scholarly journals Transcatheter Closure of Anastomotic Leakage of Aortic Root after Aortic Surgery for Type A Dissection: Two Case Reports

2021 ◽  
Author(s):  
Lin Song ◽  
Yiran Zhang ◽  
Binyu Zhou ◽  
Xiaozhou Zheng ◽  
Peixuan Shi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Anastomotic Leakage ◽  
Aortic Root ◽  
Transcatheter Closure ◽  
Case Reports ◽  
Aortic Surgery ◽  
Clinical Manifestations ◽  
Early Detection Of Disease ◽  
Type A Dissection ◽  
Early Effects

Abstract Background: Anastomotic leakage of postoperative aortic dissection is an intractable complication with different clinical manifestations. It is important to detect and manage anastomotic leakage in a timely manner. This case report describes 2 patients who were admitted to the hospital with different clinical manifestations and were diagnosed with aortic root anastomotic leakage through imaging. Both patients received transcatheter closure treatment with definite early effects.Case presentation: Two middle-aged women with aortic root anastomotic leakage who were admitted with different clinical manifestations and received transcatheter closure.Conclusion: Paying attention to the clinical manifestations and imaging diagnosis of patients after aortic dissection surgery is important for early detection of disease progression. Transcatheter closure can be used as an alternative treatment who cannot tolerate secondary thoracotomy due to its small trauma and exact efficacy in the near and medium terms, but further follow-up is needed for long-term clinical outcomes.

Bentall–de Bono procedure for acute aortic dissection

2021 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Acute Type ◽  
Aortic Diseases ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.

scholarly journals Chronic Type A Aortic Dissection and Giant Aortic Root Aneurysm After Aortic Valve Replacement

Aorta ◽  
2016 ◽  
Vol 04 (03) ◽  
pp. 108-110 ◽  
Author(s):  
Andrés Enríquez Puga ◽  
Sara Castaño Rodríguez ◽  
Blanca Mateos Pañero ◽  
Beatriz Castaño Moreira ◽  
Luis Fernando López Almodóvar
Keyword(s):  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Surgery ◽  
Mechanical Valve ◽  
Type A ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Aortic Root Aneurysm ◽  
Valve Conduit ◽  
Type A Dissection

AbstractWe describe the case of a 61-year-old male with a giant aortic root aneurysm associated with chronic aortic Type A dissection. The patient had been operated on 16 years before due to aortic annuloectasia with mechanical valve replacement. The patient underwent revision aortic surgery with a Bentall-De Bono operation with Svensson modification, using a #21 On-X Valsalva mechanical valve conduit. The postoperative course was uneventful.

Abstract 18498: Description of Aortic Root Growth and Outcomes in a Cohort of Pediatric Patients with Loeys-Dietz Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nitya Viswanathan ◽  
Shaine A Morris
Keyword(s):  
Aortic Dissection ◽  
Root Growth ◽  
Aortic Root ◽  
Aortic Surgery ◽  
Genetic Mutation ◽  
Root Diameter ◽  
Adverse Outcomes ◽  
Rate Of Change ◽  
Z Score ◽  
Repeat Surgery

Background: Loeys Dietz Syndrome (LDS) is associated with rapid aortic dilation and aortic dissection, but data on children with LDS are limited. The goal of this study is to describe aortic root growth and outcomes in children with LDS. Methods: Patients with LDS were identified from an institutional database. Data regarding genetic mutation, medications, aortic root dimensions by transthoracic echocardiography (TTE), aortic dissection and surgical intervention were collected. For those with >2 TTEs 1 year apart, rate of change in z-score was calculated using linear regression. TTEs performed after aortic surgery were excluded. We examined if variables were associated with rate of aortic root growth. Results: Of 16 patients, 8 were female. Five had a TGFBR1 and 9 had a TGFBR2 mutation; 2 patients did not have genetic data available. Median aortic root Z-score at diagnosis was 3.5 (range 0.5-25.4). Fifteen patients were on medication (2 beta-blocker (BB), 5 angiotensin receptor blocker (ARB), 5 BB+ARB, and 3 with past use of both). Four patients underwent prophylactic root replacement at ages 3.3, 6.7, 8.7, and 9.4 years at root dimensions 3.2, 6.5, 4.0, and 4.1 cm respectively. One patient had a Type A dissection at age 15y after prior root replacement and underwent repeat surgery. Another underwent heart transplant at 6.9 years old after prior root replacement. Ten patients had serial TTE data. Median change in aortic root diameter and Z-score was 0.11cm/year and 0.1/year respectively. Mean change in z-score per year for those on on BB was -0.1± (range -1.2 to 0.7), ARB 0.5 (range 0.1 to 1.1) and both 0.0 (range -0.2 to 0.2, p=NS). No variables studied were associated with faster aortic growth. Conclusions: Degree of aortic root dilation and rate of aortic root growth is highly variable in children with LDS, although factors associated more aggressive disease are unclear. The high proportion of patients with adverse outcomes including aortic dissection and surgery is concerning.

