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Furui M, Uesugi N, Matsumura H, Hayashida Y, Kuwahara G, Fujii M, Shimizu M, Morita Y, Ito C, Hayama M, Wada H. Relationship between false lumen morphology and entry tear in acute type A aortic dissection. Eur J Cardiothorac Surg 2024; 65:ezad389. [PMID: 37988138 DOI: 10.1093/ejcts/ezad389] [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: 08/13/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between false lumen morphology and the size, aortic segment and position of the entry tear for acute type A aortic dissection. METHODS The records of patients who underwent emergency operation for acute type A aortic dissection in our institution between April 2011 and May 2022 were examined. Data regarding size, location and position of the entry tear and preoperative computed tomography findings were reviewed. The relationship of these variables with false lumen morphology was examined and retrospectively compared according to tear size. RESULTS Of 243 cases, characteristics of the entry tear, visualized during surgery, were confirmed in 134 cases (age = 70.9 ± 12.6 years, male = 45.5%). Tear sizes at different aortic segments were not significantly different (P = 0.376). Tears posterior to the lesser curvature were significantly smaller than those anterior to the greater curvature (P = 0.004). A thrombosed false lumen was associated with a significantly smaller tear size and position on the posterior to the lesser curvature side in aortic cross-section (all P < 0.001). Multivariate analysis showed that tear size, the presence of re-entry and tear position anterior to the greater curvature were independent predictors of a patent false lumen. CONCLUSIONS In acute type A aortic dissection, larger tear size, the presence of re-entry and tear position anterior to the greater curvature are risk factors for a patent false lumen. Although the results of this study are valid only for patients in whom intimal tears were detected during aortic surgery, this trend may provide information for pathophysiology of the disease.
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Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Noriko Uesugi
- Pathology Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Hitoshi Matsumura
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshio Hayashida
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Go Kuwahara
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Mitsuru Fujii
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Masayuki Shimizu
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuichi Morita
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Chihaya Ito
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Masato Hayama
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Hideichi Wada
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
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Valente T, Sica G, Romano F, Rea G, Lieto R, De Feo M, Della Corte A, Guarino S, Massimo C, Scaglione M, Muto E, Bocchini G. Non-A Non-B Acute Aortic Dissection: Is There Some Confusion in the Radiologist's Mind? Tomography 2023; 9:2247-2260. [PMID: 38133078 PMCID: PMC10746994 DOI: 10.3390/tomography9060174] [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] [Received: 08/01/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The aim of this study is to define and determine the rate of acute non-A-non-B aortic dissections, and to evaluate CT angiography findings and possible complications, as well as to discuss management strategies and currently available therapy. Non-A non-B type of aortic dissection is still a grey area in the radiologist's mind, such that it is not entirely clear what should be reported and completed in terms of this disease. METHODS A retrospective single-center study including 36 pre-treatment CT angiograms of consecutive patients (mean age: 61 years) between January 2012 and December 2022 with aortic dissection involving the aortic arch with/without the thoracic descending/abdominal aorta (type non-A non-B). RESULTS According to the dissection anatomy, we identified three modalities of spontaneous acute non-A-non-B anatomical configurations. Configuration 1 (n = 25) with descending-entry tear and retrograde arch extension (DTA entry). Configuration 2 (n = 4) with Arch entry tear and isolated arch involvement (Arch alone). Configuration 3 (n = 7) with Arch entry and anterograde descending (±abdominal) aorta involvement (Arch entry). CT angiogram findings, management, and treatment options are described. CONCLUSIONS Acute non-A non-B dissection represents an infrequent occurrence of aortic arch dissection (with or without involvement of the descending aorta) that does not extend to the ascending aorta. The complete understanding of its natural progression, distinct CT angiography subtypes, optimal management, and treatment strategies remains incomplete. Within our series, patients frequently exhibit a complex clinical course, often necessitating a more assertive approach to treatment compared to type B dissections.
