31 Acute Dissection with Hemodynamic Infarctions

Abstract. Background: Aortic dilatation in Marfan syndrome (MFS) is progressive. It is associated with oxidative stress and endothelial dysfunction that contribute to the early acute dissection of the vessel and can result in rupture of the aorta and sudden death. We evaluated the participation of the glutathione (GSH) system, which could be involved in the mechanisms that promote the formation and progression of the aortic aneurysms in MFS patients. Patients and methods: Aortic aneurysm tissue was obtained during chest surgery from eight control subjects and 14 MFS patients. Spectrophotometrical determination of activity of glutathione peroxidase (GPx), glutathione-S-transferase (GST), glutathione reductase (GR), lipid peroxidation (LPO) index, carbonylation, total antioxidant capacity (TAC), and concentration of reduced and oxidized glutathione (GSH and GSSG respectively), was performed in the homogenate from aortic aneurysm tissue. Results: LPO index, carbonylation, TGF-β1, and GR activity were increased in MFS patients (p < 0.04), while TAC, GSH/GSSG ratio, GPx, and GST activity were significantly decreased (p < 0.04). Conclusions: The depletion of GSH, in spite of the elevated activity of GR, not only diminished the activity of GSH-depend GST and GPx, but increased LPO, carbonylation and decreased TAC. These changes could promote the structural and functional alterations in the thoracic aorta of MFS patients.

Download Full-text

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.

Download Full-text

Separation of coronary ostium caused by pseudoaneurysm formation after composite valve graft replacement for acute dissection of the ascending aorta

Heart ◽

10.1136/heart.88.3.265 ◽

2002 ◽

Vol 88 (3) ◽

pp. 265-265

Author(s):

T C Konings

Keyword(s):

Ascending Aorta ◽

Coronary Ostium ◽

Graft Replacement ◽

Pseudoaneurysm Formation ◽

Acute Dissection

Download Full-text

ICVTS on-line discussion A Patency of distal false lumen in acute dissection

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2006.132233a ◽

2006 ◽

Vol 6 (2) ◽

pp. 207-208 ◽

Cited By ~ 1

Author(s):

J. Bachet

Keyword(s):

False Lumen ◽

On Line ◽

Acute Dissection

Download Full-text

Early and Long-Term Results of a Valve-Sparing Operation for Marfan Syndrome

Circulation ◽

10.1161/circ.100.suppl_2.ii-29 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Cited By ~ 1

Author(s):

Emma J. Birks ◽

Carole Webb ◽

Anne Child ◽

Rosemary Radley-Smith ◽

Magdi H. Yacoub

Keyword(s):

Infective Endocarditis ◽

Marfan Syndrome ◽

Ascending Aorta ◽

Long Term Results ◽

Thromboembolic Complications ◽

Actuarial Survival ◽

Acute Dissection ◽

Valve Sparing

Background —We have previously described the experience, rationale, and development of a valve preserving technique, but its role in patients with Marfan syndrome has not previously been defined. Here, we attempt to determine the early and long-term results, timing, and determinants of outcome of this operation in patients with Marfan syndrome. Methods and Results —Since 1979, 82 patients (73.2% of all patients with Marfan syndrome undergoing resection of aneurysm of the ascending aorta) were operated on using this technique. Ages ranged from 2 to 69 years (mean, 33.9 years). In all, there were 4 early deaths (4.9%), 2 with acute dissection and 2 with chronic aneurysm operated on as emergencies. There were no early deaths in 67 patients operated on electively. Actuarial survival for patients operated for chronic aneurysm was 94.2%, 94.2%, and 94.2% at 1, 5, and 10 years, respectively; that for acute dissection was 72.7%, 63.6%, and 63.6%; and that for chronic dissection was 100%, 85.7%, and 75.0%. The probability of needing reoperation was 5.7%, 17.3%, and 17.3% at 1, 5, and 10 years. There were no instances of infective endocarditis or thromboembolic complications except in 2 patients operated on early in the series who had cusp extension. At the end of the follow-up, trivial or no aortic regurgitation was demonstrated in 33.3%, mild in 45.6%, moderate in 21.1%, and severe in 0. Conclusions —Valve-sparing operations are feasible in most patients with Marfan syndrome; they are applicable to patients with both dissection and chronic aneurysm. The early and long-term results are encouraging. Results are better in the absence of dissection, and prophylactic operation is warranted in some cases.

Download Full-text