scholarly journals 4D flow MRI of type B dissection with later retrograde progression to type A dissection in Marfan: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Max J P van Hout ◽  
Joe F Juffermans ◽  
Arthur J Scholte ◽  
Hildo J Lamb
Keyword(s):  
Risk Assessment ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type B ◽  
4D Flow ◽  
Type B Dissection ◽  
Type A Dissection

Abstract Background  Due to the malfunction of connective tissue, Marfan patients are at increased risk of aortic dissection. Uncomplicated acute type B dissection is usually managed with medical therapy. Retrograde progression or new type A dissection is a relatively rare but often fatal complication that occur most frequently in the first 6 months after acute type B dissection. Case summary  We present a 31-year-old male with Marfan syndrome and a recent uncomplicated type B dissection from the left subclavian to the right common iliac artery who underwent 4D flow magnetic resonance imaging (MRI). The dissection had a large proximal intimal tear just distal to the left subclavian artery (15 mm) and large false lumen (35 mm). Aortic blood flow just distal to the left subclavian artery (3.6 L/min) was split disproportionately into the true (0.8 L/min, 22%) and false lumen (2.8 L/min, 78%). 4D flow streamlines revealed vortical flow in the proximal false lumen. Increased wall shear stress was observed at the sinotubular junction (STJ), inner wall of the ascending aorta and around the subclavian artery. Two weeks after MRI, the patient presented with jaw pain. Computed tomography showed a type A dissection with an entry tear at the STJ for which an acute valve-sparing root, ascending and arch replacement was performed. Discussion  Better risk assessment of life-threatening complications in uncomplicated type B dissections could improve treatment strategies in these patients. Our case demonstrates that besides clinical and morphological parameters, flow derived parameters could aid in improved risk assessment for retrograde progression from uncomplicated type B dissection to acute type A dissection.

Aortic emergencies

2015 ◽  
Author(s):  
Parla Astarci ◽  
Laurent de Kerchove ◽  
Gébrine el Khoury
Keyword(s):  
Type A ◽  
Limb Ischaemia ◽  
Acute Type ◽  
Type B ◽  
Endovascular Techniques ◽  
Stent Grafts ◽  
Term Survival ◽  
Acute Aortic Syndromes ◽  
Type B Dissection ◽  
Type A Dissection

Acute aortic dissections account for the leading and most feared of aortic emergencies. Acute dissections are associated with a dreadful mortality rate; therefore, an accurate diagnosis and immediate treatment are mandatory. The key point of a lifesaving management strategy is the distinction between acute type A dissection, uncomplicated type B dissection, and complicated type B dissection, and those including contained ruptured aorta (severe pleural effusion) and/or malperfusion syndrome (by end-organ ischaemia: paraplegia, intestinal ischaemia, renal insufficiency, limb ischaemia). Type A generally requires urgent surgery; uncomplicated type B dissections are treated conservatively, while complicated type B dissections are currently managed by means of minimally invasive endovascular techniques, eventually associated with a tight surgical time (e.g. in the case of limb ischaemia). Surgical repair of type A dissection consists of the replacement of the ascending aorta. The repair is extended proximally towards the aortic root and valve, and distally towards the aortic arch, in function of the lesions found and the clinical presentation of the patient (haemodynamic status, age, comorbidities). The emergence of endovascular techniques and the contribution of thoracic endovascular aortic repair, with thoracic stent-grafts deployed from the proximal descending aorta to reopen the true lumen and to seal the entry tear in type B dissections, have revolutionized the surgical treatment algorithm in this pathology, and thus the patient’s immediate and medium-term survival. In the same group of acute aortic syndromes, traumatic aortic isthmic ruptures are also life-threatening conditions and account for one of the main causes of death at the time of traumatic accidents. As in the case of complicated type B dissections, the introduction of aortic stent-grafts has changed the outcome of these patients.

747 A Case Report: Spontaneous Recovery of Type B Aortic Dissection

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Sherif ◽  
P Witharana
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
False Lumen ◽  
Rare Event ◽  
Sudden Onset ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

