Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

scholarly journals Outcomes of patients who declined surgery for acute Stanford type A aortic dissection with patent false lumen of the ascending aorta†

2017 ◽  
Vol 25 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Tadashi Kitamura ◽  
Shinzo Torii ◽  
Tetsuya Horai ◽  
Koichi Sughimoto ◽  
Yusuke Irisawa ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Patent False Lumen

scholarly journals Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

2016 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Xiao-yan Chen ◽  
Fan-liang Kong ◽  
Tong-guo Wu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Aortic Dissection ◽  
Emergency Room ◽  
Male Patient ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection

Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

Immediate Regression of Thrombosed False Lumen in Ascending Aorta of Retrograde Type A Aortic Dissection

2009 ◽  
Vol 87 (5) ◽  
pp. e49 ◽  
Author(s):  
Koichi Akutsu ◽  
Shinya Yokoyama ◽  
Noritake Hata ◽  
Takuro Shinada ◽  
Kyoichi Mizuno
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection

scholarly journals Strategy for Stanford Type A Acute Aortic Dissection with Thrombosed False Lumen of the Ascending Aorta.

2001 ◽  
Vol 30 (6) ◽  
pp. 280-284
Author(s):  
Hidefumi Obo ◽  
Tsutomu Shida ◽  
Syuuichi Kozawa ◽  
Tatsurou Asada ◽  
Nobuhiko Mukohara ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta

Endo-Bentall for proximal aortic dissection: from conception to application

2020 ◽  
pp. 021849232092921
Author(s):  
Maximilian Kreibich ◽  
Bartosz Rylski ◽  
Friedhelm Beyersdorf ◽  
Matthias Siepe ◽  
Martin Czerny
Keyword(s):  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Covered Stent ◽  
Ascending Aorta ◽  
Coronary Perfusion ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Transcatheter Aortic Valve

The endovascular treatment of pathologies of the ascending aorta has not been incorporated into routine clinical practice. The aim of this article is to provide an overview of the endovascular treatment of pathologies of the ascending aorta, particularly type A aortic dissection. A thorough analysis and discussion of anatomical, physiological, clinical and technical challenges, and obstacles is performed. Conventional straight stent-grafts alone are not capable of fixing the entire complex underlying problem in the vast majority of patients with acute type A aortic dissection. An endovascular valve-carrying conduit consisting of a proximal transcatheter aortic valve connected to a covered stent-graft would be able to close a primary entry tear in the ascending aorta, ensure coronary perfusion, initiate true lumen expansion, treat malperfusion, treat aortic regurgitation, drain any pericardial effusion through a transapical approach, and possibly stabilize the distal aorta. Two thirds of all patients with acute aortic dissection are potential candidates for endovascular treatment, and the concept may help to significantly improve survival in patients with acute aortic dissection.

scholarly journals Surgical Management of Acute Type A Aortic Dissection: An Overview

2021 ◽  
pp. 263246362097804
Author(s):  
Sreedhar Reddy Nagaradona ◽  
Krishna Machiraju ◽  
Srinivasulu Reddy Kurapati ◽  
Srinivas Boggula ◽  
Sridhar Anumala Setty ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Wall ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
The Past ◽  
Catastrophic Disease

Acute type A aortic dissection is a catastrophic disease that develops from a tear within the intima of the aortic wall, thereby creating a false lumen in the ascending aorta. Early suspicion, diagnosis, and prompt surgery play a key role in the survival of patients. It is a surgical emergency and requires replacement of the ascending aorta/aortic root with or without aortic arch replacement. Over the past decade the surgical outcomes have improved in specialized tertiary centers.

Initial medical management in acute type A aortic dissection patients with a thrombosed false lumen in the ascending aorta combining intramural hematoma and retrograde dissection from the descending to the ascending aorta

2018 ◽  
Vol 9 (3_suppl) ◽  
pp. S13-S20 ◽  
Author(s):  
Kenji Sadamatsu ◽  
Susumu Takase ◽  
Shuichiro Sagara ◽  
Kensuke Ohe ◽  
Jun-ichiro Nishi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Management ◽  
False Lumen ◽  
Intramural Hematoma ◽  
Type A ◽  
Daily Practice ◽  
Ascending Aorta ◽  
Maximum Diameter ◽  
Acute Type ◽  
Type A Aortic Dissection