scholarly journals Bicuspid Aortic Valve: Role of Multiple Gene Variants in Influencing the Clinical Phenotype

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Elena Sticchi ◽  
Rosina De Cario ◽  
Alberto Magi ◽  
Sabrina Giglio ◽  
Aldesia Provenzano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Rare Variants ◽  
Aortic Surgery ◽  
Genetic Diagnosis ◽  
Clinical Manifestations ◽  
Aortic Dilatation ◽  
Reduced Penetrance ◽  
Next Generation Sequencing Ngs

Background. Bicuspid aortic valve (BAV) is a common congenital heart defect with increased prevalence of aortic dilatation and dissection. BAV has an autosomal dominant pattern of inheritance with reduced penetrance and variable expressivity. BAV has been described as an isolated trait or associated with other clinical manifestations in syndromic conditions. Identification of a syndromic condition in a BAV patient is clinically relevant in order to personalize indication to aortic surgery. We aimed to point out how genetic diagnosis by next-generation sequencing (NGS) can improve management of a patient with complex BAV clinical picture. Methods and Results. We describe a 45-year-old Caucasian male with BAV, thoracic aortic root and ascending aorta dilatation, and connective features evocative but inconclusive for clinical diagnosis of Marfan syndrome (MFS). Targeted (91 genes) NGS was used. Proband genetic variants were investigated in first-degree relatives. Proband carried 5 rare variants in 4 genes: FBN1(p.Asn542Ser and p.Lys2460Arg), NOTCH1(p.Val1739Met), LTBP1(p.Arg1330Gln), and TGFBR3(p.Arg423Trp). The two FBN1 variants were inherited in cis by the mother, showing systemic features evocative of MFS, but with a milder phenotype than that observed in the proband. Careful clinical observation along with the presence of the FBN1 variants allowed diagnosis of MFS in the proband and in his mother. NOTCH1 variant was found in mother and brother, not exhibiting BAV, thus not definitely supporting/excluding association with BAV. Interestingly, the proband, his brother and father, all showing root dilatation, and his sister, with upper range aortic root dimension, were carriers of a TGFBR3 variant. LTBP1 might also modulate the vascular phenotype. Conclusions. Our results underline the usefulness of NGS together with family evaluation in diagnosis of patients with monogenic traits and overlapping clinical manifestations due to contribution of the same genes and/or presence of comorbidities determined by different genes.

scholarly journals Pregnancy after Aortic Root Replacement in Marfan's Syndrome: A Case Series and Review of the Literature

2018 ◽  
Vol 08 (04) ◽  
pp. e234-e240 ◽  
Author(s):  
Dominique Williams ◽  
Kathryn Lindley ◽  
Melissa Russo ◽  
Jennifer Habashi ◽  
Harry Dietz ◽  
...  
Keyword(s):  
Literature Review ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Aortic Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Aortic Root Replacement ◽  
Marfan’S Syndrome ◽  
Marfan's Syndrome ◽  
Case Series Study

Objectives We sought to characterize pregnancy-related aortic complications in women with Marfan's syndrome who had prior aortic root replacement. Study Design This is a retrospective case series study and literature review of women with Marfan's syndrome with pregnancy after aortic root replacement. We surveyed women with Marfan's syndrome who had successful pregnancy after aortic root replacement using the Marfan Foundation Website and from two large tertiary care Marfan's clinics. Clinical data, counseling information, and details of pregnancy-related aortic complications were compiled. A literature review was performed assessing aortic outcomes in women with Marfan's syndrome with pregnancy after aortic surgery. Results Fourteen women with 20 pregnancies were identified. Two women had three pregnancies following root replacement for aortic dissection. There were no aortic dissections during the 20 pregnancies. In contrast, aortic dissection was frequently reported in the literature. Conclusions Women with Marfan's syndrome who become pregnant following aortic root replacement remain at risk for distal aortic dissection related to pregnancy. The exact risk is difficult to quantify but is not zero and women should be counseled accordingly.

