Acute type A aortic dissection in an adult patient with Turner's syndrome

Abstract

Objective-To investigate the hypothesis that the time to washout of radiographic contrast medium trapped distal to an occluded collateral receiving vessel is inversely related to collateral flow, and that this provides an accurate method for characterising coronary collaterals. Methods-An intracoronary pressure derived collateral flow index was determined in 54 patients undergoing percutaneous transluminal coronary balloon angioplasty (PTCA). The study group was subdivided according to whether the collateral vessels were suYcient (n = 17) or insuYcient (n = 37) to prevent ECG signs of myocardial ischaemia during PTCA. Washout collaterometry-an angiographic washout method-was carried out simultaneously; after injection of radiographic contrast medium into the collateral receiving vessel followed immediately by vascular occlusion, the number of heart beats was counted until approximately half the length of the epicardial vessel was cleared of contrast. Results-The collateral flow index was higher (0.28 (0.09) v 0.12 (0.07); p < 0.0001) and the contrast washout time shorter (8.0 (2.9) v 17.5 (6.7) heart beats; p < 0.0001) in patients with suYcient versus insuYcient collaterals. There was an inverse correlation between contrast washout time and collateral flow index (r = 0.72, p < 0.0001). Washout of contrast distal to the occluded vessel within 11 heart beats correctly determined suYcient and insuYcient collaterals with 88% sensitivity and 81% specificity. Conclusions-Washout collaterometry is a new radiographic contrast washout method based on the inverse relation between collateral flow and the time to clearance of radiographic dye injected into the ipsilateral vessel during PTCA. It appears to be an accurate method of characterising coronary collateral vessels. (Heart 2001;86:540-546)

Aortic Dissecting Aneurysm with a Bicuspid Aortic Valve in Turner's Syndrome: Report of a Case

“…[4][5][6][7][8] To our knowledge, this is the fi rst case to undergo a successful combined total arch replacement for a Stanford type A chronic aortic dissection using the modifi ed Bentall procedure for bicuspid aortic valve in TS.…”