Aortic dissection with extension to a patent ductus arteriosus

Festić, Emir; Steiner, Robert M.; Spatz, Eileen

doi:10.1007/s10554-004-7985-z

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…muscular configuration of the ductus wall strengthens the wall and resists dissection. 19,20 Pulmonary artery dissection is much less common. Only 64 cases have been reported, of which 9 were diagnosed during life.…”

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confidence: 99%

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

et al. 2007

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A 3-year-old male, castrated, miniature pinscher weighing 9 kg was presented to the University of Zurich Veterinary Teaching Hospital Cardiology Service for evaluation of lethargy, a newly recognized cardiac murmur, and labored breathing. For the previous 3 days, the dog had been progressively reluctant to move and breathing had become labored. Before the current presentation, the dog had always been in excellent health.On admission, the dog was in sternal recumbency, profoundly lethargic, and showed expiratory dyspnea. Diffuse petechiation was visible on the skin and mucous membranes. Heart and pulse rate were 160 beats per minute and irregular, pulse quality was weak, and rectal temperature was 37.1uC (98.8uF). On auscultation, no respiratory or cardiac sounds were heard on the left side and muffled sounds were heard on the right side with a continuous heart murmur, grade 3/6. The jugular veins were distended and abdominal palpation disclosed hepatomegaly and ascites.Laboratory abnormalities on presentation included severe thrombocytopenia (11,000/mL; reference range, 130,000-394,000/mL), hypoproteinemia (43 g/L, reference range: 56-71 g/L), hypoalbuminemia (22 g/L, reference range: 29-37 g/L), hyponatremia (136 mmol/ L; reference range, 152-159 mmol/L), and hyperkalemia (5.4 mmol/L; reference range, 4.3-5.3 mmol/L). A coagulation profile was normal.An ECG indicated sinus tachycardia with single ventricular premature complexes and non-sustained ventricular tachycardia with a left bundle branch block pattern. The QRS complexes during sinus tachycardia were consistent with right ventricular enlargement and the ST segments were depressed in leads I, II, and aVF and increased in lead aVR.Thoracic radiographs revealed marked pleural effusion, moderate right heart enlargement, diminished pulmonary vasculature, engorged caudal vena cava, hepatomegaly, and ascites. Analysis of abdominal and pleural fluids indicated that they were modified transudates.On 2-dimensional and M-mode transthoracic echocardiography, a the right ventricle (RVDd, 2.45 cm) and right atrium (RA, 4 cm) appeared markedly dilated with flattening of the interventricular septum. The left ventricle was hypovolemic (LVDd, 1.4 cm). In the main pulmonary artery, a membranous structure that originated laterally slightly above the pulmonary valve annulus was bulging into the lumen (Fig 1a). An echodense structure suggestive of a thrombus at the site of the pulmonary artery bifurcation completely occluded the left pulmonary artery. Color Doppler echocardiography indicated moderate tricuspid insufficiency (TI), mild pulmonic insufficiency (PI), and continuous turbulent flow from the descending aorta to the main pulmonary artery through a patent ductus arteriosus (PDA). Furthermore, the systolic outflow signal above the pulmonary valve was only a narrow turbulent jet that passed medially to the described membrane. Behind the membrane, there was no systolic flow but only diastolic blood flow in the main pulmonary artery towards the pulmonary valve (Fig 1b). Sp...

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confidence: 99%

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

et al. 2007

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“…6,7 Only a few cases of DAA in adulthood have been reported in the literature. 1,3,4,8,9 Earlier reports included only patients in whom DAA was found incidentally during thoracotomy performed for other pathology 2 or, like in our case, for an abnormal chest radiograph. 4,10,11 Adult presentation of DAA is associated with higher mortality than in childhood.…”

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confidence: 69%

Incidental detection of a giant ductus arteriosus aneurysm by low-dose multidetector computed tomography in an asymptomatic adult

Andreini

Bartorelli

Dainese

et al. 2010

Journal of Vascular Surgery

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Aneurysm of the ductus arteriosus is a very rare congenital lesion in adults that can be associated with thromboembolism, rupture, and death. Its detection in a silent clinical phase is very important for planning appropriate treatment and avoiding potentially fatal complications. We report a case of a patent ductus arteriosus aneurysm of very large size (65.5 mm) that was incidentally discovered with low-dose (3.2 mSv) multidetector computed tomography in an asymptomatic 67-year-old man. The presence of coronary disease was also ruled out with this non-invasive imaging modality. Further evaluation with echocardiography and selective angiography confirmed the diagnosis. At surgery, the aneurysm was successfully resected via a left posterolateral thoracotomy.

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“…[3,5] Coexistence of PDA and aortic dissection is very rare, with only a few case reports describing the phenomenon. [6][7][8] For Stanford type B aortic dissection, thoracic endovascular aortic repair (TEVAR) is the preferred treatment option over open surgery because of its minimally invasive nature, lower mortality rates, and fewer complications. The treatment principle of TEVAR is to induce thrombus formation and remodel the false lumen by deploying a stent graft to seal the entry tear site.…”

Section: Introductionmentioning

confidence: 99%

Transvenous embolization using the Amplatzer Vascular Plug II in patent ductus arteriosus concomitant with Stanford type B aortic dissection: A case report

2023

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Rationale: Thoracic endovascular aneurysm repair (TEVAR) is commonly used to treat Stanford type B aortic dissections. However, coexistence of aortic dissection and patent ductus arteriosus (PDA) is an extremely rare phenomenon, and TEVAR alone is insufficient for treatment. Herein, a case of endovascular treatment in a patient with both aortic dissection and PDA is reported. Patient concerns: A 31-year-old woman presented to the authors’ hospital with chest pain extending to the back. At presentation, her blood pressure was 130/70 mm Hg. Her father, brother, and uncle were all diagnosed with aortic dissection. Diagnoses: Computed tomography (CT) revealed Stanford type B aortic dissection from the aortic arch to the infrarenal abdominal aorta; however, PDA was incidentally identified. Interventions: TEVAR was immediately performed. Follow-up CT scan performed 2 months later did not reveal any thrombosis or remodeling of the false lumen, and the PDA remained open. Therefore, an additional PDA embolization procedure was performed using the Amplatzer Vascular Plug II via the transvenous route. Outcomes: On follow-up CT performed 6 months after PDA embolization, successful remodeling, and shrinkage of the false lumen were observed, and PDA closure was confirmed. Lessons: If Stanford type B aortic dissection and PDA coexist, TEVAR alone may not be a sufficient treatment and additional PDA embolization may be required. In the present case, transvenous embolization of PDA using an Amplatzer Vascular Plug II was safe and effective.

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Aortic dissection with extension to a patent ductus arteriosus

Cited by 8 publications

References 15 publications

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

Dissection of a Patent Ductus Arteriosus with Right Heart Failure in an Adult Dog

Incidental detection of a giant ductus arteriosus aneurysm by low-dose multidetector computed tomography in an asymptomatic adult

Transvenous embolization using the Amplatzer Vascular Plug II in patent ductus arteriosus concomitant with Stanford type B aortic dissection: A case report

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