A Case of Stanford Type A Aortic Dissection Complaining Only of Headache With a History of Migraine

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

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Natural history of the false channel of type A aortic dissection after surgical repair: CT study.

Radiology ◽

10.1148/radiology.170.3.2916028 ◽

1989 ◽

Vol 170 (3) ◽

pp. 743-747 ◽

Cited By ~ 27

Author(s):

T Yamaguchi ◽

D F Guthaner ◽

L Wexler

Keyword(s):

Natural History ◽

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Type A Aortic Dissection ◽

History Of

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A Widened Mediastinum in an Asymptomatic Man With a Remote History of Repaired Type-A Aortic Dissection

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2013.08.017 ◽

2014 ◽

Vol 28 (4) ◽

pp. 1167-1170

Author(s):

Melinda McFarland-Kennedy ◽

Ghulam Murtaza ◽

G. Hossein Almassi ◽

Zahir A. Rashid ◽

Paul S. Pagel

Keyword(s):

Aortic Dissection ◽

Type A ◽

Type A Aortic Dissection ◽

History Of

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Type a Aortic Dissection Presenting with Acute Lower Extremity Vascular Insufficiency in the Absence of Chest Pain

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s8042 ◽

2012 ◽

Vol 5 ◽

pp. OJCS.S8042

Author(s):

Thomas J. Earl ◽

Athena Poppas

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Lower Extremity ◽

Type A ◽

Type A Aortic Dissection ◽

Non Invasive ◽

Left Lower Extremity ◽

Vascular Insufficiency ◽

History Of ◽

Aortic Dissections

We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.

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Low arterial pressure on admission as a predictor of mortality in operated patients with type A aortic dissection

Vojnosanitetski pregled ◽

10.2298/vsp1105410p ◽

2011 ◽

Vol 68 (5) ◽

pp. 410-416 ◽

Cited By ~ 1

Author(s):

Katica Pavlovic ◽

Nada Cemerlic-Adjic ◽

Aleksandra Jovelic ◽

Dalibor Somer

Keyword(s):

Blood Pressure ◽

Aortic Dissection ◽

Arterial Hypertension ◽

Type A ◽

Left Ventricular ◽

Ascending Aorta ◽

Acute Type ◽

Type A Aortic Dissection ◽

History Of ◽

Aorta Diameter

Background/Aim. Hypertension is a known predictor of proximal aortic dissection, but it is not commonly present in these patients on presentation. The associations between ascending aorta with left ventricular hypertrophy, cardiovascular risk factors and coronary atherosclerosis, and outcome of these patients are not fully elucidated. Methods. This retrospective study included 55 consecutive patients with acute type A aortic dissection treated surgically in our institution during the last 2 years. The diagnosis was based on imaging studies. Diameter of ascending aorta was measured with echocardiography. Results. The mean age of the patients was 55.4 ? 12.19 years, and 72.7% were men. A history of arterial hypertension was present in 76.4% of the patients. Maximal ascending aorta diameter was 4.09 ? 0.59 cm, while patients with frank aneurysm accounted for 5.5%. Systolic blood pressure on admission was < 150 mmHg in 58.2% of the patients. Diastolic blood pressure on admission was < 90 mmHg in 54.5% of the patients. Mean arterial pressure on admission was 104.9 ? 24.6 mmHg. No correlations were demonstrated between maximal ascending aorta diameter and diameter of the left ventricular wall, any obtained risk factor and with coronary artery atherosclerosis (p > 0.05). After six months 11 (20%) patients died, while intrahospital mortality was 72%. According to logistic regression analysis which included traditional risk factors, echo parameters, coronary artery disease and logistic euro scor, mean arterial blood pressure was the independent predictor of a six-month mortality [RR 0.956; CI (0.918-0.994 ); p = 0.024]. Conclusion. In our population the acute type A aortic dissection occurred rarely in the setting of frank ascending aortic aneurysms > 5.0 cm. The majority of patients had a history of arterial hypertension. A history of arterial hypertension was not associated with maximal ascending aorta diameter. Mean arterial blood pressure was the independent predictor of a six-months mortality.

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Non-Traumatic Splenic Rupture After Open Surgery for Type A Aortic Dissection: A Case Report and Literature Review

The Heart Surgery Forum ◽

10.1532/hsf.2175 ◽

2020 ◽

Vol 23 (3) ◽

pp. E315-E317 ◽

Cited By ~ 1

Author(s):

Xudong Guo ◽

Xinyan Pang ◽

Zhengqin Liu

Keyword(s):

Aortic Dissection ◽

Splenic Rupture ◽

Type A ◽

Left Shoulder ◽

Severe Condition ◽

Type A Aortic Dissection ◽

Life Threatening ◽

History Of ◽

Intraperitoneal Bleeding ◽

Traumatic Splenic Rupture

Aortic dissection is a severe condition that involves a tear in the wall of the major artery carrying blood out of the heart (aorta). This cardiac disease has a high mortality, particularly Stanford type A, which involves the first part of the aorta. Aortic dissection is characterized by urgent onset, rapid progress, and poor outcome [Nienaber 2003; Mehta 2002]. Surgery is the most effective treatment. Although there have been remarkable recent advances in the understanding and management of various aspects of these complex surgeries, many potential complications remain. Non-traumatic splenic rupture is a rare postoperative complication of type A aortic dissection, and there are only a few published reports discussing this complication. Splenic rupture is a life-threatening cause of intraperitoneal bleeding and often is associated with the preexisting pathology of the spleen in the absence of trauma [Renzulli 2009]. Its manifestation is characterized by abdominal pain, left shoulder pain, and even shock. Because of the history of aortic dissection, physicians initially may suspect arterial rupture. In our report, we aim to present the possibility of splenic rupture as a complication of aortic dissection surgery and the need for immediate surgical intervention.

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