Effects of Gender on Outcomes and Survival Following Repair of Acute Type A Aortic Dissection

Previous studies have demonstrated gender-related differences in early and late outcomes following type A dissection diagnosis. However, it is widely unknown whether gender affects early clinical outcomes and survival after repair of type A aortic dissection. The goal of this study was to compare the early and late clinical outcomes in women versus men after repair of acute type A aortic dissections.Between January 2000 and October 2010 a total of 251 patients from four academic medical centers underwent repair of acute type A aortic dissection. Of those, 79 were women and 172 were men with median ages of 67 (range, 20–87 years) and 58 years (range, 19–83 years), respectively (p < 0.001). Major morbidity, operative mortality, and 10-year actuarial survival were compared between the groups.Operative mortality was not significantly influenced by gender (19% for women vs. 17% for men, p = 0.695). There were similar rates of hemodynamic instability (12% for women vs. 13% men, p = 0.783) between the two groups. Actuarial 10-year survival rates were 58% for women versus 73% for men (p = 0.284).Gender does not significantly impact early clinical outcomes and actuarial survival following repair of acute type A aortic dissection.     

Difficulty Diagnosing Retrograde Type A Aortic Dissection with Intramural Hematoma and Risk of Re-dissection and Rupture: A Report of Two Cases

Acute type A aortic dissection is a potentially fatal disease, and emergency surgery should be considered when it is diagnosed. We herein report two cases of retrograde type A aortic dissection with intramural hematoma, followed by re-dissection, rupture, and cardiac tamponade. The diagnoses in these cases had to be made carefully, as the false lumen of the ascending aorta was sometimes unclear on contrast-enhanced computed tomography.     

Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Aortic Dissection Rupture into Right Ventricular Outflow Tract: A Case Report and Review of the Literature

We present a case of chronic ascending thoracic aortic dissection with rupture into the right ventricular outflow tract (RVOT) diagnosed by two-dimensional transthoracic echocardiogram in which live/real time three-dimensional (3D) transthoracic echocardiogram provided incremental value by demonstrating: (a) a tortuous false lumen that encroached and ruptured into the RVOT, (b) exact location of the rupture site in relation to other surrounding structures in 3 dimensions (c) en face view of the rupture site facilitating assessment of its size and shape, and (d) localized compression of the main pulmonary artery (PA) by the false lumen. In addition, cropping of the 3D data set permitted visualization of the origin of the left main coronary in a rapid manner excluding involvement of this vessel with the dissection process. These findings have potential implications for surgical planning and were corroborated by a computed tomography angiogram. We summarize seven previously reported aortic dissection cases with rupture into the right ventricle .     

Onset of Aortic Dissection Complicated with Cushing's Disease: A Case Report and Review of the Literature

Cushing''s syndrome and Cushing''s disease cause various metabolic disorders associated with high cortisol levels. Some reports have shown that Cushing''s syndrome is complicated with dissecting aortic aneurysm and aortic dissection after long-term exposure to high cortisol levels. We herein report a rare case of aortic dissection complicated with Cushing''s disease. Aortic dissection may occur even under relatively short periods of high cortisol conditions. This case suggests that hypercortisolemia should be treated as soon as possible in order to prevent aortic dissection in subjects with Cushing''s disease.     

Percutaneous Endovascular Repair of Abdominal Aortic Aneurysm with Coexisting Horseshoe Kidney: Technical Aspects and Review of the Literature

Surgical repair of abdominal aortic aneurysms (AAAs) with coexisting horseshoe kidney (HSK) is technically challenging because of complex anatomy. Endovascular repair has emerged as a common approach to AAA repair and represents a valid alternative in selected patients with AAA and concomitant congenital renal anomalies. We report a case of successful percutaneous endovascular repair in a patient with coexistent AAA and HSK. Careful preoperative planning is essential in successful endovascular management of abdominal aneurysms in these patients.     

系统性红斑狼疮合并主动脉夹层1例及文献复习

目的:探讨系统性红斑狼疮(SLE)合并主动脉夹层(AD)患者的临床特点,夹层形成的病理生理机制及本病的治疗.方法:分析我院收治的1例SLE合并AD以及1969年至今的国内外文献报道共29例.结果:29例中大多为中青年,长期服用激素治疗,大多数伴有高血压.按Stanford分型A型19例,手术治疗8例,全部存活;保守治疗11例,均死亡.B型10例,手术治疗5例(包括1例介入治疗),存活3例;保守治疗5例,存活1例.结论:长期激素治疗、SLE相关的高血压、动脉粥样硬化共同促进了AD的发生.手术治疗的存活率明显高于保守治疗者.     

Refractory Asthma Coexisting with a Double Aortic Arch: A Case Report and Literature Review

Asthma that is poorly controlled despite adequate treatment should be investigated for medication compliance, treatment adherence, environmental control, asthma mimics, and comorbidities especially in infants and young children. Here, the case of a 2-year-old child with refractory asthma coexisting with a double aortic arch is reported.     

Quadricuspid Aortic Valve: A Case Report and Review of the Literature

The quadricuspid aortic valve (QAV) is a rare malformation; often isolated, sometimes associated with other heart diseases. Before the era of echocardiography, the diagnosis was made incidentally at autopsy or during surgery of valve replacement. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic approach is suitable for the diagnosis but, transesophageal echocardiography is a tool for the accurate definition of the valve anatomy. This review analyzes, after the presentation of a clinical case, the current knowledge on embryogenesis, classification, diagnosis and clinical course of QAV.     

Rupture of a Giant Popliteal Artery Aneurysm,Associated with Type III Aortic Dissection: A Case Report

Popliteal artery aneurysms are the most common peripheral artery aneurysms. We present a case of rare combination of chronic aortic dissection type III and rupture of a giant popliteal aneurysm in 74 years old patient. We ligated the ruptured popliteal aneurysm with interposition of PTFE 8/5 prosthesis with a distal venous ‘cuff’. Postoperatively, the patient had palpable pedal pulses. He was discharged on the twenty-third postoperative day not on anticoagulant therapy because of the chronic aortic dissection type III, but on aspirin.