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Frati G, Bernardi M, Biondi-Zoccai G, Wael S, Giordano A. Is female sex impactful in the pathophysiology, presentation, management, and outlook of type A acute aortic dissection? Eur J Prev Cardiol 2023; 30:1162-1164. [PMID: 36753273 DOI: 10.1093/eurjpc/zwad043] [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: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Acute aortic dissection (AAD) is the most common acute aortic syndrome. It is a life-threatening condition and surgical emergency associated with high mortality if not treated promptly. While it is well established that cardiovascular disease recognises different pathophysiological pathways between men and women, there is limited evidence of sex differences in AAS, especially in type A AAD. According to a recent synthesis of clinical studies on gender differences in type A AAD, women were found to have different baseline characteristics, presentation and outcomes, and thus sex should be considered relevant for diagnosis, risk-stratification and management of type A AAD.
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Affiliation(s)
- Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy
- IRCCS NEUROMED, Via Atinense 18, 86077 Pozzill, Italy
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio 2, 80122 Napoli, Italy
| | - Saade Wael
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Arturo Giordano
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Via Domiziana Km 30, 81030 Castel Volturno, Italy
- Operative Unit of Hemodynamics, Santa Lucia Hospital, Via Aielli 109, 80047 S. Giuseppe Vesuviano, Italy
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2
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Pavlou A, Cardenas Ramos L, Vanek M, Regelmann DJ. A Case of Chronic Aortic Dissection With Hemopericardium and Tamponade. Cureus 2022; 14:e23924. [PMID: 35530841 PMCID: PMC9076048 DOI: 10.7759/cureus.23924] [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] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
Abstract
Type A aortic dissection involves the separation of the wall of the ascending aorta into a true lumen and a false lumen. The finding of an aortic dissection in a patient experiencing mild to moderate symptoms for several weeks may be surprising for clinicians, given the severity of the underlying process. Here, we present an 88-year-old patient who was admitted to our hospital due to orthopnea and leg swelling for the past two to three weeks and was found to have a chronic dissection of the ascending aorta, complicated by hemopericardium and tamponade. The existing literature very rarely reports chronic type A aortic dissection with tamponade on presentation.
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3
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Fatma K, Carine GC, Marine G, Philippe P, Valérie D. Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution. Med Biol Eng Comput 2022; 60:769-783. [PMID: 35076858 DOI: 10.1007/s11517-021-02480-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
Residual type B aortic dissection was numerically investigated to highlight the contribution of biomechanical parameters to the pathology's evolution. Patient-specific geometries from cases involving both favorable and unfavorable evolution were modeled to assess their hemodynamic features. This original approach was supported by a longitudinal study confirming the association between morphological changes, hemodynamic features, adverse clinical outcomes, and CT-angioscan observations on the same patient. Comparing one patient with unfavorable evolution with one with favorable one, we identify potential biomechanical indicators predictive of unfavorable evolution: (i) a patent false lumen with a flow rate above 50% of inlet flow rate; (ii) high wall shear stress above 18 Pa at entry tears, and above 10 Pa at some regions of the false lumen wall; (iii) low time-averaged wall shear stress in distal false lumen below 0.5 Pa; (iv) vortical structure dynamics. Although these comparisons could only be conducted on 2 patients and need to be confirmed by a larger number of cases, our findings point to these hemodynamic markers as possible candidates for early evaluation of the pathology's evolution towards an unfavorable scenario. Graphical Abstract Correlation between hemodynamics index and thrombus initiation for unfavorable case. ET2 and ET3 are entry tear numbers 2 and 3 respectively. WSS is wall shear stress. TAWSS is time average shear stress.
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Affiliation(s)
- Khannous Fatma
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
| | | | - Gaudry Marine
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Piquet Philippe
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Deplano Valérie
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France.
