Abstract 13504: Timely Recognition and Successful Clinical Outcome of an Acute Debakey Type I Aortic Dissection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dakshin Gangadharamurthy ◽  
Muhammad M Furqan ◽  
Allan L Klein ◽  
Saurabh Malhotra ◽  
Rachel Harrison ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Care Facility ◽  
Type I ◽  
Malperfusion Syndrome

Background: Acute Aortic dissection is a critical etiology of chest pain with very high mortality. 1% to 2% of patients die per hour during the initial 24 to 48 hours. Case: A 62 year old lady with history of diabetes, hypertension, hyperlipidemia, hypothyroidism, smoking and no pertinent family history presented with atypical chest pain. She remained hemodynamically stable with no discrepancy of BP between arms. Labs: troponin 0.64, 0.63 ng/ml. EKG: sinus bradycardia. Chest x-ray: no mediastinal widening or signs of aortic aneurysm. Coronary angiogram showed 20-30 % stenosis in left anterior descending and right coronary arteries. An aortogram showed dilated aortic root over 6 cm with aortic regurgitation. Decision-making: An emergent echocardiogram confirmed acute aortic regurgitation and dissection. CT angiogram showed DeBakey type I aortic dissection extending from aortic annulus to infra renal aorta, supra aortic great vessels, celiac axis and left renal artery. She had no signs of malperfusion syndrome. She was started on iv Esmolol and emergently airlifted to tertiary care facility for surgical repair. Intra operative TEE showed findings consistent with acute aortic dissection. She had successful modified Bentall procedure with replacement of aortic valve, aortic root, ascending aorta and hemi arch. She had excellent recovery and continues to do well at follow up visits in our clinic. Conclusion: An early diagnosis of acute aortic dissection requires high index of suspicion due to variable symptoms and clinical manifestations. DeBakey type I aortic dissection may have better chance of survival in the absence of malperfusion syndrome if treated early as in this case.

scholarly journals Bentall surgery for acute aortic dissection (type-a) in a patient with marfan syndrome

KYAMC Journal ◽  
2018 ◽  
Vol 9 (2) ◽  
pp. 95-100
Author(s):  
Mohammad Arifur Rahman ◽  
Md Lutfar Rahman ◽  
Prakash Chandra Munshi ◽  
Taslim Yusuf Tamal ◽  
Mejbaur Rahman ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Clinical Manifestations ◽  
Type A ◽  
Moderate Hypothermia ◽  
Type I ◽  
Acute Type ◽  
Aortic Dissection Type A

Background: Marfan syndrome is an autosomal-dominant hereditary connective tissue disorder with the clinical manifestations involving the ocular, skeletal, and cardiovascular systems. The cardiovascular manifestations include aortic root dilatation, aortic valvular insufficiency, mitral valve prolapse, mitral regurgitation, aortic dissection and aortic rupture. Acute aortic dissection is one of the most common catastrophes involving the aorta. A high index of suspicion is important in patients who have predisposing risk factors. Classification is based on the location of dissection and its duration. Stanford type A (De bakey type I /type II) dissection should be treated surgically in essentially all cases.Objective: To report our experience in Bentall surgery in Acute aortic dissection (type A ). The efficacy of right axillary artery cannulation was investigated.Materials & Methods: Patient with acute type A aortic dissection involving coronary sinuses with 3 vessels of the arch free of lesions underwent aortic valve with ascending aorta and hemiarch replacement with composite valve graft (Bentall procedure) and reimplantation of coronary arteries under moderate hypothermia. The axillary artery was used for arterial cannulation.Results: Weaning from CPB was smooth. Perioperative period was eventless. Follow-up Echo revealed normal cardiac parameters.Conclusion: Prompt establishment of the diagnosis, through focused physical examination and noninvasive imaging, followed by rapid medical and surgical therapy, are the only effective methods to alter survival in patients with acute aortic dissection.KYAMC Journal Vol. 9, No.-2, July 2018, Page 95-100

scholarly journals REDO-BENTALL OPERATION – ITERATIVE AORTIC ROOT RECOSTRUCTION – THERAPEUTIC DECISION-MAKING COMPLEXITY AND PROCEDURAL COMPLEXITY

