Eight-Year Experience of Intraoperative Aortic Dissection

2009 ◽  
Vol 17 (4) ◽  
pp. 408-412 ◽  
Author(s):  
Tzu-Yu Lin ◽  
Yih-Sharng Chen ◽  
Kuan-Ming Chiu ◽  
Ron-Bin Hsu ◽  
Hsi-Yu Yu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Transesophageal Echocardiography ◽  
Posterior Wall ◽  
Ascending Aorta ◽  
Elective Cardiac Surgery ◽  
Intraoperative Transesophageal Echocardiography ◽  
Primary Procedure ◽  
Aortic Dissections ◽  
Immediate Reoperation ◽  
Cardiac Operations

Aortic dissection is a rare but devastating complication of cardiac operations. The purpose of this investigation was to assess the occurrence of aortic dissection during elective cardiac operations and the usefulness of intraoperative transesophageal echocardiography for the diagnosis and management of this complication. Data of consecutive adult patients undergoing elective cardiac surgery with transesophageal echocardiographic monitoring during an 8-year period were studied retrospectively. Aortic dissection was identified in 7 (0.13%) of 5,247 patients, and diagnosed immediately by transesophageal echocardiography in 5 of them; 2 were diagnosed later by transesophageal echocardiography. All aortic dissections were type A and they occurred after completion of the primary procedure. Two patients treated conservatively died within 5 days. Four of the 5 patients who underwent immediate reoperation survived with serious postoperative complications. Transesophageal echocardiography should be carried out when there is a risk of aortic dissection during cardiac operations, especially in the posterior wall of the ascending aorta, to avoid missing the diagnosis and delaying treatment.

Intraoperative Dissection of Aorta and Successful Repair

1998 ◽  
Vol 6 (1) ◽  
pp. 66-67
Author(s):  
Nainar Madhu Sankar ◽  
Kevin Lai ◽  
Kenneth Harrison ◽  
Peter Klineberg ◽  
William Meldrum Hanna
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Transesophageal Echocardiography ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Ascending Aorta ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Intraoperative Transesophageal Echocardiography ◽  
Successful Repair

A 67-year-old female undergoing coronary artery bypass grafting developed dissection of the ascending aorta during decannulation. It was diagnosed by intraoperative transesophageal echocardiography and she underwent a successful repair.

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 Echocardiographic Evaluation of the Thoracic Aorta: Tips and Pitfalls

Aorta ◽  
2021 ◽  
Vol 09 (01) ◽  
pp. 001-008
Author(s):  
Krishna Upadhyaya ◽  
Ifeoma Ugonabo ◽  
Keyuree Satam ◽  
Sarah C. Hull
Keyword(s):  
Aortic Dissection ◽  
Aortic Wall ◽  
Ultrasound Image ◽  
Leading Edge ◽  
Posterior Wall ◽  
Blind Spot ◽  
Anterior Wall ◽  
Ascending Aorta ◽  
Color Flow ◽  
Leading Edges

AbstractBy convention, the ascending aorta is measured by echo from leading edge to leading edge. “Leading edge” connotes the edge of the aortic wall that is closest to the probe (at the top of the inverted “V” of the ultrasound image). By transthoracic echo (TTE), the leading edges are the outer anterior wall and inner posterior wall. By transesophageal echo (TEE), the leading edges are the outer posterior wall and inner anterior wall. Aortic measurements should be taken (by convention) in diastole (when the aorta is moving least). Simple TTE is 70 to 85% sensitive in diagnosing ascending aortic dissection. TEE sensitivity approaches 100%, though the tracheal carina imposes a blind spot on TEE, impeding visualization of distal ascending aorta and proximal aortic arch. While computed tomography angiography may be superior for defining full anatomic extent of aortic dissection, echocardiography is superior in assessing functional consequences such as mechanism and severity of aortic regurgitation, evidence of myocardial ischemia when complicated by coronary dissection, or evidence of tamponade physiology when pericardial effusion is present. Reverberation artifact can mimic a dissection flap. A true flap moves independently of the outer aortic wall which can be confirmed by M-mode. Color flow respects a true flap but does not respect a reverberation artifact. Assessment for bicuspid aortic valve (BAV) morphology should be done in systole, not diastole. In diastole, when the valve is closed, the raphé can make a bicuspid valve appear trileaflet. Doming in the parasternal long axis (PLAX) view and an eccentric closure line on PLAX M-mode should also raise suspicion for BAV.

Impact of Intraoperative Transesophageal Echocardiography on Acute Type-A Aortic Dissection

2014 ◽  
Vol 28 (5) ◽  
pp. 1203-1207 ◽  
Author(s):  
Marit E. Thorsgard ◽  
Gregory J. Morrissette ◽  
Benjamin Sun ◽  
Frazier Eales ◽  
Vibhu Kshettry ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Transesophageal Echocardiography ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intraoperative Transesophageal Echocardiography

scholarly journals Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome

2016 ◽  
Vol 43 (5) ◽  
pp. 428-429 ◽  
Author(s):  
Ahmet Dolapoglu ◽  
Kim I. de la Cruz ◽  
Ourania Preventza ◽  
Joseph S. Coselli
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Surgical Approach ◽  
Axillary Artery ◽  
Ascending Aorta ◽  
Dacron Graft ◽  
Bentall Procedure ◽  
Surgical Bypass ◽  
Aortic Dissections ◽  
Bypass Technique

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

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