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Affiliation(s)
- Tullio Valente
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Giacomo Sica
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Federica Romano
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Gaetano Rea
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Roberta Lieto
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Marisa De Feo
- Department of Translational Medical Sciences, Vanvitelli University, Monaldi Hospital, 80131 Naples, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, Vanvitelli University, Monaldi Hospital, 80131 Naples, Italy
| | - Salvatore Guarino
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Candida Massimo
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassary, 07100 Sassari, Italy;
| | - Emanuele Muto
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Giorgio Bocchini
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
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Orii M, Sone M, Fujiwara J, Sasaki T, Chiba T, Kin H, Morino Y, Tanaka R, Yoshioka K. A Comparison of Retrospective ECG-Gated CT and Surgical or Angiographical Findings in Acute Aortic Syndrome. Int Heart J 2023; 64:839-846. [PMID: 37704411 DOI: 10.1536/ihj.23-002] [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] [Indexed: 09/15/2023]
Abstract
The best cardiac phases in retrospective ECG-gated CT for detecting an intimal tear (IT) in aortic dissection (AD) and an ulcer-like projection (ULP) in an intramural hematoma (IMH) have not been established. This study aimed to compare the detection accuracy of diastolic-phase and systolic-phase ECG-gated CT for IT in AD and ULP in IMH, with subsequent surgical or angiographical confirmation as the reference standard.In total, 81 patients (67.6 ± 11.8 years; 41 men) who underwent emergency ECG-gated CT and subsequent open surgery or thoracic endovascular aortic repair for AD (n = 52) or IMH (n = 29) were included. The accuracies of detecting IT and ULP were compared among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of retrospective ECG-gated CT; surgical or angiographical findings were used as the reference standard. The detection accuracy for IT and ULP using only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of ECG-gated CT was 93% [95% CI: 87-97], 94% [95% CI: 88-97], and 95% [95% CI: 90-97], respectively. There were no significant differences in detection accuracy among the 3 acquisition methods (P = 0.55). Similarly, there were no significant differences in the accuracy of detecting IT in AD (P = 0.55) and ULP in IMH (P > 0.99) among only diastolic-phase, only systolic-phase, and both diastolic- and systolic-phase ECG-gated CT.Retrospective ECG-gated CT for detecting IT in AD and ULP in IMH yields highly accurate findings. There were no significant differences seen among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase ECG-gated CT.
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Affiliation(s)
- Makoto Orii
- Department of Radiology, Iwate Medical University
| | - Misato Sone
- Department of Radiology, Iwate Medical University
| | - Jumpei Fujiwara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tadashi Sasaki
- Center for Radiological Science, Iwate Medical University
| | - Takuya Chiba
- Center for Radiological Science, Iwate Medical University
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Ryoichi Tanaka
- Division of Dental Radiology, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
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Kim DH. Toward an Easily Obtainable Novel Biomarker for Type A Dissection? JACC. ASIA 2022; 2:777-779. [PMID: 36444324 PMCID: PMC9699999 DOI: 10.1016/j.jacasi.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Dae-Hee Kim
- Address for correspondence: Dr Dae-Hee Kim, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-gu, Seoul 138-736, South Korea.
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Xu K, Sun W, Dong Z, Xing H, Huang Y. Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:243-246. [PMID: 30673141 DOI: 10.1002/jcu.22685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
We report the case of a patient with chronic type A aortic dissection (AD), who had been admitted, 18 months ago, to another hospital with acute chest-tearing pain accompanied with transient loss of consciousness. His symptoms resolved but he reported after discharge a toothache and fluctuating right mandibular pain. He presented to our outpatient clinic because his facial pain aggravated. Physical examination demonstrated a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection extending into the extracranial right internal carotid artery (ICA), which was tortuous. The patient refused surgery. This case reminds us that AD can involve the extracranial ICA, and that long-term survival is possible with type A acute AD without treatment. Carotid ultrasonography is noninvasive, inexpensive, easily performed, and can lead to the detection of chronic type A AD extending to the extracranial ICA.
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Affiliation(s)
- Ke Xu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhenya Dong
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiying Xing
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
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Huang F, Chen Q, Lai QQ, Huang WH, Wu H, Li WC. Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection. Medicine (Baltimore) 2016; 95:e4984. [PMID: 27684852 PMCID: PMC5265945 DOI: 10.1097/md.0000000000004984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation.MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Qing-quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
- Correspondence: Qing-quan Lai, Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, P.R. China (e-mail: )
| | - Wen-han Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Wei-cheng Li
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
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