Abstract Introduction An aortic dissection occurs when there is a tear in the intimal and medial layer of the aorta, leading to a false lumen within the media. Type B aortic dissections (TBAD), according to the Stanford Classification are where the entry tear is located distally from the left subclavian artery. Resolution of a Type B aortic dissection (TBAD) by medical therapy is a very rare event. Case Presentation 58-year-old gentleman presented with sudden onset central chest pain. A CTPA was organised following a high d-dimer. This showed a TBAD extending from the origin of the left subclavian artery to the level of the diaphragm. His blood pressure was aggressively controlled with IV labetalol and IV isosorbide dinitrate and was monitored for 2 weeks. He was then discharged home on oral antihypertensive medication. A follow up CT aortogram was done 7 months later which showed that the false lumen of the TBAD has improved from 18mm to 2 mm. Discussion The anti-inotropic effect of beta blockers reduces the stress on the aortic wall and therefore prevents further dilatation. Aggressive control of blood pressure and heart rate comes with its own disadvantages. It had been shown, patients managed conservatively were more likely to develop renal failure (43%) compared to those having endovascular repair. About half of those patients required surgical treatment. There are not many cases in literature where a TBAD had resolved with medication. Conclusions As evident from this case, rigorous management of blood pressure may help with cases of Type B Dissection.

scholarly journals Morphological predictor of remodelling of the descending thoracic aortic false lumen that remains patent after repair of acute type A dissection

2018 ◽  
Vol 28 (4) ◽  
pp. 629-634
Author(s):  
Toshitaka Watanabe ◽  
Toshiro Ito ◽  
Hiroshi Sato ◽  
Takuma Mikami ◽  
Ryosuke Numaguchi ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Acute Type A Dissection ◽  
Type A Dissection

scholarly journals Complicated acute type B dissection originating from an aberrant right subclavian artery

2014 ◽  
Vol 46 (1) ◽  
pp. e20-e20 ◽  
Author(s):  
Gioia Di Stefano ◽  
Michele Murzi ◽  
Marco Solinas ◽  
Mattia Glauber
Keyword(s):  
Subclavian Artery ◽  
Aberrant Right Subclavian Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Dissection

A Novel Insight into the Role of Entry Tears in Type B Aortic Dissection: Pressure Measurements in an in Vitro Model

2017 ◽  
Vol 40 (10) ◽  
pp. 563-574 ◽  
Author(s):  
Stefania Marconi ◽  
Ettore Lanzarone ◽  
Hector De Beaufort ◽  
Michele Conti ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
False Lumen ◽  
Patient Characteristics ◽  
Acute Type ◽  
Type B ◽  
Type B Dissection ◽  
Vitro Model ◽  
Insight Into

Introduction Predicting aortic growth in acute type B dissection is fundamental in planning interventions. Several factors are considered to be growth predictors in the literature and, among them, size and location of entry tears have been recognized to particularly influence the false lumen pressure. In this study, we develop an in vitro setting to analyze the actual impact of size and location of the entry tears on false lumen pressure, in the absence of other confounding factors such as the deformability of the aortic wall. Methods We formalize some indexes that synthetically describe the false lumen pressure with respect to the true lumen pressure. Then, we experimentally derive their values in several configurations of the in vitro setting, and we look for trends in the indexes with respect to the size and location of entry tears. Results: Results show that the tears have a relevant impact on the false lumen pressure, but that their size and location alone are not enough to explain the phenomena observed in vivo. Conclusions To predict the behavior of acute type B dissection, we therefore recommend not limiting to size and location, as many effects may derive from the interactions between these parameters and other patient characteristics.

Aortic emergencies

2021 ◽  
pp. 805-819
Author(s):  
Marc Schepens ◽  
Eric Graulus
Keyword(s):  
Type A ◽  
Acute Type ◽  
Type B ◽  
Endovascular Techniques ◽  
Adequate Treatment ◽  
Urgent Surgery ◽  
Acute Type A Dissection ◽  
Golden Standard ◽  
Life Threatening ◽  
Type A Dissection

Acute aortic dissection is without any doubt the most feared and life threatening aortic emergency. It is associated with a dreadful mortality rate and an immediate and accurate diagnosis without delay followed by adequate treatment is mandatory. It is important to make a distinction between acute type A, uncomplicated and complicated type B. Acute type A dissection generally requires urgent surgery, complicated type B dissections are treated with endovascular techniques; there is ongoing debate whether uncomplicated type B dissections should also be treated by endografts in its early phase. Surgical repair of acute type A dissection consists of the replacement of the intrapericardial ascending aorta with varying segments of the arch and/or aortic root. The endovascular techniques with stentgrafts deployed into the proximal descending aorta in type B dissections have revolutionized the surgical therapy and the patient�s immediate and medium-term survival. For chronic postdissection aneurysms open surgery still remains the golden standard. Acute traumatic aortic isthmus ruptures are similar life threatening conditions and account for one of the main causes of death at the time of traumatic accidents. In these situations also stentgrafts have changed the outcome of these severe and multiple traumatic patients.

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