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4
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Wu J, Xie E, Qiu J, Huang Y, Jiang W, Zafar MA, Zhang L, Yu C. Subacute/chronic type A aortic dissection: a retrospective cohort study. Eur J Cardiothorac Surg 2021; 57:388-396. [PMID: 31317195 DOI: 10.1093/ejcts/ezz209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Our goal was to outline the clinical presentations, surgical treatment and outcomes of subacute/chronic type A aortic dissection (TAAD). METHODS A total of 1092 patients with TAAD were enrolled retrospectively and divided into 2 groups based on acuity of TAAD (181 subacute/chronic vs 911 acute cases of TAAD). Early and late outcomes were investigated and compared using propensity score matching. RESULTS The top 3 symptoms for subacute/chronic TAAD were chest tightness (80/181, 44.2%), mild pain (65/181, 35.9%) and sweating (58/181, 32.0). Fifteen (15/181, 8.3%) patients were symptom-free. Typical symptoms of acute TAAD were less common in patients with subacute/chronic TAAD such as intense/sharp pain (48/181, 26.5%), tear-like pain (35/181, 19.3%) and radiating pain (30/181, 16.6%). Patients with subacute/chronic TAAD had better early and late survival rates, with an early mortality rate of 6.1% (11/181) compared to 11.6% (106/911) of those with acute TAAD (P = 0.038). Before propensity score matching, survival at 1, 3 and 5 years was 93.1% [95% confidence interval (CI) 89.4-96.9%], 88.4% (95% CI 83.1-93.9%) and 86.4% (95% CI 80.1-93.1%) for subacute/chronic TAAD and 86.9% (95% CI 84.7-89.2%), 82.6% (95% CI 79.9-85.3%) and 79.0% (95% CI 75.5-82.7%) for acute TAAD, respectively (P = 0.039). The propensity score matching analysis substantiated the foregoing results. CONCLUSIONS Subacute/chronic TAAD was clearly distinct from acute TAAD in terms of clinical presentations and had better early and late survival rates. Current surgical strategies for acute TAAD are applicable to subacute/chronic TAAD with excellent outcomes.
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Affiliation(s)
- Jinlin Wu
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China.,Aortic Institute at Yale-New Haven Hospital, New Haven, CT, USA
| | - Enzehua Xie
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Juntao Qiu
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Yan Huang
- Beijing University of Chinese Medicine, Beijing, China
| | - Wenxiang Jiang
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | | | - Liang Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Beijing, China
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Keskin HA, Kurtul A, Esenboğa K, Çiçek MC, Katırcıoğlu SF. Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection. Perfusion 2020; 36:710-716. [PMID: 33070761 DOI: 10.1177/0267659120961937] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute Stanford type A aortic dissection (ATAAD) is a life-threatening medical emergency. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a novel inflammatory marker for ATAAD patients undergoing surgical repair. METHODS We retrospectively examined the medical records of 151 ATAAD patients who treated surgically. Patients were divided into two groups (survival and death) and these groups were compared with respect to clinical and laboratory parameters. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of in-hospital mortality. RESULTS The mean age of the study cohort was 61 ± 12 years, 99 (65.6%) were males, and 35 (23.2%) patients died during the hospital stay. The PNI levels were significantly lower in death group compared with survival group (32.80 ± 4.90 vs. 37.94 ± 5.42, p < 0.001). Multivariate analysis showed that the PNI (OR: 0.795, p = 0.005), age (odds ratio [OR]: 1.085, p = 0.034), operating time (OR: 1.660, p = 0.042), and D-dimer (OR: 1.002, p = 0.001) independently predicted in-hospital mortality. The calculated cutoff value of the PNI was 33.01. CONCLUSION Lower PNI values are independently associated with in-hospital mortality in ATAAD. The PNI may be a useful tool for predicting the early mortality of ATAAD patients after surgical repair.
