scholarly journals Postoperative Care of Two Patients With End-stage Heart Disease Combined With Type a Aortic Dissection

2021 ◽  
Author(s):  
Xiaofeng Xu ◽  
Yunqing Cheng ◽  
Juntao Kuang ◽  
Xuejun Xie ◽  
Jinsong Huang ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Dissection ◽  
Heart Transplantation ◽  
Type A ◽  
Acute Type ◽  
Donor Heart ◽  
Timely Manner ◽  
Type A Aortic Dissection ◽  
Life Threatening ◽  
End Stage

Abstract BackgroundHeart transplantation is a major method in the treatment of end-stage heart disease. Acute type A aortic dissection is a rare and life-threatening disease requiring emergency surgery. Although surgical treatment has achieved certain progress in terms of techniques and equipment in the recent years, the surgical mortality rate is still as high as 25%. It is very rare for patients with end-stage heart disease to simultaneously contract aortic dissection. This study will explore the main points of care after end-stage heart disease combined with aortic dissection.ResultsThe cold ischemic times of the donor heart of the two patients were 340 min and 361 min, and the cardiopulmonary bypass times were 381 min and 411 min. Both were successfully operated and discharged uneventfully. ConclusionsThe combination of heart transplantation with aortic dissection surgery is complicated and is prone to multiple postoperative complications. The nursing staff is required to master the main points of care after heart transplantation and aortic dissection, observe problems in a timely manner, intervene early, and promote the patient’s recovery.

scholarly journals Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

Aorta ◽  
2018 ◽  
Vol 06 (01) ◽  
pp. 034-036
Author(s):  
Fabio Ramponi ◽  
Theone Papps ◽  
James Edwards
Keyword(s):  
Pulmonary Embolism ◽  
Aortic Dissection ◽  
Type A ◽  
Management Plan ◽  
Acute Onset ◽  
Correct Identification ◽  
Acute Type ◽  
Pulmonary Embolectomy ◽  
Type A Aortic Dissection ◽  
Life Threatening

AbstractPatients presenting with acute onset of chest pain require prompt diagnosis and rapid establishment of a management plan. Acute aortic dissection and acute pulmonary embolism are life-threatening emergencies that can mimic each other at presentation. Correct identification of this uncommon scenario is crucial to initiate the appropriate interventions. The authors present a unique case of concomitant acute type A aortic dissection and acute saddle pulmonary embolism; the patient underwent successful aortic repair and pulmonary embolectomy.

scholarly journals Type A aortic dissection in a young 37 weeks pregnant lady successfully treated by Bentall procedure: A case report

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Rehan Shahid ◽  
◽  
Adnan Izhar ◽  
Ali Husnain ◽  
Anum Sohail ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Post Partum ◽  
Type A ◽  
Acute Type ◽  
Third Trimester ◽  
Type A Aortic Dissection ◽  
Bentall Procedure ◽  
Period 2 ◽  
Life Threatening ◽  
Sporadic Cases

Aortic dissection is intimal tear in aorta and collection of blood in between the layers of aortic wall. The incidence of acute type A aortic dissection is between 2.1 and 16.3 per 100,000 persons [1]. Aortic dissection is an infrequent but potentially life threatening complication of pregnancy with most of the cases occurring in third trimester and post-partum period [2]. The most important predisposing factors to aortic dissection are Marfan, Ehlers-Danlos, Turner and Loeys-Dietz syndromes [3]. However, the non sporadic cases can also occur in pregnancy [4].

scholarly journals Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Xuan Jiang ◽  
Enyi Shi ◽  
Ruixin Fan ◽  
Ximing Qian ◽  
Hongjia Zhang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Antiplatelet Therapy ◽  
Type A ◽  
Coronary Intervention ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Before And After ◽  
Life Threatening ◽  
Immediate Surgery

Background: Acute type A aortic dissection(ATAAD) is life-threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as acute coronary syndrome and may lead to subsequent antiplatelet therapy. We used the Chinese Acute Aortic Syndrome Collaboration Database (AAS) to study the effects of antiplatelet therapy (APT) on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching, the incidence of complications and mortality was compared between APT and non-APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non-APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non-APT group. We found 10 cases with percutaneous coronary intervention in the APT group(33.3%). The APT group received more volume of packed red blood cell (RBC), 8.4±6.05 units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92 units). The drainage volume was much more in the APT group( 5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs 10%, P=0.027). The preoperative APT was independent predictor of mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT prior to ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient’s status and the surgeon’s experience.

scholarly journals Case Report: Are We Witnessing an Increase of Chronic Ascending Aortic Dissection as a Collateral Effect to the COVID-19 Pandemic?

