Acute concomitant pulmonary artery and aortic dissection with rupture

Pulmonary artery (PA) dissection is uncommon and may lead to rupture and sudden death if encountered. A 63-year-old man presented to our emergency room with episodic left chest pain radiating to the back followed by shortness of breath. A 64-row multidetector computed tomography (MDCT) revealed ruptured dissection of the PA and the aorta with hemopericardium, hemomediastinum, and prominent extravasated blood along the central bronchovascular bundles of both lungs. The patient experienced cardiogenic shock immediately following CT study and died after resuscitation. Concomitant PA and aortic dissection with rupture is extremely rare with the pathogenesis remaining investigated. MDCT proves to be a powerful tool in its diagnosis for a timely surgical repair if the patient could survive to have the operation.     

Acute rupture of an aortic false aneurysm treated with a stent-graft.

PURPOSE: To report the use of an aortic endograft to treat a ruptured false aneurysm at the anastomosis of an aortofemoral bypass graft. METHODS AND RESULTS: A 68-year-old man with a 30-year-old aorto-right femoral bypass and multiple comorbidities was admitted to the hospital complaining of acute abdominal pain. Imaging identified a 60-mm ruptured aortic false aneurysm with associated retroperitoneal hematoma, a 9-cm right femoral false aneurysm, and a calcified 23-mm left common iliac aneurysm. Two slightly overlapping Vanguard straight stent-grafts were implanted in the aorta and left common iliac artery in an emergency procedure owing to the patient's high surgical risk. The anastomotic false aneurysm and the bypass were excluded. A left-to-right femorofemoral bypass was performed to re-establish flow to the right femoral artery with ligation of the external iliac artery. The patient recovered uneventfully. He remained well with a successful repair until his death of a myocardial infarction 6 months after the procedure. CONCLUSIONS: Endovascular grafting can be used successfully for the urgent treatment of aortic false aneurysm rupture.     

Acute aortic dissection

Acute aortic dissection is an uncommon but potentially catastrophic illness with high mortality. Significant advances in the understanding, diagnosis, and management have been made since the first reported case of aortic dissection 3 centuries ago. This comprehensive review discusses the pathophysiology, classification, clinical manifestations, early diagnosis, and management of this important cardiovascular emergency.     

Acute aortic dissection

Disease processes affecting the aorta are gaining increasing attention as average longevity of the population in this country increases and as awareness of conditions such as hypertension and atherosclerotic cardiovascular disease improves. Aortic dissection is commonly seen as a manifestation of these processes in the aging population and is the most common catastrophic illness affecting the aorta. Familiarity with its pathogenesis, diagnosis, and therapy is mandatory to prevent almost certain death if left untreated.     

彩色多普勒超声诊断小儿腹主动脉瘤1例

患儿男,10岁.咳嗽半个月突然并发剧烈腹痛.家长述4年前曾因腹痛来本院就诊,CT检查诊断为腹主动脉瘤.     

Acute thoracic aortic dissection: The basics

With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnostic possibility in patients presenting to the emergency department with acute chest or back pain. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode. But with successful initial therapy, the 5-year survival rate increases to 75%. Hence, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. This article reviews acute thoracic aortic dissection, including ED diagnosis and management.     

Images in emergency medicine: giant ascending aortic aneurysm dissection with hemopericardium

BACKGROUND:

Acute chest pain represents a common presentation at emergency department. Aortic dissection in young patients, however, is fortunately rare.

METHODS:

We report a case of giant ascending aortic aneurysm with Stanford type A aortic dissection in an otherwise well 22-year-old male patient. Operative aortic valve and root replacement was undertaken with favourable outcome.

RESULTS:

Histopathologic examination of the resected aorta revealed acute on chronic inflammatory change with Langerhans type giant cells consistent with a diagnosis of giant cell aortitis.

CONCLUSION:

While uncommon, emergencies of the aorta may present in young patients. Predisposing conditions are discussed.KEY WORDS: Aorta, Aneurysm, Tamponade, Dissection     

Acute aortic dissection with painless paraplegia: report of 2 cases

Acute aortic dissection is often a life-threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. There are a few reports of atypical findings or no pain in the literature. We report 2 patients with painless acute aortic dissection who presented to the emergency department (ED) with sudden onset paraplegia.     

Acute abdominal aortic aneurysm rupture presenting as transient paralysis of the lower legs: a case report

This article describes the case of a 40-year-old man with transient paralysis of both legs as the major symptom of an acute abdominal aortic aneurysm rupture presumably due to the occlusion of blood flow to the conus medullaris.     

急性主动脉夹层动脉瘤破裂抢救的护理配合

主动脉夹层动脉瘤是指主动脉内膜及中层损伤后,血液经撕裂的内膜口进入主动脉壁中层,产生血管壁剥离,形成假性腔道。随血流冲击,血管壁剥离逐渐延伸呈瘤样扩张,侵及主动脉内环,导致瓣环变形扩张,形成主动脉瓣关闭不全[1]。依据其病变范围主动脉夹层动脉瘤可分为Ⅲ型,其中Ⅰ型因侵及主动脉升部、弓部、降部,需行主动脉根部替换+主动脉弓置换+降主     

Contained aortic annulus rupture with persisting false aneurysm after transfemoral transcatheter aortic valve implantation

With older age and increasing comorbidities, conventional operative procedures for severe symptomatic aortic stenosis are associated with a high surgical risk. To date, transfemoral transcatheter aortic valve implantation (TF-TAVI) represents an accepted alternative method of intervention with a cardiovascular and all-cause mortality similar to operative replacement at early and long-term follow-up in this high risk population (Thomas et al., Circulation 124:425–433, 2011). Despite growing experience of the operators and improvement of the devices procedural and perioperative complications still occur (Panchal et al., Am J Cardiol, 2013). Aortic annulus rupture as well as the rupture of the membranous ventricular septum has been reported (Aminian et al., Catheter Cardiovasc Interv 81:E72–E75, 2013). We present the unusual case of an 80-year-old female who developed a false aneurysm following a contained aortic annulus rupture during a TF-TAVI procedure.     

彩色多普勒超声诊断腹主动脉夹层动脉瘤

目的　应用彩色多普勒超声诊断腹主动脉夹层动脉瘤。方法　应用彩超测量腹主动脉内径 ,观察腹主动脉及其分支内膜分离的部位和范围 ,以及鉴别真假腔。结果　内膜分离是本病最可靠的诊断依据 ,血流分隔现象、动脉扩张和管腔内血栓等具有重要的辅助诊断价值。彩超能很好地鉴别真假腔和诊断夹层动脉瘤破裂。结论　彩超能正确地评价本病受累血管 ,是诊断腹主动脉夹层动脉瘤的一种较为可靠的影像检查方法。     

Acute aortic dissection in women: challenges and opportunities

Acute aortic dissection (AAD) is a severe and potentially fatal disease which requires rapid diagnosis and appropriate treatment in order to improve survival. The variable and sometimes non-specific presentation of this rare condition makes it a continued diagnostic challenge for even the best of clinicians. Multiple clinical factors have been studied for their role in increasing the risk of AAD. While the complete pathophysiology of the condition is not known, contemporary research has shed light on many important factors that might lead to the development of aortic aneurysms and AAD. Despite continued research in this area, there is scant research looking at gender-related differences in the epidemiology, presentation, treatment and outcomes of patients with AAD. This review first revisits lessons about gender-related differences seen in various cardiovascular diseases, and then critically examines the data on gender-related differences in AAD diagnosis, management and outcomes. A summary of the pathophysiology and possible reasons for gender-specific differences in the development of aneurysms and dissections is also provided.