1
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Tsai TY, Guo XJ, Kageyama S, Lim RP, Tanaka K, De Mey J, La Meir M, Onuma Y, Poon EKW, Serruys PW. Managing Iatrogenic Aortic Dissection: Insight From 3D Holographic Imaging and CT Computational Fluid Dynamic Simulations. J Am Coll Cardiol 2024; 84:130-136. [PMID: 38754705 DOI: 10.1016/j.jacc.2024.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Iatrogenic aortic dissection is a rare but life-threatening complication of coronary artery bypass surgery. We report a case with incidentally detected iatrogenic aortic dissection related to aorta cross-clamping that was successfully managed with watchful follow-up. The decision making was based on 3-dimensional holographic and fluid dynamic analysis guidance.
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Affiliation(s)
- Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Xiao-Jing Guo
- Department of Mechanical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shigetaka Kageyama
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Ruth P Lim
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia; Department of Radiology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, University Hospital Brussels, Free University Brussels, Brussels, Belgium
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.
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2
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Pamulapati H, Taduru SS, Janga P, Kaja AK. Iatrogenic Aorto-Coronary Dissection: A Rare Complication With Fatal Prognosis. Cureus 2024; 16:e60690. [PMID: 38899246 PMCID: PMC11186605 DOI: 10.7759/cureus.60690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Iatrogenic aorto-coronary dissection (IACD) is a rare complication of interventional and surgical cardiac procedures, with a very high mortality burden. Here, we report the case of a 71-year-old female with a past medical history of paroxysmal atrial fibrillation, mild to moderate aortic insufficiency, hypertension, and hyperlipidemia, who presented with classic anginal symptoms and underwent a cardiac catheterization, during which she suffered Iatrogenic right coronary artery (RCA) dissection and ascending aortic dissection resulting in sudden death. IACD is a rare complication, with a fatal prognosis. Coronary angiography and percutaneous coronary intervention (PCI) are considered safe, with a low risk of major complications including coronary perforations, and a very low risk of Iatrogenic aortic dissection (IAD). The coronary injury occurs more commonly during PCI of chronic total occlusion (CTO) or RCA interventions and can extend to the aortic root. IAD is often fatal and has worse outcomes than spontaneous dissection.
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Affiliation(s)
- Hema Pamulapati
- Cardiovascular Disease, University of Kanas Medical Center, Kansas City, USA
- Cardiology, Hays Medical Center, Hays, USA
| | - Siva Sagar Taduru
- Cardiovascular Medicine, University of Kansas, Kansas City, USA
- Cardiology, Hays Medical Center, Hays, USA
| | - Pramod Janga
- Internal Medicine, Hays Medical Center, Hays, USA
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3
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Asami M, Dejima H, Yamauchi Y, Saito Y, Saito K, Kondo H, Sakao Y. Arterial Embolization and Cone-Beam Computed Tomography-Guided Lung Resection for Anomalous Systemic Arterial Blood Supply to Normal Lung: Two Case Reports. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 36927845 PMCID: PMC10902647 DOI: 10.5761/atcs.cr.23-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Systemic arterial blood supply to a normal lung is a rare anatomical abnormality. Surgery is usually indicated because this abnormality leads to pulmonary hypertension. Herein, we report our experience and ideas for safe vessel dissection. Case 1 was a woman in her 50s. We performed a left lower lobectomy following percutaneous coil embolization. The aberrant artery with emboli was confirmed intraoperatively by cone-beam computed tomography (CBCT) to safely dissect under thoracoscopic surgery (TS). Case 2 was a man in his 40s. Following percutaneous endovascular plug occlusion, we performed a left partial resection using indocyanine green fluorescence navigation. Intraoperatively, CBCT imaging demonstrated the aberrant artery and exact position of the emboli. This combination technique of interventional radiology and TS with CBCT imaging was considered safe and more secure for the treatment of anomalous systemic arterial blood supply to a normal lung.
