This technique consists of performing distal fenestration of dissection flap, induced by balloon dilation of an uncovered aortic stent in the visceral aorta. This tear microscopically revealed dissection through the media, as seen below the center arrow, as well as dissection into the outer media, as seen at the upper left arrow. Abdominal aortic dissections are similar to thoracic dissections in their presentation, with acute shearing. Rare presentation of acute aortic dissection in a family. Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis. We report a typical case of severe ar with intimal. To propose a classification system based on the position and extension of the intimal flap to assist in the endovascular repair of aortic dissection complicated by a malperfusion syndrome. Tears in the intimal layer result in the propagation of dissection proximally or distally secondary to blood entering the intimamedia space. Open fenestration for complicated acute aortic b dissection acute type b aortic dissection abad is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. B computed tomography scan of the head and neck showing an acute aortic dissection of the ascending thoracic aorta.
Nov 09, 2018 aortic dissection essentially features a tear in the intimal layer, followed by the formation and propagation of a subintimal hematoma. We compared longterm outcomes of aada repaired with a root replacement versus a supracoronary tube graft, regardless of the proximal extent of the intimal tear. Asymmetric thickening of the right coronary cusp secondary to. The condition most frequently occurs in men in their 60s and 70s. Echocardiographic findings mimicking type a aortic dissection. Partial thrombosis of the false lumen in patients with. Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation. John libbey eurotext sang thrombose vaisseaux results. A man underwent an operation for type a aortic dissection. Relationship of intimal flap position to endovascular.
The lesions exhibit low attenuation in relation to the aortic lumen on postcontrast ct and can be far more subtle, hence a noncontrast phase before cta is often done in an acute aortic syndrome protocol. Aortic dissection is a lifethreatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation dissection of the layers of. Mortality is still high despite advances in diagnostic and therapeutic modalities. Open fenestration for complicated acute aortic b dissection. John libbey eurotext sang thrombose vaisseaux results of. At autopsy, the pericardial cavity was opened to reveal 300 ml of clotted and 330 ml of liquid blood that produced cardiac tamponade. Demers p, miller dc 2004 surgery of the aortic arch, descending thoracic and thoracoabdominal surgery, and aortic dissection. We compared longterm outcomes of aada repaired with a root replacement versus a supracoronary tube graft, regardless of. Aortopulmonary fistula is an exceedingly rare complication of aortic dissection.
Pdf summary aortic dissection is defined as the separation of the layers within the aortic wall. The heart weighed 350 gm and the coronary arteries showed. Iatrogenic aortic dissections ads that are localized a few centimetres beyond the aortic valve may be treated by sealing the entry point by means of. Aortic dissections limited to the abdominal aorta occur infrequently. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. Comparison of outcomes of root replacement procedures and supracoronary techniques for surgical repair of acute aortic dissection. John libbey eurotext sang thrombose vaisseaux role of. Between 2015 and november 2017, seven patients with marfan syndrome were treated with the stabilise endovascular technique for type b acute aortic dissection. At surgery, a fistula was discovered between the false lumen and the main pulmonary artery. However, when an aortic dissection is detected early and treated promptly, the chance of survival greatly improves. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second bloodfilled channel within the wall.
Successful endovascular treatment of iatrogenic coronary. A recent study identified rupture as the cause of death in approximately onethird of affected patients admitted to the hospital, although the rate of nonfatal rupture may be considerably higher 1, 2. This blood emanated from an area on adventitia of posterior aortic arch. A standard electrocardiogram showing lateral cardiac ischemia. Surgical approach to type a acute aortic dissection aada is usually dictated by the presenting anatomy. It may extend proximally closer to the heart or distally away from the heart or both. Acute type b aortic dissection abad is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Aortic dissection essentially features a tear in the intimal layer, followed by the formation and propagation of a subintimal hematoma.
Coronary artery dissection is a wellknown complication of coronary angiography and angioplasty. Intimal flap aortic dissection rr school of nursing. Comparison of outcomes of root replacement procedures and. Gaxotte v, cocheteux b, haulon s 2003 relationship of intimal flap position to endovascular. At surgery, a fistula was discovered between the false lumen and the main. However, it is possible that pulmonary embolism first occurs and leads to aortic dissection by the anxiety that it causes in the patient in addition to the pain and dyspnea. At surgery there was a circumferential intimal tear in the aortic root, and an intussuscepted dissection flap was retrieved from the arch and descending aorta. Aortic regurgitation ar with intimal intussusception, secondary to aortic dissection, is relatively rare and the images are interesting findings. Only 4 cases in acute dissection and 8 cases in the chronic one have been published previously. Les syndromes aortiques aigus regroupent les dissections aortiques, les. Unlike aortic dissection, no intimal flap is present on the cta. Aortic dissection is a lifethreatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the.
It is defined as a separation within the coronary arterial wall secondary to intramural bleeding with or without intimal tear, creating a false channel. Classification et etiologie des syndromes aortiques aigus. Due to the high pressures in the aorta, blood enters the media at the point of the tear. The movement of the intimal flap depends on the extent of separation and the blood flow dynamics in the true. The accuracy of transesophageal echocardiography for ancillary findings of aortic dissection intimal flap, fenestration and thrombosis was assessed in the 60 patients with available surgical data.
Aortic intramural hematoma radiology reference article. Pdf africa unusual complication of aortic dissections. The aorta demonstrated marked atherosclerosis, including the arch and thoracic portion, as well as abdominal aorta. The initiating event in an aortic dissection is a tear in the intimal lining of the aorta. The incidence of aortic dissection has been reported. Infrequently, iatrogenic coronary dissection may result in retrograde extension into the ascending aorta and further. Severe aortic regurgitation with intimal intussusception. Elles representent une complication relative ment frequente des. However, in most of these studies, researchers considered only the location of the intimal tear and not the extent of flap propagation. Jan 08, 2019 aortic dissection see the image below is defined as separation of the layers within the aortic wall.
Asymmetric thickening of the right coronary cusp secondary to psoriatic aortitis was found to. Aortic dissection is the most common acute emergency condition of the aorta, often resulting in the death of the patient. Dissection aortique aigue igeneralites iicauses iiianatomopathologie ivdiagnostic positif vdiagnostic differentiel vihistoire naturelle et evolution viitraitement generalites 1definition. The management of localized abdominal aortic dissections. The dissecting hematoma commonly occupies up to 50% and, occasionally, 100% of the aortic circumference, leading to the development of a false lumen or doublebarreled aorta. Le flap intimal peut egalement obstruer lorigine du tronc supra aortique. In general, surgical management of dissections is not based on the site of the intimal tear but rather on the most cephalic extension of the dissection flap 18. The intimal flap is resected proximally in a triangular shape to maximize. Note the large false lumen f, small true lumen t, intimal flap arrow. Comparison of outcomes of root replacement procedures and supracoronary techniques for surgical repair of acute aortic dissection background. Spontaneous coronary artery dissection scad is a rare cause of acute coronary syndrome acs. The third mechanism is that if there was an extensive intimal tear, the intimal flap may prolapse into the lv outflow tract, causing intimal intussusception into the aortic valve preventing proper valve closure.