [PMID: 36193494 PMCID: PMC9526592 DOI: 10.1155/2022/3021599] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
Objective This study was to evaluate the clinical efficacy of thoracic endovascular aortic repair (TEVAR) combined with Best Medical Therapy (BMT) in acute uncomplicated type B aortic dissection (TBAD). Methods Using the random method, 90 patients admitted to our hospital between January 2018 and January 2020 with acute uncomplicated TBAD were randomly divided into a control group and a study group, with 45 cases in each of the groups. The effectiveness of BMT combined with TEVAR treatment was compared. Results The incidence of recent adverse reactions did not differ significantly between the two groups. Compared to the control group, the 1-year survival rate and 2-year survival rate of patients in the study group were considerably higher. In order to examine the relationship between survival and time, the Kaplan-Meier curve was used. Both groups reached the median survival time after 24 months of follow-up. The expected survival time of the study group was longer than that of the control group. False lumen thrombosis or absence of thrombus was significantly more prevalent in the study group than in the control group. Conclusion For patients with acute uncomplicated TBAD, BMT combined with TEVAR can significantly improve the long-term survival rate and increase the expected survival time.
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Affiliation(s)
- Li Wei
- Department of Anesthesiology and Operation, 1st Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Meng
- Department of Peripheral Vascular Disease, 1st Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guofeng Zhang
- Department of Peripheral Vascular Disease, 1st Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Qin
- Department of Peripheral Vascular Disease, 1st Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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8
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Wang C, Wang B, Lv Z, Zhi J, Yang J, Hao Y. Painless aortic dissection presenting as pseudo ileus: A case report. Exp Ther Med 2022; 23:415. [PMID: 35601071 PMCID: PMC9117947 DOI: 10.3892/etm.2022.11342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Aortic dissection is a serious acute cardiovascular disease with rapid onset, progression and a high mortality rate. Due to the range of different branching vessels involved, the clinical symptoms are complex and diverse. The typical clinical symptom is a severe tearing pain in the chest, back or abdomen, but some patients also have atypical symptoms, which are easily missed or misdiagnosed and can be life-threatening. The present study reports a case of painless type B aortic dissection, initially diagnosed as ileus. The objective of this study is to enhance the clinical understanding of painless aortic dissection so that the disease can be quickly and accurately detected, and treated in a timely manner, thereby improving patient outcomes.
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Affiliation(s)
- Chunhua Wang
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Bo Wang
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Zanmei Lv
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Jia Zhi
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Jie Yang
- Outpatient Department, The Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of the People's Liberation Army, Beijing 100032, P.R. China
| | - Yuqing Hao
- Department of Clinical Laboratory, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
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9
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Jolobe OMP. Potential causes of diagnostic delay or misdiagnosis in aortic dissection. QJM 2022; 114:904-905. [PMID: 34009366 DOI: 10.1093/qjmed/hcab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/13/2022] Open
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10
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Sonaglioni A, Lombardo M, Rigamonti E, Nicolosi GL, Trevisan R, Zompatori M, Anzà C. An unusual case of painless type A aortic dissection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:682-685. [PMID: 33433015 DOI: 10.1002/jcu.22974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/15/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
The pathogenesis of acute aortic dissection (AAD) is not fully elucidated yet, but it was recently shown that inflammation contributes to the occurrence and development of both Stanford type A and type B AAD. We describe a rare case of a painless type A aortic dissection that occurred in an 85-year-old male, with moderate calcified aortic stenosis and a moderately dilated ascending aorta in 6-month clinical and echocardiographic follow-up. A chronic calculous cholecystitis with neutrophilic leukocytosis and severely increased C reactive protein was diagnosed in the last 3 months. In this patient, a chronic systemic inflammatory state might have contributed to generate the intimal entry tear in the aortic root. In particular, a neutrophil mobilization might have played a causative role in aortic rupture.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | | | | | - Roberta Trevisan
- Department of Radiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Maurizio Zompatori
- Department of Radiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Milan, Italy
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11
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Chuah BM, Aung TKK, Wong BSS, Yong KP. Painless Aortic Dissection Presenting with Isolated Dysphagia. Am J Med 2021; 134:e285-e286. [PMID: 33144133 DOI: 10.1016/j.amjmed.2020.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
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12
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Yin XB, Wang XK, Xu S, He CY. Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report. World J Clin Cases 2021; 9:232-235. [PMID: 33511190 PMCID: PMC7809677 DOI: 10.12998/wjcc.v9.i1.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed.
CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.
CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.
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Affiliation(s)
- Xin-Bo Yin
- Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Department of Emergency, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Kai Wang
- Department of Emergency, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Su Xu
- Melbourne Dental School, University of Melbourne, Melbourne 3000, Australia
| | - Cai-Yun He
- Faculty of Nursing, School of Medicine, Hunan Normal University, Changsha 410013, Hunan Province, China
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13
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Luo JC, Zhong J, Duan WX, Tu GW, Wang CS, Sun YX, Li J, Lai H, Luo Z. Early risk stratification of acute type A aortic dissection: development and validation of a predictive score. Cardiovasc Diagn Ther 2020; 10:1827-1838. [PMID: 33381427 PMCID: PMC7758751 DOI: 10.21037/cdt-20-730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The performance of published preoperative risk scores for acute type A aortic dissection (aTAAD) is suboptimal. So, the predictive power of these scores were externally validated in order to develop and validate a more reliable preoperative score for identification of patients at high risk of mortality. METHODS Potential preoperative risk variables of consecutively admitted patients with aTAAD were prospectively collected. Seven published risk scores were validated with our dataset. For derivation and internal validation, the original population was divided at a ratio of 7:3. Logistic regression was used to identify variables for the new score. A 50-patient retrospective dataset was used for external validation. The predictive accuracy for post-operative mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. RESULTS During the study period, 225 patients with aTAAD were admitted preoperatively. Of these, 209 underwent surgical repair and 29 died postoperatively. The AUROCs of the seven published pre-operative risk scores for post-operative mortality ranged from 0.57 to 0.77. Four variables were derived for the new score system, i.e., Acute myocardial ischemia, Lactate, Iliac arteries involved, and CreatininE (the ALICE score). The AUROCs for post-operative mortality in the derivation, internal and external validation populations were 0.85, 0.88 and 0.83, respectively. At a cutoff value of 3, the ALICE score for post-operative mortality had a sensitivity of 71% to 88% and specificity of 78% to 86%. CONCLUSIONS The ALICE score comprising four components might help bedside clinicians in early detection of the most severe aTAAD patients.
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Affiliation(s)
- Jing-Chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Zhong
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Xun Duan
- Department of Cardiovascular Surgery, Xijing Hospital (the First Affiliated Hospital), the Air Force Medical University, Xi’an, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun-Sheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong-Xin Sun
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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14
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Wang J, Yao C, Wu Y, Lai B. Asymptomatic long-segmental type A aortic dissection diagnosed by transthoracic echocardiography: A case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:574-578. [PMID: 32627206 DOI: 10.1002/jcu.22889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Aortic dissection (AD) is a life-threatening disease. Patients usually experience severe pain in the chest, back, or abdomen, but some patients report a variety of other symptoms without pain. Completely asymptomatic AD is sporadic and probably under-recognized. The present study aimed to (a) report an extremely rare case of asymptomatic long-segmental type A AD, wherein exaggeratedly low diastolic blood pressure and broad pulse pressure were the primary signs, and (b) summarize the clinical characteristics of asymptomatic AD through the literature review.