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Affiliation(s)
- Momoko Asami
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hitoshi Dejima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Koji Saito
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Alattab N, Althobaiti SA, Alwehaibi NS, Mahjoub ST. Brachiocephalic Artery Dissection Following Type A Aortic Dissection Repair. Cureus 2023; 15:e51379. [PMID: 38292995 PMCID: PMC10825813 DOI: 10.7759/cureus.51379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with major morbidity and mortality. Arterial dissections, particularly the brachiocephalic artery, can remain as a residual dissection after type A aortic dissection repair. We present a rare case of brachiocephalic artery dissection due to the clamping effect and the management of ATAAD patients. A 47-year-old male known for aortic aneurysm and uncontrolled hypertension presented with high blood pressure, unequal pulses, and a history of chest pain. A thoracic and abdominal aorta angiogram showed aneurysmal dilatation of the aortic root and ascending aorta with a peripheral linear filling defect shortly distal to the aortic root. The patient underwent the Bentall procedure, hemi-arch replacement, and patent ductus arteriosus closure. The brachiocephalic artery was clamped. The angiogram showed right common carotid occlusion. Endovascular intervention was made by balloon-mounted covered stent graft and kissing technique. The patient had a smooth post-procedure period without major events. Iatrogenic brachiocephalic artery dissection can occur during type A aortic dissection repair and is frequently affected by residual dissection. The decision of intervention versus conservative management is based on a patient's general condition.
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Affiliation(s)
| | | | | | - Saleh T Mahjoub
- College of Medicine, King Saud University Medical City, Riyadh, SAU
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5
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Etuk AS, Odigwe CI, Singu S, Amoran EO, Pursley M. Incidental Finding of Thoracic Aortic Dissection in a Patient Post-Coronary Artery Bypass Graft Surgery. Cureus 2023; 15:e40443. [PMID: 37456414 PMCID: PMC10349285 DOI: 10.7759/cureus.40443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Thoracic aortic dissection (TAD) is an uncommon but potentially fatal complication of coronary artery bypass graft (CABG). Most patients present to the emergency room with severe chest pain, shortness of breath, or after a syncopal episode. Asymptomatic patients pose a challenge to diagnosis. The authors present a case of an 82-year-old male, who was found to have an incidental finding of a 5-cm ascending aortic aneurysm with an intimal dissection flap four months after CABG. Extensive workup on possible risk factors such as underlying aortic diseases, genetic conditions, and hypertensive crisis proved noncontributory. Aggressive blood pressure control was achieved, and the patient was observed in the intensive care unit before discharge with follow-up. The purpose of this case report is to alert clinicians of TAD after CABG and highlight the importance of developing a protocol for follow-up and monitoring of patients who have undergone CABG, as complications can be asymptomatic. Early and accurate diagnosis of TAD as a complication of CABG is essential to improving survival rates.
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Affiliation(s)
- Aniekeme S Etuk
- Internal Medicine, Thomas Hospital, Infirmary Health, Fairhope, USA
| | | | - Sravani Singu
- Internal Medicine, Thomas Hospital, Infirmary Health, Fairhope, USA
| | - Emmanuel O Amoran
- Cardiovascular Disease, Northeast Georgia Medical Center Gainsville, Gainsville, USA
| | - Michael Pursley
- Cardiovascular Disease, Thomas Hospital, Infirmary Health, Fairhope, USA
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Mahdi A, Akkawi AR, Mahdi M, Farhoud H. The Silent Threat: A Case of Iatrogenic Asymptomatic Aortic Dissection Post Coronary Artery Bypass Grafting. Cureus 2023; 15:e41035. [PMID: 37519582 PMCID: PMC10374978 DOI: 10.7759/cureus.41035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Asymptomatic aortic dissection (AD) is a rare but potentially life-threatening complication that can occur following coronary artery bypass graft (CABG) surgery. While CABG is a well-established surgical procedure for managing multivessel coronary artery disease, it can inadvertently predispose patients to the development of AD, especially in those with pre-existing aortic pathology. The pathophysiology underlying AD after CABG is multifactorial, with factors, such as atherosclerosis, manipulation of the aorta during surgery, and hemodynamic stress, playing significant roles. Notably, the absence of symptoms poses a diagnostic challenge, as patients may remain unaware of the underlying condition until a catastrophic event occurs. Therefore, a high index of suspicion and vigilant postoperative monitoring are crucial in identifying asymptomatic AD. Diagnostic modalities including imaging techniques, such as computed tomography angiography (CTA), magnetic resonance imaging (MRI), and echocardiography, play pivotal roles in confirming the diagnosis and determining the extent of the dissection. Prompt surgical intervention is generally recommended in symptomatic patients or those with evidence of impending complications. We hereby present a case report of a patient who presented with asymptomatic AD post CABG surgery and discuss the pathophysiology, presentation, diagnostic workup, and treatment options.
