1
|
Nakamura K, Orii K, Hanai M, Abe T, Haida H. Management of acute pulmonary embolism after acute aortic dissection surgery. J Cardiol Cases 2020; 22:195-197. [PMID: 33014204 PMCID: PMC7520534 DOI: 10.1016/j.jccase.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Acute aortic dissection (AAD) continues to be associated with high mortality and morbidity. Pulmonary embolism is also a life-threatening disease. The treatment of these life-threatening diseases remains controversial in case complications arise. Thrombolytic therapy and intensive treatment would be needed to manage these fatal diseases. A 49-year-old man with progressive back pain was admitted to our hospital. Computed tomography (CT) scan revealed type A AAD. Emergency operation for hemiarch replacement was performed. Two weeks postoperatively, the patient’s oxygenation worsened and his d-dimer levels elevated. CT scan revealed a massive thrombus in the bilateral pulmonary arteries. Intensive anticoagulation therapy was started immediately. On postoperative day 27, the patient was weaned from mechanical ventilation, but the false lumen with thrombus was recanalized again. The patient was discharged on postoperative day 75 without resulting in major complications for aortic dissection. The diagnosis of pulmonary embolism concomitant with AAD is difficult. The treatment of pulmonary embolism after AAD is controversial. Our strategy seems to be suitable for acute pulmonary embolism that occurs during the treatment of AAD. ˂Learning objective: The diagnosis of pulmonary embolism concomitant with acute aortic dissection (AAD) is difficult. The treatment of pulmonary embolism after AAD is controversial. Investigating factor XIII levels might help in the early detection of pulmonary embolism.>
Collapse
Affiliation(s)
- Ken Nakamura
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Kouan Orii
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Makoto Hanai
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Takayuki Abe
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Hirofumi Haida
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| |
Collapse
|
2
|
Chen SK, Qiu ZH, Fang GH, Wu XJ, Chen LW. Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:331-338. [PMID: 31220275 DOI: 10.1093/icvts/ivz080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.
Collapse
Affiliation(s)
- Shuang-Kun Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhi-Huang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guan-Hua Fang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xi-Jie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
3
|
Fujimura N, Kawaguchi S, Obara H, Yoshitake A, Inoue M, Otsubo S, Kitagawa Y, Shimizu H. Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients. Circ J 2017; 81:1388-1394. [DOI: 10.1253/circj.cj-17-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital
- Department of Cardiovascular Surgery, Saiseikai Central Hospital
- Department of Surgery, Keio University School of Medicine
| | - Shinji Kawaguchi
- Department of Cadiovascular Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | - Akihiro Yoshitake
- Department of Cadiovascular Surgery, Keio University School of Medicine
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine
| | - Satoshi Otsubo
- Department of Cardiovascular Surgery, Saiseikai Central Hospital
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
| | - Hideyuki Shimizu
- Department of Cadiovascular Surgery, Keio University School of Medicine
| |
Collapse
|
4
|
Sytnik P, White CW, Nates W, Lytwyn M, Strumpher J, Arora RC, Freed DH. Type A aortic dissection complicated by an aorto-right atrial fistula. J Card Surg 2014; 30:173-8. [PMID: 25545438 DOI: 10.1111/jocs.12503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 63-year-old male underwent an ascending aortic replacement for an acute type A dissection. Nine days later a fistulous communication between the right coronary sinus and right atrium was identified and surgically repaired. We present a literature review, including the clinical presentation, diagnosis, and surgical management of this rare complication.
Collapse
Affiliation(s)
- Peter Sytnik
- Division of General Surgery, University of Manitoba, Canada
| | | | | | | | | | | | | |
Collapse
|
5
|
Kinner S, Eggebrecht H, Maderwald S, Barkhausen J, Ladd SC, Quick HH, Hunold P, Vogt FM. Dynamic MR angiography in acute aortic dissection. J Magn Reson Imaging 2014; 42:505-14. [PMID: 25430957 DOI: 10.1002/jmri.24788] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the benefit (additional flow information), image quality, and diagnostic accuracy of a dynamic magnetic resonance angiography (MRA) combining high spatial and temporal resolution for the preinterventional assessment of acute aortic dissection. METHODS Nineteen patients (12 men, 7 women; aged 32-78 years) with acute aortic dissection underwent contrast-enhanced four-dimensional (4D) MRA and 3D conventional high-resolution MRA (3D MRA) within one examination on a 1.5 Tesla MR system. Both MRA datasets for each patient were evaluated and compared for image quality and visualization of vascular details on a 5-point scale (5 = excellent image quality, 1 = nondiagnostic image quality). In addition, presence and relevance of additional hemodynamic information (flow direction and organ perfusion delay) gained by dynamic MRA were assessed. RESULTS Conventional 3D MRA provided significantly higher values for image quality of the aorta and aortic side branches compared with dynamic MRA (aorta: 4.3 versus 3.3; P = 0.006 side branches: 4.2 versus 3.3; P = 0.02). However, in 10 of the 19 patients (53%) the additionally available information on flow dynamics due to dynamic MRA (e.g., delayed perfusion of parenchymal organs) led to a change in therapy planning and realization. CONCLUSION Dynamic MRA is a technique that combines functional flow and morphological information. Thus, the combination of 3D and dynamic MRA provides all requested information for treatment planning in patients suffering from acute aortic dissection.