Abstract 13504: Timely Recognition and Successful Clinical Outcome of an Acute Debakey Type I Aortic Dissection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dakshin Gangadharamurthy ◽  
Muhammad M Furqan ◽  
Allan L Klein ◽  
Saurabh Malhotra ◽  
Rachel Harrison ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Care Facility ◽  
Type I ◽  
Malperfusion Syndrome

Background: Acute Aortic dissection is a critical etiology of chest pain with very high mortality. 1% to 2% of patients die per hour during the initial 24 to 48 hours. Case: A 62 year old lady with history of diabetes, hypertension, hyperlipidemia, hypothyroidism, smoking and no pertinent family history presented with atypical chest pain. She remained hemodynamically stable with no discrepancy of BP between arms. Labs: troponin 0.64, 0.63 ng/ml. EKG: sinus bradycardia. Chest x-ray: no mediastinal widening or signs of aortic aneurysm. Coronary angiogram showed 20-30 % stenosis in left anterior descending and right coronary arteries. An aortogram showed dilated aortic root over 6 cm with aortic regurgitation. Decision-making: An emergent echocardiogram confirmed acute aortic regurgitation and dissection. CT angiogram showed DeBakey type I aortic dissection extending from aortic annulus to infra renal aorta, supra aortic great vessels, celiac axis and left renal artery. She had no signs of malperfusion syndrome. She was started on iv Esmolol and emergently airlifted to tertiary care facility for surgical repair. Intra operative TEE showed findings consistent with acute aortic dissection. She had successful modified Bentall procedure with replacement of aortic valve, aortic root, ascending aorta and hemi arch. She had excellent recovery and continues to do well at follow up visits in our clinic. Conclusion: An early diagnosis of acute aortic dissection requires high index of suspicion due to variable symptoms and clinical manifestations. DeBakey type I aortic dissection may have better chance of survival in the absence of malperfusion syndrome if treated early as in this case.

scholarly journals High Failure Rate After Valve-sparing Aortic Root Replacement Using the “Remodeling Technique” in Acute Type A Aortic Dissection

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
Rainer G. Leyh ◽  
Stefan Fischer ◽  
Klaus Kallenbach ◽  
Theo Kofidis ◽  
Klaus Pethig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Aortic Root Replacement ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Type A Dissection ◽  
Valve Sparing

Background Valve-sparing surgery including the replacement of the sinus of valsalvae were initially meant to be promising approaches in the treatment of acute type A aortic dissection. However, the long-term outcome after valve-sparing aortic root replacement in acute type A dissection is currently the subject of intense debate, and the evidence reported in the literature is sparse. Here we report on our experience on valve sparing aortic root replacement inpatients with acute type A dissection. Methods From August 1995 to November 2000, 30 patients with acute type A dissection received valve-sparing aortic root replacement. Two different techniques were performed: the “remodeling” technique, first described by Yacoub in 1983 (8 patients) and the “reimplantation” technique, initially described by David and Feindel, in 1992 (22 patients). Endpoints of the study were early and late mortality, as well as aortic valve-related complications and reoperations. Results The mean follow-up time was 22.6±15.4 months. The overall 30 day mortality was 17% (5/29) and the late mortality 4% (1/24). During the observation period, 4 patients had to be reoperated (n=3) for acute aortic valve regurgitation after aortic root remodeling and for acute aortic valve endocarditis (n=1) after aortic root reimplantation. In the 3 patients with acute aortic valve regurgitation, symptoms occurred 44, 24, and 17 months after the initial operation in these patients. Intraoperatively prolapsing aortic leaflets because of commissural detachment was found in all 3 cases. In all other patients the latest echocardiographic follow-up examination revealed freedom from aortic regugitation higher than grade 1. Conclusions The high failure rate of aortic root remodeling inpatients with acute type A aortic dissection is discouraging. Whether this technique should be applied in acute type A aortic dissection is questionable. In contrast, aortic root reimplantation lead to favorable midterm outcome. Thus, we recommend consideration of this technique for surgical treatment of patients with acute type A aortic dissection.