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Affiliation(s)
- Ahmad Mahdi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Abdul Rahman Akkawi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Mahmoud Mahdi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Hussam Farhoud
- Cardiology, University of Kansas School of Medicine-Wichita, Wichita, USA
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7
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Sane N, Tan S, Brown AJ. Iatrogenic Aortic Pseudoaneurysm Causing Superior Vena Cava Syndrome. Heart Lung Circ 2023; 32:e16-e18. [PMID: 36572630 DOI: 10.1016/j.hlc.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/16/2022] [Accepted: 11/20/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Nikhita Sane
- Monash Health, Melbourne, Vic, Australia. https://twitter.com/MonashHeart
| | - Sean Tan
- Monash Health, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. https://twitter.com/MonashHeart
| | - Adam J Brown
- Monash Health, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
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8
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Gerstein NS, Panikkath PV, Mirrakhimov AE, Lewis AE, Ram H. Cardiopulmonary Bypass Emergencies and Intraoperative Issues. J Cardiothorac Vasc Anesth 2022; 36:4505-4522. [PMID: 36100499 DOI: 10.1053/j.jvca.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
Cardiopulmonary bypass (CPB) is a complex biomechanical engineering undertaking and an essential component of cardiac surgery. However, similar to all complex bioengineering systems, CPB activities are prone to a variety of safety and biomechanical issues. In this narrative review article, the authors discuss the preventative and intraoperative management strategies for a number of intraoperative CPB emergencies, including cannulation complications (dissection, malposition, gas embolism), CPB equipment issues (heater-cooler failure, oxygenator issues, electrical failure, and tubing rupture), CPB circuit thrombosis, medication issues, awareness during CPB, and CPB issues during transcatheter aortic valve replacement.
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Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Pramod V Panikkath
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Alexander E Lewis
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Harish Ram
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL
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Biancari F, Pettinari M, Mariscalco G, Mustonen C, Nappi F, Buech J, Hagl C, Fiore A, Touma J, Dell’Aquila AM, Wisniewski K, Rukosujew A, Perrotti A, Hervé A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Rodriguez Lega J, Pinto AG, Mäkikallio T, Acharya M, El-Dean Z, Field M, Harky A, Gerelli S, Di Perna D, Jormalainen M, Gatti G, Mazzaro E, Juvonen T, Peterss S. Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection. J Clin Med 2022; 11:jcm11226729. [PMID: 36431205 PMCID: PMC9696328 DOI: 10.3390/jcm11226729] [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: 10/24/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p < 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.
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Affiliation(s)
- Fausto Biancari
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
- Correspondence:
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium
| | | | - Caius Mustonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80539 Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Joseph Touma
- Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
| | - Francesco Onorati
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
| | - Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Amer Harky
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | | | - Dario Di Perna
- Centre Hospitalier Annecy Genevois, 74370 Annecy, France
| | - Mikko Jormalainen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Tatu Juvonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
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10
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The Correlation and Copathogenesis of Coronary Aortic Sandwich and Renal Cysts. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5483155. [PMID: 35990829 PMCID: PMC9385302 DOI: 10.1155/2022/5483155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
Objective To determine the correlation for aortic occlusion and hydronephrosis and the pathogenesis of copathogenesis. Methods A retrospective census was established to probe the correlation with renal cysts by gathering aortic coarctation details concerning generic symptoms, diabetes, and liver and kidney profiles from 244 hospitalized aortic clinographers from April 2014 to December 2021 (study category, SG category), 150 hypertensive clients with primary hypertension attending our institution in the same period (matched category, MG category), and 150 able-bodied volunteers (control category, CG category). Results (1) Intercategory discrepancies in regard to aortic occlusion, diabetic malfunction, and kidney and liver abnormality were neither mutually nor predominantly measured (P > 0.05); (2) 244 enrolled SG for aortic occlusion and 150 CG for aortic occlusion were categorized by whether or not aortic occlusion was manifested, and the correlation between maternal age, gender, diabetic malfunction, and kidney and liver abnormality and renal cysts was estimated. The correlation of clogged aorta was demonstrated by a multifactorial logistic regression with gender and the presence of renal cysts (P < 0.05); (3) the correlation of clogged aorta was demonstrated by a multifactorial logistic regression with renal cysts as an independent risk factor for clogged aorta (95% CI: 1.028–10.291;P = 0.031). Conclusion As renal cysts are an autonomous risk of aortic coarctation, it is recommendable to strengthen clinical investigations such as monitoring of clinical blood pressures in kidney cyst recipients to assess their aortic function in order to evaluate their prognosis and minimize the prevalence of aortic coarctation.