Background: The feasibility of medical management for select patients with acute type A aortic dissection has been reported from a few institutions. In this study, we retrospectively investigated the safety and feasibility of our conservative approach for patients with type A aortic dissection in daily practice. Methods: From January 2013 to December 2017, 131 consecutive patients were admitted to our institution for acute aortic dissection, including 58 patients of type A. Initial medical management was attempted in select patients who were clinically stable and had a thrombosed false lumen of the ascending aorta without ulcer-like projections in the ascending aorta. Results: Except for nine patients contraindicated for surgery, urgent surgery was performed in 26 patients (SRG group), while 23 patients (MED group) were treated with the initial medical management. The maximum diameter of the ascending aorta was significantly larger in the SRG group than in the MED group. In the MED group, the heart rate and blood pressures were well-controlled at admission to the intensive-care unit, and the systolic blood pressure was further reduced at 24 h after. The in-hospital mortality rates of the MED and SRG groups were 0% and 15%, respectively. During the follow-up period, the survival rate was significantly higher in the MED group than in the SRG group, and the aortic event-free survival at one year was 80%. Conclusions: The initial medical management for select patients with a thrombosed false lumen in the ascending aorta was a safe and feasible strategy in real-world practice.

scholarly journals Watch-and-wait strategy for type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta: a Japanese single-centre experience

2020 ◽  
Vol 58 (3) ◽  
pp. 590-597 ◽  
Author(s):  
Tadashi Kitamura ◽  
Shinzo Torii ◽  
Takashi Miyamoto ◽  
Toshiaki Mishima ◽  
Hirotoki Ohkubo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Pain Score ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Intramural Haematoma ◽  
Watch And Wait ◽  
Significant Difference

Abstract OBJECTIVES In this study, we investigated the early and midterm outcomes of initial watch-and-wait strategy for Stanford type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta in patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection in the ascending aorta. METHODS Inpatient and outpatient records were retrospectively reviewed. RESULTS Of the 81 patients with type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta between April 2011 and April 2019, a watch-and-wait strategy was selected in 46 patients. The mean age of the patients was 68 years, and 22 (48%) patients were female. Ten patients underwent emergency pericardial drainage for cardiac tamponade at the time of presentation and 8 patients underwent aortic repair during hospitalization for new ulcer-like projection, re-dissection or rupture. In-hospital mortality occurred in 2 (4%) patients. During follow-up, survival at 1 and 2 years was 95% and 92%, respectively. There was no significant difference in survival or aortic events between patients in whom the watch-and-wait strategy and emergency surgical treatment were indicated. CONCLUSIONS The early and midterm outcomes of the initial watch-and-wait strategy were favourable for type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta in Japanese patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection. Further study is required to show the safety of this strategy.

Direct true lumen cannulation for type A aortic dissection (Samurai technique) in emergency scenarios

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
False Lumen ◽  
Arterial Occlusion ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Cannulation Site

Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the possible problems that may arise. In this video tutorial, we present a patient with acute type A aortic dissection who, after cardiopulmonary bypass with axillary arterial cannulation, developed a major complication: intraoperative malperfusion due to pressurization of the false lumen. The patient developed occlusion of the right coronary artery with electrocardiogram changes, inferior akinesia, and ventricular arrhythmias. Cerebral saturation was also significantly decreased. This scenario of acute malperfusion calls for immediate action. We proceeded to switch the cardiopulmonary bypass configuration from axillary to direct true lumen cannulation. This technique, also known as the Samurai technique, is feasible in most cases and advantageous in this emergency situation, allowing prompt reestablishment of adequate perfusion of the true lumen . Some authors even advocate more widespread use of this technique because it may ensure antegrade perfusion while avoiding progression of the dissection flap and reduce the rate of the most common complications of other cannulation sites such as plexus injury during axillary cannulation or cerebral embolization through mobilization of thrombi or calcification from femoral retrograde perfusion. This technique is useful in cases of circumferential dissection and in patients with relative contraindications for peripheral cannulation such as morbid obesity or peripheral arterial occlusion by atherosclerosis or by the dissection itself.

scholarly journals Surgical treatment of acute type A aortic dissection

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 192
Author(s):  
Juozas Sakalauskas ◽  
Šarūnas Kinduris ◽  
Rimas Benetis ◽  
Saulius Giedraitis ◽  
Povilas Jakuška ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cardiopulmonary Bypass ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Cardiogenic Shock ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection. Patients and methods. A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6±102.9 min. The mean aortic cross-clamp time was 114.5±62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4±18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17–28°C (mean, 18.9±1.95°C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1±2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. During postoperative period, cardiogenic shock of various degrees was seen in 7 (18.4%) patients. Central nervous system injury occurred in 9 (23.7%) patients. Conclusion. The main risk factor for acute aortic dissection is the diameter of the aorta exceeding 4 cm (diagnosed in 73.7% of cases). The main postoperative complications are bleeding (42.1%), injuries of central nervous system (23.7%), and cardiogenic shock (18.4%).

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