scholarly journals Improving Outcomes of Iatrogenic Type A Aortic Dissection during Cardiac Surgery

Aorta ◽  
2019 ◽  
Vol 07 (04) ◽  
pp. 115-120 ◽  
Author(s):  
Nicholas J. Shea ◽  
Antonio R. Polanco ◽  
Alex D'Angelo ◽  
Casidhe-Nicole Bethancourt ◽  
Joseph Sanchez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Dissection ◽  
Operative Mortality ◽  
Aortic Surgery ◽  
Clinical Manifestations ◽  
Coronary Bypass ◽  
Type A ◽  
Total Arch Replacement ◽  
Type A Aortic Dissection ◽  
Arterial Perfusion

Background Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a standardized approach to management. Methods From January 1, 2000 through December 31, 2016, 23,275 patients underwent cardiac surgery at our institution. We identified 15 patients who developed IAD. Our approach to management included (1) immediate repair, (2) involvement of a second attending surgeon, (3) aggressive monitoring of malperfusion, (4) securing true lumen arterial perfusion access and systemic cooling, and (5) performance of hemiarch or total arch replacement based on the presence of suspected brain malperfusion. The index operation was also completed at the same time. Patient preoperative characteristics, operative sequence and technique, complications, and outcomes were analyzed with chart review. Results The incidence of IAD at our institution was 0.06% (n = 15). A disproportionate percentage of patients had aneurysmal ascending aortas (33.3%). The index surgery consisted of aortic surgery in five patients (33.3%), coronary bypass in three patients, valve surgery in five patients, and transplantation in one patient. The mechanism of dissection was aortic cannulation in 66.7% and aortic root vent site cannulation in 13.3%. In 46.7% of patients, the IAD was first recognized based on clinical evidence such as aortic hematoma, pericardial bleeding, or abnormal perfusion line pressures. In 40.0%, the diagnosis was made with intraoperative echocardiography without any clinical manifestations. The timing of the diagnosis was at the initiation of cardiopulmonary bypass initiation in 60.0%, while in 40.0% it was recognized after discontinuation of bypass. Hemiarch was done in 73.3% and total arch replacement performed in 13.3%. Isolated ascending repairs were done in two patients. Bypass and cross-clamp times were 229.5 ± 212.7 minutes and 130.5 ± 109.5 minutes, respectively. In-hospital mortality in our cohort was 6.7%. While stroke occurred in one patient, no visceral organ malperfusion was recognized. Conclusions Incidence of IAD is low with cannulation of an aneurysmal aorta being a risk factor. A standardized approach may result in reduced operative mortality.

scholarly journals Late complications of the Djumbodis system in patients with type A acute aortic dissection

2020 ◽  
Vol 31 (5) ◽  
pp. 704-707 ◽  
Author(s):  
Igor Vendramin ◽  
Daniela Piani ◽  
Andrea Lechiancole ◽  
Sandro Sponga ◽  
Massimo Sponza ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Case Reports ◽  
False Lumen ◽  
Type A ◽  
Suture Line ◽  
Late Complications ◽  
Metallic Stent ◽  
Specific Device ◽  
Type A Dissection

Abstract The Djumbodis system is a metallic stent designed to prevent false lumen dilatation after repair of acute aortic dissection. Although the exact number of Djumbodis stents inserted worldwide could not be ascertained from a review of the literature, available data indicate 9 specific device-related complications from 4 patient series and 3 case reports: stent deformity or fracture (4), progressive enlargement of the distal false lumen (3) and distal pseudoaneurysm (1); a further patient with pseudoaneurysm of the distal suture line is added from personal observation. The present review confirms the inability of the Djumbodis stent to provide reduction and/or elimination of the false lumen after repair of type A dissection, highlighting peculiar device-related complications. Current survivors with a Djumbodis stent should undergo close follow-up to prevent possible catastrophic events due to device failure.

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