Stanford type A aortic dissection in a hypertensive patient with atherosclerosis of aorta and aortitis

Rare Causes of Arterial Hypertension and Thoracic Aortic Aneurysms-A Case-Based Review

Thoracic aortic aneurysms may result in dissection with fatal consequences if undetected. A young male patient with no relevant familial history, after having been investigated for hypertension, was diagnosed with an ascending aortic aneurysm involving the aortic root and the proximal tubular segment, associated with a septal atrial defect. The patient underwent a Bentall surgery protocol without complications. Clinical examination revealed dorso-lumbar scoliosis and no other signs of underlying connective tissue disease. Microscopic examination revealed strikingly severe medial degeneration of the aorta, with areas of deep disorganization of the medial musculo-elastic structural units and mucoid material deposition. Genetic testing found a variant of unknown significance the PRKG1 gene encoding the protein kinase cGMP-dependent 1, which is important in blood pressure regulation. There may be genetic links between high blood pressure and thoracic aortic aneurysm determinants. Hypertension was found in FBN1 gene mutations encoding fibrillin and in PRKG1 mutations. Possible mechanisms involving the renin-angiotensin system, the role of oxidative stress, osteopontin, epigenetic modifications and other genes are reviewed. Close follow-up and strict hypertension control are required to reduce the risk of dissection. Hypertension, scoliosis and other extra-aortic signs suggesting a connective tissue disease are possible clues for diagnosis.

Particularities of cardiovascular rehabilitation after coronary artery bypass graft: a case report

Objectives. This paper assesses the importance and contribution of cardiovascular rehabilitation programs in the short- and long-term outcome following surgical revascularization procedures for patients with coronary artery disease (CAD). Methods. We present the case of a 64-year-old patient who benefited from a coronary artery bypass graft (CABG) procedure for CAD, followed by an individualized cardiac rehabilitation program. The case particularity consisted of the presence of associated peripheral vascular disease that imposed additional challenge in decision-making process regarding surgical therapy. Results and discussion. Immediately after surgery, the patient was included in a phase II residential recovery program, preceded by a ramp effort test. The rehabilitation program consisted of partial toning massage of the lumbosacral spine, and individual physiotherapy. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. In our case even preoperative assessment showed a limited physical effort capacity, further reduced by the surgical intervention. The physiotherapy plan should be personalized, safe, effective, and must increase the independent mobility of patient soon after open heart surgery. Conclusions. The main contribution of cardiac rehabilitation program should be the improvement of physical and social status of patients undergoing surgical myocardial revascularization. This program should be included in the management of all cardiac heart disease patients who benefit from cardiac surgery procedures. Implementation of CR programs at most hospitals and community centres, as well as awareness about their efficacy, would result in higher participation after coronary revascularization interventions and improvement of functional parameters and quality of life.

Stanford type A aortic dissection secondary to infectious aortitis: a case report

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Aortic Dissection Caused by Giant Cell Arteritis

Aortic dissection is a very serious condition mainly caused by degenerative diseases of the connective tissue and hypertension. Ascending aortic dissection as a consequence of aortitis in association with giant cell arteritis is very rarely seen. In this article we report on the successful surgical repair of a Stanford type A aortic dissection caused by giant cell arteritis in a 74-year-old patient. We could visualize this dissection via echocardiography and computed tomography. Histopathology confirmed this rare complication of giant cell aortitis.