Letter in response to “Acute Coronary Involvement in Acute Type A Aortic Dissection: A Subgroup Analysis of Bicuspid Aortic Valve and Marfan Syndrome”

Background We evaluated the clinical and anatomic presentations of acute type A aortic dissection according to patient age. Methods We retrospectively reviewed 235 consecutive patients who underwent acute type A dissection repair between January 2000 and December 2014. The influence of age on anatomical and clinical presentation, surgical management in the entire cohort and also after exclusion of patients with known connective tissue disorders was assessed using logistic regression. Results Males presented with type A acute aortic dissection at a younger age than females. Acute onset with signs of myocardial ischemia, connective tissue disorders, or bicuspid aortic valve characterized the younger population. Extension to the coronary sinus(es) ( p = 0.0003), descending thoracic aorta ( p = 0.016), and abdominal aorta ( p = 0.029), and an intimal tear at the level of the aortic root ( p = 0.0017) correlated inversely with patient age. Similar findings were obtained after exclusion of patients with connective tissue disorders or a bicuspid aortic valve. Conclusions More frequent proximal and distal progression of the dissection flap occurs in younger patients with acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the level of the sinus of Valsalva. These findings, associated with prognostic implications, account for the choice of more radical proximal procedures for repair of aortic dissection in younger patients.

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The significance of bicuspid aortic valve after surgery for acute type A aortic dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.03.012 ◽

2020 ◽

Vol 159 (3) ◽

pp. 760-767.e3 ◽

Cited By ~ 4

Author(s):

Ari Mennander ◽

Christian Olsson ◽

Anders Jeppsson ◽

Arnar Geirsson ◽

Vibeke Hjortdal ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Bicuspid Aortic Valve ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Bicuspid Aortic Valve Resuspension in Acute Type A Aortic Dissection Patients

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.03.102 ◽

2015 ◽

Vol 100 (3) ◽

pp. 827-832 ◽

Cited By ~ 7

Author(s):

Bartosz Rylski ◽

Matthias Siepe ◽

Friedhelm Beyersdorf ◽

Fabian A. Kari ◽

Linda Grün ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Bicuspid Aortic Valve ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Durable results of preserved valve and root after acute type A aortic dissection surgery in bicuspid aortic valve

10.22541/au.164122826.65688937/v1 ◽

2022 ◽

Author(s):

Tsu-Jui Hsu ◽

Cheng-Wei Chen ◽

Ron-Bin Hsu

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Valve Replacement ◽

Bicuspid Aortic Valve ◽

Emergency Surgery ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection

Background and aims of the study. Data on emergency surgery for acute type A aortic dissection in patients with bicuspid aortic valve were limited. Long-term results on the fate of the preserved bicuspid valve and aortic root were even rare. We sought to assess the clinical outcome of emergency acute type A aortic dissection surgery in patients with bicuspid aortic valve. Methods. From 2004 to 2021, 121 patients underwent emergency surgery for acute type A aortic dissection using a conservative aortic resection. Hospital and late outcomes were assessed in patients with bicuspid aortic valve. Results. Eight patients (6.6%) had bicuspid aortic valve with 6 males (75%) and median age of 49.5 years (range, 34 to 71). Four (50%) had significant aortic valve dysfunction. Operation included ascending aortic grafting with aortic valve preservation in 4, ascending aortic grafting with aortic valve replacement in 3 and ascending aortic grafting with Bentall root replacement in 1. Hospital mortality rate was 12.5% (1/8). With a median follow-up of 14.4 years, there was one late death and no proximal reoperation of 6 preserved roots and 3 preserved valves. Median diameter of preserved aortic roots changed from 42 (range, 33-43) to 38.5 mm (range, 35-46) with the average time of 11 years after surgery. Conclusions. Acute type A aortic dissection in bicuspid aortic valve was not associated with worse outcome. Aortic valve replacement was often required. Simultaneous root replacement was not always necessary. Preservation of normally functioning bicuspid valve and non-dilated root showed durable long-term results.

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Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1722793 ◽

2020 ◽

Vol 5 (04) ◽

pp. 331-334

Author(s):

Paolo Masiello ◽

Rocco Leone ◽

Rossella Maria Benvenga ◽

Severino Iesu

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Arch ◽

Bicuspid Aortic Valve ◽

Rare Case ◽

Unplanned Pregnancy ◽

Type A ◽

Cardiac Biomarkers ◽

High Morbidity ◽

Type A Aortic Dissection

Abstract Background Type A aortic dissection is an emergency with high morbidity and mortality when surgery is not performed. Few cases are described in the literature about aortic dissection during pregnancy. A correlation between pregnancy and aortic dissection is mainly reported in patients with family history and connective tissue disorders, such as Marfan’s syndrome (MS), Loeys–Dietz’s syndrome, and Ehlers–Danlos’s syndromes, and patients with bicuspid aortic valve (BAV); exceptional cases are also described in patients without risk factors. Case presentation A 22-year-old young woman with MS, ascending aorta dilation, and BAV became pregnant. During labor, she experienced a short-term chest pain with spontaneous resolution. The electrocardiogram (ECG) and cardiac biomarkers were negative for acute coronary artery disease, but no transthoracic echocardiogram (TTE) was performed. A caesarean section was performed without complications. After 1 month, a routine TTE showed a chronic ascending aortic dissection involving the aortic arch and supra-aortic vessels. Due to a normally functioning aortic valve, the David operation was performed (sparing aortic valve) with the replacement of the aortic arch and supra-aortic vessels. Conclusions Aortic dissection is a rare cardiovascular complication that can occur during pregnancy and is associated with very high-risk mortality. We have reported a rare case of undiagnosed type A aortic dissection involving the aortic arch during unplanned pregnancy in patients with BAV and MS, subsequently treated with the David surgery and replacement of ascending aortic arch and supra-aortic vessels. A closer clinical and instrumental follow-up is necessary in this particular group of patients at risk. Awareness of all physicians involved is mandatory.

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