Collapse
Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | | | - Stefan Maderwald
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck / Germany
| | - Susanne C Ladd
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Harald H Quick
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck / Germany
| | - Florian M Vogt
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck / Germany
| |
Collapse
|
6
|
Yang WJ, Duan QJ, Cheng HF, Dong AQ. A case study of pulmonary embolism from the right atrial shunt after acute type a aortic dissection surgery. J Cardiothorac Surg 2014; 9:180. [PMID: 25403894 PMCID: PMC4236451 DOI: 10.1186/s13019-014-0180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022] Open
Abstract
This is one case report of a 46-year-old Chinese male with type A acute aortic dissection. It is an emergent surgery including Bentall procedure, interposition graft replacement of aortic arch, stented descending aorta with the modified right atrial shunt technique. In the early post operation period, the patient was complicated with pulmonary embolism. Pulmanary arteriography showed that the right main pulmonary embolism without an extrinsic compression. After the anticoagulant therapy, the patient was well recovered and discharged from hospital 1 month later. The origin of pulmonary embolism in the patient was believed to be the thrombosis in the shunt fistula. The right atrial shunt-related complications haven't been reported for more than thirty years. Pulmonary embolism could be a severe complication after the right atrial shunt in acute type A aortic dissection.
Collapse
Affiliation(s)
- Wei J Yang
- Department of cardiovascular surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No, 88 Jiefang road, Hangzhou, China.
| | | | | | | |
Collapse
|
7
|
Kaya E, Yerebakan H, Spielman D, Isik O, Yakut C. Acute type-A aortic dissection with obstruction of the right coronary artery. Heart Surg Forum 2014; 17:E196-7. [PMID: 25179971 DOI: 10.1532/hsf98.2013246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.
Collapse
Affiliation(s)
- Erhan Kaya
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
| | - Halit Yerebakan
- New York Presbyterian Hospital, Division of Cardiothoracic Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA
| | - Daniel Spielman
- New York Presbyterian Hospital, Division of Cardiothoracic Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA
| | - Omer Isik
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
| | - Cevat Yakut
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
| |
Collapse
|
8
|
|
9
|
Gionis MN, Kaimasidis G, Tavlas E, Kontopodis N, Plataki M, Kafetzakis A, Ioannou CV. Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:52-7. [PMID: 23569563 PMCID: PMC3614383 DOI: 10.12659/ajcr.883793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 01/10/2013] [Indexed: 11/16/2022]
Abstract
Background: Acute type A aortic dissection (AAAD) is a cardiovascular emergency with a high potential for death. Rapid surgical treatment is indicated to prevent fatal complications. Aggressive appropriate medical management starts at first suspicion and is essential to prevent exacerbation or rupture of the dissection. Despite improved surgical techniques, perioperative care and the development of specialized cardiovascular centers, mortality remains high. Organ ischemia is a catastrophic manifestation of aortic dissection, demanding acute surgical intervention in specialized cardiovascular centers. Case Report: We present the case of a 62-year-old man with isolated acute limb ischemia due to an acute type A aortic dissection treated in a regional general hospital, without a specialized cardiovascular service, with immediate open malperfusion repair and aggressive medical management. The patient did not undergo further surgical aortic repair, and after a 30-month follow-up he remains symptom free and in good clinical condition, suggesting that although aortic surgery remains the gold standard for treatment of acute Type A dissection, appropriate medical management and early malperfusion repair may offer an initial limb- or life-saving procedure. Conclusions: This staged approach gives clinicians more time to properly evaluate and transfer the patient to a specialized cardiovascular center, and in some cases may even offer a definite treatment.
Collapse
Affiliation(s)
- Michalis N Gionis
- Vascular Surgery Department, University of Crete Medical School, Heraklion, Greece ; Department of Thoracic Surgery, Regional General Hospital of Chania, Greece
| | | | | | | | | | | | | |
Collapse
|
10
|
Cwikiel W, Keussen I, Gustafsson R, Mokhtari A. Endovascular treatment of two pseudoaneurysms originating from the left ventricle. Cardiovasc Intervent Radiol 2013; 36:1677-1680. [PMID: 23334841 PMCID: PMC3825576 DOI: 10.1007/s00270-012-0540-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/25/2012] [Indexed: 11/30/2022]
Abstract
A 67-year-old woman resented with an acute type A aortic dissection, which was treated surgically with aortic valve replacement as a composite graft with reimplantation of the coronary arteries. At the end of surgery, a left-ventricular venting catheter was placed through the apex and closed with a buffered suture. Consecutive computed tomography (CT) examinations verified a growing apex pseudoaneurysm. Communication between the ventricle and the pseudoaneurysm was successfully closed with an Amplatz septal plug by the transfemoral route. Follow-up CT showed an additional pseudoaneurysm, which also was successfully closed using the same method.
Collapse
Affiliation(s)
- Wojciech Cwikiel
- Department of Radiology, Skane University Hospital, 22185, Lund, Sweden.
| | - Inger Keussen
- Department of Radiology, Skane University Hospital, 22185, Lund, Sweden
| | - Ronny Gustafsson
- Department of Thoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Arash Mokhtari
- Department of Thoracic Surgery, Skane University Hospital, Lund, Sweden
| |
Collapse
|
11
|
Nordon I, Hinchliffe R, Morgan R, Loftus I, Jahangiri M, Thompson M. Progress in Endovascular Management of Type A Dissection. Eur J Vasc Endovasc Surg 2012; 44:406-10. [DOI: 10.1016/j.ejvs.2012.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022]
|
12
|
CT Angiography of the Aorta and Aortic Diseases. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|