scholarly journals ST Elevation in Lead aVR with Malperfusion Syndrome: Sign of Severe Aortic Dissection

2020 ◽  
Vol 15 (2) ◽  
pp. 297-305
Author(s):  
Azlan Helmy Abd-Samat ◽  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Lower Limb ◽  
Left Coronary Artery ◽  
Acute Limb Ischemia ◽  
Intimal Flap ◽  
Lead Avr ◽  
St Elevation ◽  
Malperfusion Syndrome

Aortic dissection presenting with ST elevation in lead aVR of electrocardiogram is strongly associated with mortality. It is also associated with dissection involving the root of aorta and coronary vessels. We report a case of young male with hypertension, who presented with severe chest pain and unilateral lower limb pain. Physical examination of the left lower limb was consistent with acute limb ischemia. Electrocardiogram revealed acute anterolateral myocardial infarction together with ST elevation in aVR. Bedside transthoracic echocardiography showed a dilated aortic root measuring 4.51 cm with presence of intimal flap which raised the suspicion of dissection of root of aorta and left coronary artery. Computed tomography angiogram revealed aortic dissection from the root of aorta including the intimal flap near the origin of the left coronary artery, down to common iliac extending to the left iliac artery. Unfortunately, the patient opted for non-surgical intervention and succumbed 48 hours later. This case highlights that in case of aortic dissection, which presents with malperfusion syndrome, the presence of ST segment elevation at lead aVR should raise the suspicion for extensive aortic dissection involving the aortic root and left coronary artery which signifies unfavourable outcome

scholarly journals “Sleeve” Sinus Valsalva Repair in Patients with Acute Type A Aortic Dissection

2020 ◽  
Author(s):  
Laichun Song ◽  
Yang Gao ◽  
Ming Xu ◽  
Bo Wang ◽  
Xiaoyong Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Coronary Sinus ◽  
Computed Tomography Angiography ◽  
Aortic Root ◽  
Acute Type ◽  
Sinus Of Valsalva ◽  
Type A Aortic Dissection ◽  
Left And Right

Purpose. The optimal surgical strategy of aortic root in acute type A aortic dissection (ATAAD) is controversial. The aim of this study was to evaluate the feasibility and safety of “Sleeve” sinus Valsalva repair for AAD limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia. Methods: From Sep 2016 to Mar 2019, 20 patients with AAD involving non-coronary sinus or partial left and right coronary sinus Valsalva underwent “Sleeve” sinus Valsalva repair . Multi slice spiral computed tomography angiography (MSCT) and three dimensional reconstruction were routinely performed in all patients to assess the maximal diameters of each segment of the aorta. Results. There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 1 patient and no bleeding was related to the proximal anastomosis. The post-operative drainage was 390.5±229.3mL. During the following-up, the echocardiography showed the normal sinus of Valsalva and aortic valvular function. The computed tomography angiography showed normal aortic root without endovascular leak or dissection around the sinus of Valsalva. All patients were free from reoperation. Conclusions. “Sleeve” sinus Valsalva repair with Dacron patch for aortic dissection limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia was technically feasible and safe.

Relief of Acute Lower Limb Ischemia with Percutaneous Fenestration of Intimal Flap in a Patient with Type III Aortic Dissection—A Case Report

Angiology ◽  
1993 ◽  
Vol 44 (9) ◽  
pp. 755-759 ◽  
Author(s):  
Noriyuki Kato ◽  
Hajime Sakuma ◽  
Kan Takeda ◽  
Tadanori Hirano ◽  
Tsuyoshi Nakagawa
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Intimal Flap ◽  
Type Iii

scholarly journals A Case of an Acute Type A Aortic Dissection with Left Coronary Artery Malperfusion that was Successfully Stented as a Bridge to Surgery

2021 ◽  
Vol 27 (2) ◽  
pp. 68-71
Author(s):  
Tatsuya Shigematsu ◽  
Hideki Okayama ◽  
Shinsuke Kido ◽  
Kenshou Matsuda ◽  
Tetsuya Aono ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Left Coronary Artery ◽  
Type A ◽  
Acute Type ◽  
Bridge To Surgery ◽  
Type A Aortic Dissection

scholarly journals Aortic root remodelling with external ring annuloplasty in acute type A aortic dissection

2019 ◽  
Vol 30 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Yasuyuki Kato ◽  
Kenichi Sasaki ◽  
Hidetaka Yamauchi ◽  
Yasuyuki Kanno ◽  
Taiyo Jinno ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
External Ring ◽  
Ring Annuloplasty

Abstract OBJECTIVES To investigate the early and mid-term results of aortic root remodelling with external ring annuloplasty in acute type A aortic dissection. METHODS From January 2015 to April 2019, a total of 194 patients underwent emergency or urgent operation for acute type A aortic dissection in our hospital. Of these, outcomes in 18 patients who underwent valve-sparing aortic root remodelling with external ring annuloplasty were retrospectively evaluated. RESULTS The mean age of the 18 patients was 49 ± 14 years. Fourteen patients (78%) were men. Five patients had Marfan syndrome and 2 patients had bicuspid aortic valve. Two patients had coronary malperfusion and 1 patient had cerebral malperfusion. All 18 patients underwent aortic root remodelling with external ring annuloplasty. Cusp repair using central cusp plication was required in 9 patients. Concomitant procedures were hemiarch replacement in 8 patients, total arch replacement in 7 patients, partial arch replacement in 1 patient and coronary artery bypass grafting to the right coronary artery in 3 patients. Thirty-day mortality rate was 5.6% (1 of 18). Postoperative echocardiography showed aortic regurgitation of <1+ in all patients. During follow-up (mean 56 ± 41 months), 1 case of recurrent aortic regurgitation required aortic valve replacement. CONCLUSIONS Aortic root remodelling with external ring annuloplasty may be an appropriate treatment in middle-aged or younger patients presenting with acute type A aortic dissection.

scholarly journals A case report of aortic root repair using a pericardial autograft for type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yi Chang ◽  
Hongwei Guo ◽  
Xiangyang Qian ◽  
Fang Fang
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Aortic Wall ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Root Repair ◽  
Coronary Ostia

Abstract Background Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues. Case presentation A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course. Conclusion Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.

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