Enlargement of aortic arch vessels after surgical repair of 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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Surgery out of office hours for type A aortic dissection: does night-time and weekend surgery worsen outcome?

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa190 ◽

2020 ◽

Vol 31 (6) ◽

pp. 806-812

Author(s):

Simone Gasser ◽

Lukas Stastny ◽

Markus Kofler ◽

Vitalijs Zujs ◽

Christoph Krapf ◽

...

Keyword(s):

Aortic Dissection ◽

Emergency Surgery ◽

Odds Ratio ◽

Surgical Repair ◽

Type A ◽

Skin Incision ◽

Night Time ◽

Femoral Access ◽

Type A Aortic Dissection ◽

Malperfusion Syndrome

Abstract OBJECTIVES Immediate surgical repair for type A aortic dissection is gold standard and at most centres is performed by the surgeon on call during night-time and weekends. The objective was to evaluate whether emergency surgery during night-time or weekends has an influence on 30-day mortality. METHODS In 319 patients undergoing surgery for type A aortic dissection, skin incision was documented. Patients were divided into 2 groups according to the time point of skin incision (05:00 a.m. to 07:00 p.m. = daytime group; 07:01 p.m. to 04:59 a.m. = night-time group). We also noted whether their surgeries were started on weekdays (Monday 00:00 to Friday 23:59) or weekends (Saturday 00:00 to Sunday 23:59). RESULTS The median age was 61 years (interquartile range 49–70) and 69.6% (n = 222) were male. Almost 50% (n = 149) of patients presented in a critical preoperative state. Forty-one percent of patients (n = 131) underwent night-time surgery. There were no differences in baseline data, time from onset of symptoms to surgery or surgical treatment between groups, except from preferred femoral access for arterial cannulation during night-time. Advanced age [odds ratio 1.042, 95% confidence interval (CI) 1.014–1.070], preoperative malperfusion syndrome (odds ratio 2.542, 95% CI 1.279–5.051) and preoperative tamponade (odds ratio 2.562, 95% CI 1.215–5.404) emerged as risk factors for 30-day mortality. Night-time or weekend surgery did not have any impact on 30-day mortality when covariates were considered. CONCLUSIONS Based on the natural course of the disease and our results, surgery for type A aortic dissection should be performed as an emergency surgery regardless of time and day.

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Non-thyroidal illness syndrome -associated multi-organ dysfunction after surgical repair of type A aortic dissection

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.08.005 ◽

2021 ◽

Author(s):

Jiayang Wang ◽

Jian Cao ◽

Junming Zhu ◽

Nan Liu

Keyword(s):

Aortic Dissection ◽

Organ Dysfunction ◽

Surgical Repair ◽

Type A ◽

Type A Aortic Dissection

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Chronic Type A Aortic Dissection

Aorta ◽

10.12945/j.aorta.2015.15.016 ◽

2016 ◽

Vol 04 (01) ◽

pp. 16-21 ◽

Cited By ~ 6

Author(s):

Conor Hynes ◽

Michael Greenberg ◽

Shawn Sarin ◽

Gregory Trachiotis

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

False Lumen ◽

Disease Process ◽

Type A ◽

Delayed Presentation ◽

Chronic Type ◽

Type A Aortic Dissection ◽

First Line Therapy ◽

Acute Dissection

AbstractStanford 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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