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Affiliation(s)
- Hasan Attila Keskin
- Department of Cardiovascular Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alparslan Kurtul
- Department of Cardiology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Kerim Esenboğa
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mustafa Cüneyt Çiçek
- Department of Cardiovascular Surgery, Konya Training and Research Hospital, Konya, Turkey
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Wang Z, Zhuang X, Chen B, Feng D, Li G, Wei M. The Role of miR-107 as a Potential Biomarker and Cellular Factor for Acute Aortic Dissection. DNA Cell Biol 2020; 39:1895-1906. [PMID: 32882141 DOI: 10.1089/dna.2020.5506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Acute aortic dissection (AD) is one of the most severe and highly mortality vascular disease. Its actual prevalence may be seriously underestimated. We studied different expression genes to understand gene profile change between acute AD and nondiseased individuals, and then discover potential biomarkers and therapeutic targets of acute AD. In our study, acute AD differentially expressed mRNAs and miRNAs were identified through bioinformatics analysis on Gene Expression Omnibus data sets GSE52093, GSE98770, and GSE92427. Then, comprehensive target prediction and network analysis methods were used to evaluate protein-protein interaction networks and to identify Gene Ontology terms for differentially expressed mRNAs. Differentially expressed mRNAs-miRNAs involved in acute AD were assessed as well. Finally, the quantitative real-time PCR and in vitro experiment was used to validate the results. We found Integral Membrane Protein 2C (ITM2C) was low expressed and miR-107-5p was highly expressed in acute AD tissues. Meanwhile, overexpression miR-107-5p promoted the cell proliferation and inhibited the cell apoptosis in RASMC cells. miR-107-5p inhibited the progression of acute AD through targeted ITM2C.
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Affiliation(s)
- Zanxin Wang
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China.,Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Xianmian Zhuang
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China
| | - Bailang Chen
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China
| | - Dongjie Feng
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China
| | - Gang Li
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China
| | - Minxin Wei
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Guangdong, P.R. China.,Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
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Hsieh WC, Henry BM, Hsieh CC, Maruna P, Omara M, Lindner J. Prognostic Role of Admission C-Reactive Protein Level as a Predictor of In-Hospital Mortality in Type-A Acute Aortic Dissection: A Meta-Analysis. Vasc Endovascular Surg 2019; 53:547-557. [PMID: 31248351 DOI: 10.1177/1538574419858161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute aortic dissection (AD) is a lethal vascular disease, accounting for over 90% cases of acute aortic syndrome. Despite advances in understanding associated risk factors, the long-term prognosis for AD patients is still poor. Several prognostic biomarkers have been used for AD as per the IRAD, such as older age (>70 years), onset of chest pain and hypotension, but they are not effective in all patients. Instead, C-reactive protein (CRP) is a consistent inflammatory marker. CRP levels are abnormally increased in AD. However, the prognostic value of serum CRP level in AD remains unclear. OBJECTIVE To perform a systematic review and meta-analysis (registration no CRD42017056205) to evaluate whether CRP is a biomarker associated with in-hospital mortality in type-A AD. METHODS PubMed, Web of Science, CNKI, SciELO, and EMBASE were searched for papers published from January 2000 to October 2017 for studies on the prognostic role of CRP at admission in type-A AD patients. Outcome data were extracted and pooled hazard ratios (HRs) were calculated. RESULTS 18 (N = 2875 patients) studies met the inclusion criteria. Elevated CRP level was associated with a significantly increased risk of in-hospital mortality in patients with type-A AD (HR = 1.15, 95% CI: 1.06-1.25, p = 0.001). The pooled sensitivity of CRP in type-A AD patients was 77% (95% CI 69%-84%, p < 0.001), and the specificity was 72% (95% CI 66%-78%, p < 0.001). CONCLUSION Elevated CRP level is significantly associated with increased risks of in-hospital mortality in patients with type-A AD. CRP is a convenient prognostic factor in type-A AD patients.
