Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

Download Full-text

Early Coronary Thrombosis without ST-Segment Elevation Following Repair of Acute Aortic Dissection

Aorta ◽

10.12945/j.aorta.2016.16.017 ◽

2016 ◽

Vol 04 (04) ◽

pp. 138-141

Author(s):

Davide Carino ◽

Francesco Nicolini ◽

Giorgio Romano ◽

Matteo Ricci ◽

Tiziano Gherli

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Coronary Thrombosis ◽

Rare Event ◽

Acute Type ◽

Type A Aortic Dissection ◽

St Segment Elevation ◽

St Segment ◽

Angioplasty And Stenting ◽

Emergent Surgery

AbstractAcute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting.

Download Full-text

Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽

10.1055/s-0041-1722897 ◽

2021 ◽

Vol 09 (01) ◽

pp. 030-032

Author(s):

Sergey Y. Boldyrev ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Drug Induced ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

Download Full-text

Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-1113329/v1 ◽

2021 ◽

Author(s):

Kayo Sugiyama ◽

Hirotaka Watanuki ◽

Masato Tochii ◽

Yasuhiro Futamura ◽

Yuka Kitagawa ◽

...

Keyword(s):

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Postoperative Results ◽

Entire Study ◽

Type A Aortic Dissection ◽

Actual Mortality ◽

Aortic Dissection Type A

Abstract Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

Download Full-text

Catheter directed diagnosis of ST-segment elevation myocardial infarction induced by type A aortic dissection

Medicine ◽

10.1097/md.0000000000018796 ◽

2020 ◽

Vol 99 (3) ◽

pp. e18796

Author(s):

Chi-Yao Huang ◽

Yu-Po Hung ◽

Tzu-Hsiang Lin ◽

Szu-Ling Chang ◽

Wen-Lieng Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Aortic Dissection ◽

Type A ◽

Type A Aortic Dissection ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Download Full-text

Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa197 ◽

2020 ◽

Vol 58 (5) ◽

pp. 1027-1034 ◽

Cited By ~ 1

Author(s):

Raphaelle A Chemtob ◽

Simon Fuglsang ◽

Arnar Geirsson ◽

Anders Ahlsson ◽

Christian Olsson ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Pericardial Tamponade ◽

Acute Type ◽

Aortic Arch Replacement ◽

Type A Aortic Dissection ◽

Total Aortic Arch Replacement ◽

Cerebral Malperfusion ◽

Mortality Hazard Ratio

Abstract OBJECTIVES Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 0.001). CONCLUSIONS Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

Download Full-text

Impact of reduced left ventricular function on repairing acute type A aortic dissection

Medicine ◽

10.1097/md.0000000000012571 ◽

2018 ◽

Vol 97 (38) ◽

pp. e12571

Keyword(s):

Aortic Dissection ◽

Left Ventricular Function ◽

Ventricular Function ◽

Type A ◽

Left Ventricular ◽

Acute Type ◽

Type A Aortic Dissection

Download Full-text

Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.09.005 ◽

2005 ◽

Vol 129 (1) ◽

pp. 112-122 ◽

Cited By ~ 328

Author(s):

Santi Trimarchi ◽

Christoph A. Nienaber ◽

Vincenzo Rampoldi ◽

Truls Myrmel ◽

Toru Suzuki ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

International Registry ◽

Results Of Surgery

Download Full-text

Successful Treatment of Acute Type A Aortic Dissection with Intestinal Necrosis.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.31.347 ◽

2002 ◽

Vol 31 (5) ◽

pp. 347-349

Author(s):

Yoshitsugu Nakamura ◽

Motomi Ando ◽

Osamu Tagusari ◽

Hitoshi Ogino ◽

Hiroaki Sasaki ◽

...

Keyword(s):

Aortic Dissection ◽

Successful Treatment ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Intestinal Necrosis

Download Full-text

Type A Aortic Dissection Masquerading as an Inferior Myocardial Infarction

Aorta ◽

10.1055/s-0041-1732396 ◽

2021 ◽

Vol 09 (05) ◽

pp. 184-185

Author(s):

Azhar Hussain ◽

Alessia Rossi ◽

Alexander Smith ◽

Ana Lopez-Marco ◽

Amina Khalil ◽

...

Keyword(s):

Myocardial Infarction ◽

Aortic Dissection ◽

Clinical Manifestations ◽

Type A ◽

Type A Aortic Dissection ◽

St Segment Elevation ◽

Presenting Symptoms ◽

St Segment ◽

Wide Range ◽

Threatening Condition

AbstractType A aortic dissection is a life-threatening condition with a wide range of clinical manifestations. Dissection can sometimes mimic an acute myocardial infarction due to similar presenting symptoms and initial clinical investigations. We report the case of a 52-year-old male who presented with an inferior ST-segment elevation myocardial infarction with two drug-eluting stents inserted as a stabilizing intervention prior to surgical repair of an acute aortic dissection.

Download Full-text