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11
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von Aspern K, Leontyev S, Etz CD, Haunschild J, Misfeld M, Borger MA. Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective. AORTA (STAMFORD, CONN.) 2022; 10:201-209. [PMID: 36521814 PMCID: PMC9754867 DOI: 10.1055/s-0042-1756670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/06/2022] [Indexed: 06/17/2023]
Abstract
Iatrogenic aortic dissection (IAD) is a rare but devastating complication in cardiac surgery and related procedures. Due to its rarity, published data on emergency surgery following IAD are limited. Herein, we discuss IAD occurring intra- and postoperatively, including those occurring during transcatheter aortic valve replacement and cardiac catheterization, and present benchmark data from our consecutive, single-center experience. We demonstrate changes in patient characteristics, surgical approaches, and outcomes over a 23-year period.
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Affiliation(s)
- Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Sergey Leontyev
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Christian D. Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Cardiac Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia
| | - Michael A. Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
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12
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Tsutsui M, Narita M, Ushioda R, Kikuchi Y, Shirasaka T, Ishikawa N, Kamiya H. A case of TEVAR for acute aortic dissection after MICS AVR and retroperitoneal tumor resection. J Surg Case Rep 2021; 2021:rjab559. [PMID: 34987757 PMCID: PMC8702344 DOI: 10.1093/jscr/rjab559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
If multiple treatments are performed within a short time, when something occurs, it is difficult to identify its cause. Here, we present a case of thoracic endovascular aortic repair (TEVAR) for acute aortic dissection (AAD) after multiple treatments. A 76-year-old woman underwent minimally invasive aortic valve replacement, transcatheter lumbar artery embolism and retroperitoneal tumor resection within a short period of time. After a series of procedures, the patient experienced sudden back pain, and computed tomography revealed an AAD Type B. Her back pain persisted; therefore, we performed TEVAR, and the post-operative course was uneventful. In this case, the relationship between AAD and treatment before AAD was unclear, but AAD should considered when performing treatments that may cause AAD.
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Affiliation(s)
- Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Ryohei Ushioda
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuta Kikuchi
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Zhang Y, Wang JW, Jin G, Liang B, Li X, Yang YT, Zhan QL. Focal intramural hematoma as a potential pitfall for iatrogenic aortic dissection during subclavian artery stenting: A case report. World J Clin Cases 2021; 9:10033-10039. [PMID: 34877347 PMCID: PMC8610905 DOI: 10.12998/wjcc.v9.i32.10033] [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: 07/06/2021] [Revised: 08/08/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic aortic dissection (IAD) is a rare but fatal complication of interventional treatment for the proximal supra-aortic large vessels. Several cases of IAD after endovascular treatment of subclavian artery have been reported. Nevertheless, the pathogenesis of IAD is still unclear. Here we report a patient with IAD following a balloon expandable stent implanted into the left subclavian artery (LSA).
CASE SUMMARY An 84-year-old man with a history of hypertension was admitted to the Neurology Department of our hospital complaining of dizziness and gait disturbance for more than 1 mo. Computed tomography angiography of the head and neck showed severe stenosis at the proximal LSA and the origin of the left vertebral artery. Magnetic resonance diffusion-weighted imaging of the brain revealed subacute infarctions in cerebellum, occipital lobe and medulla oblongata. He suffered a Stanford type B aortic dissection after the proximal LSA angioplasty with a balloon expandable stent. Thoracic endovascular aortic repair was performed immediately with the chimney technique and he was discharged 20 d later. After exploring the pathogenesis with multimodal imaging analysis, an easily neglected focal intramural hematoma (IMH) in the aorta near the junction of the LSA was found to be the main cause of the IAD. The risk of IAD should be sufficiently evaluated according to the characteristics of aortic arch lesions before the proximal LSA angioplasty.
CONCLUSION Focal aortic IMH is a potential risk factor for IAD during a seemingly simple stenting of the proximal LSA.
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Affiliation(s)
- Yu Zhang
- Department of Interventional Radiology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Jun-Wei Wang
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Ge Jin
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Bo Liang
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Xin Li
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Yong-Tao Yang
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
| | - Qun-Ling Zhan
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
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14
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Yan W, Yamashita MH. Commentary: Adapting for our patients: Reducing intraoperative adverse events as new technologies emerge. JTCVS Tech 2020; 6:88-89. [PMID: 34318153 PMCID: PMC8300914 DOI: 10.1016/j.xjtc.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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