Dissection Properties of Aneurysmal and Nonaneurysmal Human Ascending Thoracic Aorta: Preliminary Results

2010 ◽  
Author(s):  
Salvatore Pasta ◽  
Julie A. Philippi ◽  
Thomas G. Gleason ◽  
David A. Vorp
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Wall ◽  
False Lumen ◽  
Current Medical ◽  
True Lumen ◽  
Surgical Costs ◽  
Risk Of Mortality ◽  
Surgical Treatments ◽  
Significant Mortality

Ascending thoracic aortic aneurysm (ATAA) is among the most devastating forms of cardiovascular disease, causing a significant mortality despite current medical and surgical treatments [1]. Moreover these therapies themselves are associated with great risk of mortality or morbidity, complicated by the advanced age of the typical patient, and high surgical costs. The mechanics of spontaneous aortic dissection is not fully understood. It is generally believed that aortic dissection initiates as an intimal tear in which a separation of wall layers produces the formation of a ‘false’ lumen. The dissection may propagate axially and/or circumferentially due to blood flow and pressure. Dissection may lead to several possible complications. For example, the septum between the false lumen and true lumen may fracture, resulting in embolism and ischemic damage. Another possibility is that the thinned and weakened residual outer aortic wall may fail, resulting in rapid blood loss and tamponade.

Region-Specific Medial Fiber Micro-Architecture in the Longitudinal-Radial and Circumferential-Radial Planes of Ascending Thoracic Aortic Aneurysm Among Bicuspid and Tricuspid Aortic Valve Patients

2013 ◽  
Author(s):  
Alkiviadis Tsamis ◽  
Julie A. Phillippi ◽  
Ryan G. Koch ◽  
Jeffrey T. Krawiec ◽  
Antonio D’Amore ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Wall ◽  
False Lumen ◽  
True Lumen ◽  
Life Threatening ◽  
The Media ◽  
Intimal Tear

Aortic dissection is a life-threatening cardiovascular emergency with a high potential for death. It usually begins with an intimal tear which permits blood to enter the wall, split the media and create a false lumen, which can reenter the true lumen or exit through the adventitia causing complete rupture. A possible mechanism for dissection of ascending thoracic aortic aneurysm (ATAA) can be the occurrence of blood pressure-induced wall stresses in excess to the adhesive strength between the degenerated aortic wall layers.

scholarly journals Diagnosis and Treatment of Pregnancy Concurrent with Asymptomatic Aortic Dissection

2021 ◽  
Vol 24 (3) ◽  
pp. E493-E495
Author(s):  
Shao Wenchong ◽  
Tian Ailing ◽  
Fan Lufeng ◽  
Wu Han ◽  
Nianfeng Sun
Keyword(s):  
Risk Factor ◽  
Case Report ◽  
Aortic Dissection ◽  
Independent Risk Factor ◽  
Aortic Wall ◽  
False Lumen ◽  
True Lumen ◽  
Related Literature ◽  
Blood Flows ◽  
Joint Decisions

Background: Aortic dissection (AD) refers to false lumen dissected from true lumen via the internal membrane when endovascular blood flows into the aortic wall through the cleavage, which is formed after endomembrane gape of the aortic wall. Aortic dissection is a disease of extreme danger. Pregnancy is an independent risk factor for aortic dissection. Pregnancy concurrent with aortic dissection rarely is seen, not to mention pregnancy concurrent with asymptomatic aortic dissection. Case report: We present the case of a 34-year-old female patient, who was 25+ weeks pregnant, concurrent with aortic dissection. She was accepted by our hospital and successfully treated. Retrospective analysis of clinical data was carried out in this paper by combining related literature. Conclusion: This disease should be correctly straightened out to prevent misdiagnosis and save the patient’s life. Multidisciplinary joint decisions should be made to save lives of the patient and her fetus.

scholarly journals Endovascular rescue for malpositioned frozen elephant trunk into the false lumen

2021 ◽  
Author(s):  
Daichi Takagi ◽  
Takuya Wada ◽  
Wataru Igarashi ◽  
Takayuki Kadohama ◽  
kentaro kiryu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Transesophageal Echocardiography ◽  
Ultrasound Guidance ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Intraoperative Transesophageal Echocardiography

We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.

scholarly journals Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

2021 ◽  
Vol 12 ◽  
Author(s):  
Likun Sun ◽  
Jiehua Li ◽  
Lunchang Wang ◽  
Quanming Li ◽  
Hao He ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Factors Associated ◽  
Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P < 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P < 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P < 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P < 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P < 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

scholarly journals Treatment of Acute Stanford Type B Aortic Dissection With a Novel Cylindrical Balloon Catheter in Dogs

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Hiromu Terai ◽  
Nobushige Tamura ◽  
Tatsuo Nakamura ◽  
Kazunobu Nishimura ◽  
Norimasa Tsutsui ◽  
...  
Keyword(s):  
Blood Flow ◽  
Aortic Dissection ◽  
Balloon Catheter ◽  
False Lumen ◽  
Aortic Blood Flow ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Descending Aorta