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Affiliation(s)
- Wan Chin Hsieh
- 1 First Faculty of Medicine, Charles University, Prague, Czech Republic.,2 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | | | - Chong Chao Hsieh
- 4 Division of Cardiovascular Surgery, Kaohsiung Medical University School of Medicine, Chung-Ho Memorial Hospital, Kaohsiung
| | - Pavel Maruna
- 5 Institute of Pathological Physiology and the 3rd Department of Internal Medicine, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, Prague, Czech Republic
| | - Mohamed Omara
- 6 Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaroslav Lindner
- 2 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Bhardwaj R, Mahajan K, Sondhi S. Chronic painless stanford type a aortic dissection involving whole of the aorta in an elderly female. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_14_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Zhong YL, Qi RD, Ma WG, Ge YP, Qiao ZY, Li CN, Zhu JM, Sun LZ. Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection. J Thorac Dis 2018; 10:5376-5383. [PMID: 30416785 DOI: 10.21037/jtd.2018.08.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Several methods of arch vessel reconstruction, such as en bloc (island) and branched graft techniques, have been proposed to treat aortic arch pathologies during total arch replacement (TAR). We seek to review our experience with modified en bloc technique and left subclavian (LSCA)-left carotid artery (LCCA) transposition in TAR and frozen elephant trunk (FET) procedure for chronic type A aortic dissection (CTAAD). Methods From September 2010 to September 2016, 35 consecutive patients with CTAAD underwent modified en bloc arch reconstruction with LSCA-LCCA transposition during TAR and FET procedure. Computed tomographic angiography (CTA) was performed during follow-up. Results In-hospital mortality was 5.7% (2/35). No neurological deficit or spinal cord injury occurred. Re-exploration for bleeding and continuous renal replacement therapy were required in 2 patients each (5.7%). Follow-up was complete in 100% for a mean duration of 4.1±1.8 years (range, 0.5-6.7 years). One patient experienced a transient stroke and thoracoabdominal aortic replacement was performed in 1. There were 2 late non-cardiac deaths. Survival was 87.9% (95% CI, 70.7-95.3%) at 6 years. At 6 years, the incidence was 3% for reoperation, 12% for late death, and 85% of patients were alive without reoperation. The anastomosis between the LSCA and LCCA was patent in 100%. Conclusions Acceptable early and mid-term outcomes were achieved for patients with chronic type A dissection using en bloc technique with LSCA-LCCA transposition during TAR and FET procedure. This technique may be an alternative approach to chronic type A dissection in selected patients.
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Affiliation(s)
- Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Rui-Dong Qi
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Yi-Peng Ge
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Cheng-Nan Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
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Hynes CF, Greenberg MD, Sarin S, Trachiotis GD. Chronic Type A Aortic Dissection: Two Cases and a Review of Current Management Strategies. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:16-21. [PMID: 27766269 DOI: 10.12945/j.aorta.2015.15.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/20/2015] [Indexed: 01/16/2023]
Abstract
Stanford Type A aortic dissection is a rapidly progressing disease process that is often fatal without emergent surgical repair. A small proportion of Type A dissections go undiagnosed in the acute phase and are found upon delayed presentation of symptoms or incidentally. These chronic lesions may have a distinct natural history that may have a better prognosis and could potentially be managed differently then those presenting acutely. The method of repair depends on location and extent of the false lumen, as well as involvement of critical structures and branch arteries. Surgical repair techniques similar to those employed for acute dissection management are currently first-line therapy for chronic cases that involve the aortic valve, sinuses of Valsalva, coronary arteries, and supra-aortic branch arteries. In patients with high-risk for surgery, endovascular repairs have been successful, and active development of delivery systems and grafts will continue to enhance outcomes. We present two cases of chronic Type A aortic dissection and review the current literature.
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Affiliation(s)
- Conor F Hynes
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington District of Columbia, USA
| | - Michael D Greenberg
- Division of Cardiology, Veterans Affairs Medical Center, Washington District of Columbia, USA
| | - Shawn Sarin
- Department Interventional Vascular Radiology, The George Washington University, Washington District of Columbia, USA
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington District of Columbia, USA; Division of Cardiothoracic Surgery, The George Washington University, Washington District of Columbia, USA
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11
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Weymann A, Schmack B, Karck M, Szabó G. Giant pseudoaneurysm of the ascending aorta caused by chronic stanford type A aortic dissection. Can J Cardiol 2011; 27:871.e3-4. [PMID: 22118022 DOI: 10.1016/j.cjca.2011.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/28/2011] [Accepted: 08/28/2011] [Indexed: 10/15/2022] Open
Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
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