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Affiliation(s)
- Jiwei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cai Yao
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongbing Wu
- Department of Cardiac Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Lai
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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15
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Jolobe OMP. Fundamental issues in the diuretic lounge strategy. QJM 2020; 113:697. [PMID: 32353119 DOI: 10.1093/qjmed/hcaa150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O M P Jolobe
- Division of Medical, Manchester Medical Society, Simon Building Brunswick Street, Manchester M13 9PL, UK
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16
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A case of cerebral infarction caused by painless acute aortic dissection in autosomal dominant polycystic kidney disease. CEN Case Rep 2020; 9:177-181. [PMID: 31989455 DOI: 10.1007/s13730-020-00450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder, characterized by the progressive formation of renal cysts. Although ADPKD is strongly associated with cerebral and cardiovascular complications, cerebral ischemia caused by dissection of thoracic and carotid arteries has rarely been reported. We report the case of a 71-year-old Japanese woman who complained of hemiparesis. She required maintenance hemodialysis therapy with a background of ADPKD. Cerebral infarction was initially diagnosed by excluding intracranial hemorrhage and aneurysm rupture that are recognized as common complications of ADPKD and thereby anticoagulation therapy was initiated. However, the patient was suspected as having painless aortic dissection because a chest X-ray examination showed expanded upper mediastinum. Sequential vascular imagings revealed dissection of the aorta, originating from brachiocephalic trunk to the right common carotid artery with mediastinal hematoma. The patient died from progression of dissection. Herein, we described a case of the ADPKD patient that an acute aortic dissection without any pain induced the occlusion of supplying vessels to the brain, resulting in cerebral ischemic symptoms. A high level of clinical vigilance for an acute aortic dissection should be maintained in the ADPKD population with sudden onset of neurological symptoms even in the absence of pain. Furthermore, the initiation of anticoagulation treatment for cerebral ischemia which may aggravate the risk of further dissection requires careful consideration.
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17
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Ruan Y, Wang Z, Wu Z, Ren W, Ren Z, Yu A, Rahouma M. Painless retrograde type A aortic dissection followed conservative treatment of type B aortic dissection: a case report. BMC Cardiovasc Disord 2020; 20:17. [PMID: 31931757 PMCID: PMC6956508 DOI: 10.1186/s12872-020-01331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background Retrograde type A aortic dissection (RTAD) is a fatal aortic disease secondary to descending aortic dissection, and might be misdiagnosed due to its atypical symptoms lead to catastrophic outcomes. Case presentation We herein reported a case of a 40-year old Chinese non-comorbid man who received conservative treatment for acute type B aortic dissection and progressed to RTAD in a painless manner in a week. After open surgical aortic repair with stented elephant truck technique, the patient survived without obvious complication and cured with a satisfactory outcome in a half-year follow-up. Conclusion This case indicates that RTAD may present without typical symptoms, early diagnosis and open surgical procedure are imperative for treating RTAD.
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Affiliation(s)
- Yongle Ruan
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China.,Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, 10065, USA
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China.
| | - Zhiyong Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Wei Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Zongli Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Anfeng Yu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, 10065, USA
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Bhogal S, Khalid M, Murtaza G, Bhandari T, Summers J. Nearly Missed: Painless Aortic Dissection Masquerading as Infective Endocarditis. Cureus 2018; 10:e2587. [PMID: 30009101 PMCID: PMC6037334 DOI: 10.7759/cureus.2587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aortic dissection is a life-threatening emergency associated with significant mortality rate. Early diagnosis is essential to improve the survival. Although the most common presentation is severe chest pain, it can be variable leading to delay in the diagnosis especially if it is painless. Painless aortic dissection is a rare entity with sparse data available based on case reports. We present a case of a young male with an atypical presentation where the presumptive diagnosis of infective endocarditis was made based on initial presentation but was eventually diagnosed as painless aortic dissection.
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Affiliation(s)
- Sukhdeep Bhogal
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Muhammad Khalid
- Department of Internal Medicine, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Ghulam Murtaza
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Tarun Bhandari
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Jeffrey Summers
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
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