2018 ◽  
Vol 1 (2) ◽  
pp. 67-70
Author(s):  
Celia Ciobanu ◽  
C. Voica ◽  
B. Rădulescu ◽  
H. Moldovan
Keyword(s):  
Decision Making ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Ascending Aorta ◽  
Type I ◽  
Therapeutic Decision ◽  
Bentall Operation ◽  
Therapeutic Decision Making

We present the case of a 59-year-old woman who undergoes surgery 12 years after the Bentall-de Bono operation (replacement of the aortic valve and ascending aorta with valvular duct and direct reimplantation of the coronaryan ostia in the duct). For the acute aortic dissection of type I De Bakey (Stanford type A), diagnosed with subacute infectious endocarditis at the level of the aortic valvular duct with abscess in the aortic root.

Combined David and Frozen Elephant Trunk Procedure in Acute Aortic Dissection

2018 ◽  
Vol 67 (05) ◽  
pp. 372-378 ◽  
Author(s):  
Nora Goebel ◽  
Ragi Nagib ◽  
Schahriar Salehi-Gilani ◽  
Samir Ahad ◽  
Marc Albert ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Root Replacement ◽  
Type I ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Valve Sparing ◽  
Aortic Root Repair ◽  
Aortic Remodeling

Background Valve sparing aortic root repair by reimplantation (David procedure) is an established technique in acute aortic dissection Stanford type A involving the aortic root. In DeBakey type I dissection, aortic arch replacement using the frozen elephant trunk (FET) was introduced to promote aortic remodeling of the downstream aorta. The combination of these two complex procedures represents a challenging surgical strategy and was considered too risky so far. Methods All patients with acute aortic dissection DeBakey type I undergoing valve sparing aortic root repair by reimplantation technique of David combined with extended aortic repair using the FET at our center between October 2009 and December 2016 were evaluated. Outcomes are compared with patients who underwent prosthetic aortic root replacement and FET for aortic dissection in the same timeframe. Results A total of 28 patients received combined David and FET procedure, while 20 patients received prosthetic aortic root replacement and FET procedure. Thirty-day mortality was 10.7% (n = 3) for the David group and 20% (n = 4) for the root replacement group (p = 0.43). Postoperative echocardiographic control revealed an excellent aortic valve function with regurgitation grade 0° or maximum grade I° and a mean gradient of 4.3 ± 2.1 mm Hg in all patients in the David group versus 7.2 ± 2.4 mm Hg in the aortic root replacement group, p = 0.003. Computed tomography angiography scan showed positive aortic remodeling in all but three patients (91.9%). Mid-term follow-up survival was 82.1% in the David group and 68.4% in the root replacement group, p = 0.28. There was no need for reintervention at the root or descending aorta. Conclusion Simultaneous application of the David and FET procedure in patients with acute aortic dissection is safe and feasible in experienced hands as compared with standard aortic root replacement plus FET. The mid-term outcomes are encouraging and noninferior to conventional surgery results.

OC51 NEW TECHNIQUE IN TYPE I ACUTE AORTIC DISSECTION FOR ARCH STABILIZATION AND FUTURE LANDING ZONE CREATION WITHOUT ARCH REPLACEMENT

2018 ◽  
Vol 19 ◽  
pp. e3
Author(s):  
P. Masiello ◽  
A. Longobardi ◽  
A. Panza ◽  
G. Mastrogiovanni ◽  
F. Cafarelli ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
New Technique ◽  
Type I ◽  
Landing Zone

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

Bentall–de Bono procedure for acute aortic dissection

2021 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Acute Type ◽  
Aortic Diseases ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.

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