Background —Despite recent progress in medical and surgical treatment, acute type B aortic dissection still carries a high mortality rate. We have developed a novel cylindrical balloon catheter for less invasive treatment to block the entry of the dissection and induce thrombotic occlusion of the false lumen. The balloon has the shape of a sheet when deflated but a double-cylinder shape when inflated. Therefore, aortic blood flow is maintained through the cylindrical lumen during balloon inflation. Methods and Results —Six beagle dogs underwent a left thoracotomy at the 6th intercostal space. An acute dissection of 4-cm length was created surgically on the descending aorta. The balloon catheter was inserted through the distal descending aorta and advanced to the entry site. The balloon catheter was inflated for 6 hours. The blood flow in the descending aorta and the position of the balloon was monitored by color Doppler echovasculography. Four dogs were killed humanely on the following day and 2 dogs 10 days after the surgery. The descending aorta was examined macroscopically and microscopically in all dogs. In all dogs, the false lumen was occluded by thrombi. Although no dog had clinical evidence of distal thromboembolism, 2 of the 4 dogs that were killed on the second postoperative day had fresh mural thrombi in the true lumen. Conclusions —The false lumen of the acute type B aortic dissection was effectively occluded by the novel cylindrical balloon catheter in the canine experimental model. The thrombus formation in the true lumen is the problem to be solved.

scholarly journals Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure

2019 ◽  
Author(s):  
Jan Raupach ◽  
Vendelin Chovanec ◽  
Veronika Kozakova ◽  
Jan Vojacek
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Elephant Trunk Procedure ◽  
Frozen Elephant Trunk Technique

Abstract We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.

Deep Learning-Based 3D Segmentation of True Lumen, False Lumen, and False Lumen Thrombosis in Type-B Aortic Dissection

2021 ◽  
Author(s):  
Liana D. Wobben ◽  
Marina Codari ◽  
Gabriel Mistelbauer ◽  
Antonio Pepe ◽  
Kai Higashigaito ◽  
...  
Keyword(s):  
Deep Learning ◽  
Aortic Dissection ◽  
False Lumen ◽  
Type B ◽  
3D Segmentation ◽  
Type B Aortic Dissection ◽  
True Lumen

scholarly journals Intravascular Ultrasound–Assisted Endovascular Treatment of Mesenteric Malperfusion in a Multichannel Aortic Dissection With Full True Lumen Collapse

2018 ◽  
Vol 26 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Baolei Guo ◽  
Daqiao Guo ◽  
Zhenyu Shi ◽  
Zhihui Dong ◽  
Weiguo Fu
Keyword(s):  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Intravascular Ultrasound ◽  
Mesenteric Ischemia ◽  
False Lumen ◽  
Patient Specific ◽  
Chronic Mesenteric Ischemia ◽  
True Lumen ◽  
True Lumen Collapse ◽  
Ivus Imaging

Purpose: To describe endovascular treatment of mesenteric malperfusion in a multichannel aortic dissection (MCAD) with full true lumen (TL) collapse following thoracic endovascular aortic repair (TEVAR). Case Report: A 54-year-old man presented with chronic mesenteric ischemia and a previous TEVAR for MCAD complicated by superior mesenteric artery (SMA) malperfusion. Computed tomography angiography (CTA) demonstrated a 3-channel aortic dissection with a “false-true-false” configuration. The SMA was malperfused through the collapsed TL. CTA also showed a secondary entry tear, measuring 18 mm in diameter, at the end of the previous endograft. Direct open surgery or endovascular revascularization of the SMA was not feasible. A plan was devised to improve SMA perfusion by increasing the TL inflow. With the assistance of intravascular ultrasound (IVUS), an endograft was placed through one false lumen in the abdominal aorta and through the TL in the descending thoracic aorta to seal the secondary entry tear. Symptoms of mesenteric ischemia resolved 2 days after the procedure. At 1 year, he is asymptomatic, has gained weight, and has improved SMA perfusion and remodeling of the 3-channel dissection on CTA. Conclusion: IVUS imaging can help evaluate the complex hemodynamics of MCAD. Patient-specific endovascular treatment of MCAD with mesenteric malperfusion seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.

scholarly journals Acute aortic dissection with highly compressed true lumen: unanticipated pitfall of point-of-care ultrasonography

2021 ◽  
Vol 14 (3) ◽  
pp. e239328
Author(s):  
Hisashi Dote ◽  
Masaaki Koide ◽  
Shunsuke Kobayashi ◽  
Takahiro Atsumi
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Point Of Care ◽  
False Lumen ◽  
Computed Tomographic Angiography ◽  
Sudden Onset ◽  
True Lumen ◽  
St Segment Elevation ◽  
Computed Tomographic ◽  
Point Of Care Ultrasonography

A 46-year-old man presented with sudden onset of chest pain. He was in cardiogenic shock at arrival. Based on the results of ECG and echocardiogram, he was diagnosed with ST-segment elevation myocardial infarction. Point-of-care ultrasonography (POCUS) did not reveal acute aortic dissection (AAD). During an emergency coronary angiography, aortic dissection was detected and computed tomographic angiography (CTA) revealed Stanford type A AAD with a highly compressed true lumen. Because of this form of aortic dissection, the enlarged false lumen could be potentially misidentified as a normal aorta in POCUS. Although POCUS is useful when AAD is suspected, we should not overestimate its findings and lower the threshold for CTA.

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