2021 ◽  
Vol 8 ◽  
Author(s):  
Arnaud Lyon ◽  
Ziyad Gunga ◽  
Lars Niclauss ◽  
Valentina Rancati ◽  
Piergiorgio Tozzi
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Ct Scan ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Delayed Treatment ◽  
Lower Limb Pain ◽  
Life Threatening

Background: The COVID-19 (coronavirus disease 2019) pandemic is reducing health care accessibility to non–life-threatening diseases, thus hiding their real incidence. Moreover, the incidence of potentially fatal conditions such as acute type A aortic dissection seems to have decreased since the pandemic began, whereas the number of cases of chronic ascending aortic dissections dramatically increased. We present two patients whose management has been affected by the exceptional sanitary situation we are dealing with.Case report: A 70-year-old man with chest pain and an aortic regurgitation murmur had his cardiac workup delayed (4 months) because of sanitary restrictions. He was then diagnosed with chronic type A aortic dissection and underwent urgent replacement of ascending aorta and aortic root. The delay in surgical treatment made the intervention technically challenging because the ascending aorta grew up to 80 mm inducing strong adhesions and chronic inflammation. The second case report concerns a 68-year-old woman with right lower-limb pain who was diagnosed with deep vein thrombosis. However, a CT scan to exclude a pulmonary embolism could not be realized until 5 months later because of sanitary restrictions. When she eventually got the CT scan, it fortuitously showed a chronic dissection of the ascending aorta. She underwent urgent surgery, and the intervention was challenging because of adhesions and severe inflammation.Conclusion: Delayed treatment due to sanitary restrictions related to COVID-19 pandemic is having a significant impact on the management of potentially life-threatening conditions including type A aortic dissection. We should remain careful to avoid COVID-19 also hitting patients who are not infected with the virus.

scholarly journals Shone’s Complex and Aortic Dissection: Case Report and Review of a Rare, Underdiagnosed Congenital Heart Disease

2021 ◽  
Author(s):  
Steven Sinfield ◽  
Sachini Ranasinghe ◽  
Stephani Wang ◽  
Fernando Mendoza ◽  
Ali Khoynezhad
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aortic Dissection ◽  
Atrial Flutter ◽  
Congenital Heart ◽  
Type A ◽  
Left Ventricular ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Patient Prosthesis Mismatch

Abstract BackGround Shone’s complex is a rare congenital heart disease consisting of a variety of left ventricular inflow and outflow tract lesions. Patients typically present in childhood and require early surgical intervention. However, with improved surgical techniques these patients are surviving later into adulthood which comes with a new set of medical complications providers need to be aware of. Case Presentation We present a case of a patient with a complex cardiac history including an incomplete Shone’s complex diagnosed in childhood with multiple surgical interventions who presents with persistent symptomatic atrial flutter and a type A aortic dissection in the setting of severe patient prosthesis mismatch. The patient was being followed outpatient for an enlarging chronic aortic aneurysm and was non-compliant with his medications when he presented with sharp chest pain radiating to his back. He was found to have an acute type A aortic dissection and was taken emergently to the operating room for a skirted Bentall procedure, aortic valve replacement, and right sided MAZE. Conclusions Shone’s complex is a rare congenital heart disease associated with significant morbidities in adulthood, such as atrial flutter, patient prosthesis mismatch, and aortic dissection. As patients continue to live longer into adulthood with this disease, it is important to raise awareness of this rare syndrome for providers and highlight its potential complications. Further research is needed to determine appropriate guidelines for when to intervene on aortopathy-associated CHD.

scholarly journals Management of acute type A aortic dissection with acute lower extremities malperfusion

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Dong Hoon Kang ◽  
Jong Woo Kim ◽  
Sung Hwan Kim ◽  
Seong Ho Moon ◽  
Jun Ho Yang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Management Strategy ◽  
Lower Extremities ◽  
Type A ◽  
Acute Type ◽  
Case Presentation ◽  
Type A Aortic Dissection ◽  
Life Threatening ◽  
Distal Perfusion

Abstract Background Acute type A aortic dissection complicated by malperfusion is a life – threatening emergency. The optimal management strategy for malperfusion remains controversial. Case presentation A 46-year-old man presented to another institution with acute type A aortic dissection with abdominal aorta occlusion. Motor and sensory grade of both lower extremities were zero. Immediate antegrade distal perfusion of both lower extremities was achieved, and total arch replacement with left axillo-bifemoral bypass was performed. At the time of discharge, motor and sensory grades of both lower extremities were 2 and 3, respectively. Conclusion This case demonstrates many of the techniques in the management of acute type A aortic dissection with abdominal aorta occlusion. In this case, direct antegrade perfusion of both lower extremities and axillo-bifemoral bypass may be helpful for patients presenting with severe malperfusion of both lower extremities with acute type A aortic dissection.

State of the Art Review: Surgical Treatment of Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Matteo Montagner ◽  
Markus Kofler ◽  
Karel Van Praet ◽  
Roland Heck ◽  
Semih Buz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Imaging Techniques ◽  
Type A ◽  
Acute Type ◽  
Organ Protection ◽  
Type A Aortic Dissection ◽  
Advanced Planning ◽  
Protection Strategies ◽  
Life Threatening

Acute type A aortic dissection (ATAAD) is a life-threatening event that requires immediate surgical treatment. Improvements in surgical treatment, graft technology, organ protection and imaging techniques have led to improved clinical outcomes. Individualized treatment concepts have emerged based on more advanced planning tools that allow for a tailored approach even in complex situations such as multi-level malperfusion. This review provides an overview of the current surgical treatment of ATAAD, focusing on new disease classifications, preoperative computed tomography angiography (CTA) assessment, new prosthesis and stent technologies, and organ-protection strategies.

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