Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography.

Erbel, Raimund; Oelert, H.; Meyer, Jürgen; Puth, Maria; Mohr-Katoly, S; Hausmann, Dirk; Daniel, Werner G.; Maffei, Stefano; Caruso, Aurelio; Covino, Franco Enrico

doi:10.1161/01.cir.87.5.1604

Cited by 366 publications

(169 citation statements)

References 43 publications

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“…TEE was performed in these patients, which revealed complete thrombus formation of the false lumen in the ascending aorta (retrograde thrombosed). 15 The remaining 13 patients showed equal or larger size of false lumen than that of true lumen with incomplete or no thrombus formation in the ascending aorta (retrograde nonthrombosed, Figure 2). Patients who showed no intimal tear, regional aortic wall thickening in TEE and a crescentic or circular high attenuation area along the aortic wall without contrast enhancement in CT were diagnosed as having aortic intramural hematoma.…”

Section: Patient Characteristicsmentioning

confidence: 97%

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Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Kaji

Katayama²,

Yamamuro³

et al. 2003

Circulation

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Background-Natural history of aortic dissection (AD) with intimal tear in the descending or abdominal aorta and retrograde extension into the ascending aorta (retrograde AD) remains unknown. The purpose of this study was to elucidate medium-term prognosis of patients with retrograde AD. Methods and Results-Study population consisted of 109 patients with acute type A AD. There were 27 patients (25%) with retrograde AD and 82 patients (75%) with intimal tear in the ascending aorta (antegrade AD). In antegrade AD patients, 60 patients underwent surgery and 22 patients were treated medically. In retrograde AD patients, 14 patients showed localized crescentic high attenuation area along the ascending aortic wall without enhancement in computed tomography. Transesophageal echocardiography revealed complete thrombosis of false lumen (FL) in the ascending aorta (retrograde thrombosed). The remaining 13 patients showed incomplete or no thrombosis (retrograde nonthrombosed). All retrograde nonthrombosed AD patients underwent surgery except for 1 patient with stroke, whereas all retrograde thrombosed AD patients were treated medically. In-hospital mortality rate of retrograde AD patients was significantly lower than that of antegrade AD patients (15% versus 38%, Pϭ0.027). The survival rates in retrograde AD patients were all 85% at 1, 2, and 5 years, which were significantly higher than those of antegrade AD patients (63%, 62%, and 57%, respectively)(Pϭ0.009). Conclusions-Patients

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Section: Patient Characteristicsmentioning

confidence: 97%

“…Erbel et al 15 reported that there were 22 patients with retrograde dissection in the ascending aorta in a prospective follow-up study of 168 patients with aortic dissection including 52% type A and 48% type B AD. Surgical treatment was selected in 21 patients and medical treatment in one patient.…”

Section: Ii-303mentioning

confidence: 99%

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Kaji

Katayama²,

Yamamuro³

et al. 2003

Circulation

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“…The De Bakey classification subdivides the dissection process, with type I dissection involving the entire aorta, type II dissection involving only the ascending aorta, and type III dissection sparing the ascending aorta and the arch. Various attempts to further subdivide both classification systems have not been established in the medical community, 38,39 although the arch region deserves integration into a modern classification system. 40 Recent observations highlight the importance of precursors of typical aortic dissection such as intramural hematoma (IMH), penetrating aortic ulcers, or localized intimal tears as variants of a wall-dissecting process.…”

Section: Staging Of Aortic Dissectionmentioning

confidence: 99%

Aortic Dissection: New Frontiers in Diagnosis and Management

2003

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“…It is known that non-communicating dissection has a better prognosis than communicating dissection. 26) In small-scale clinical observations, medical treatment of type A intramural hemorrhage showed no difference in mortality from early surgical repair, especially in cases of uncomplicated small intramural hemorrhage. 9) During the late follow-up study, we observed partial or complete resolution of intramural hemorrhage in 60% of the patients.…”

Section: Discussionmentioning

confidence: 97%

“…There have been several recent reports 8,9,25,26) indicating that intramural hemorrhage might be expected to have a better prognosis than aortic dissection. These reports suggest that intramural hemorrhage has a similar prognosis to non-communicating dissection, and intramural hemorrhage shows a lower incidence of complication in these studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Prognosis of Acute Aortic Intramural Hemorrhage Compared with Those of Acute Aortic Dissection. A Single Center Experience.

et al. 2001

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SUMMARYThe clinical manifestations and natural history of acute aortic intramural hemorrhage are not well characterized. Therefore, we have evaluated the differences in the clinical features and prognosis between acute intramural hemorrhage and acute classic aortic dissection.One hundred two consecutive patients with acute aortic syndrome were diagnosed between November 1994 and May 1999. The clinical features, treatment modalities and survival of these patients were analyzed.Thirty one of the 102 patients (30%) had intramural hemorrhage and 71 (70%) had aortic dissection. Patients with intramural hemorrhage were older than those with aortic dissection (mean ages 67 and 55 years, respectively) (p < 0.001), and intramural hemorrhage showed a lower proportion of type A than did aortic dissection (32% and 58%, respectively) (p = 0.018). The incidence of severe complications was significantly lower in patients with intramural hemorrhage than in those with aortic dissection (19% and 27%, respectively) (p < 0.001). Mean follow-up duration was 23.1 ± 16.0 months.The overall death rate for patients with intramural hemorrhage (2 / 31; 6%) tended to be lower than those with aortic dissection (14 / 71; 20%) (p = 0.104). The Stanford classification and treatment modalities were not correlated with death. Late follow-up imaging studies in intramural hemorrhage showed partial to complete resolution of intramural hematoma (9/15; 60%).In this study, intramural hemorrhage was fairly common, more frequent among older patients, had a lower proportion of type A, and showed a lower incidence of severe complications and a more favorable prognosis in terms of mortality, than aortic dissection. (Jpn Heart J 2001; 42: 91-100)

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Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography.

Cited by 366 publications

References 43 publications

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Aortic Dissection: New Frontiers in Diagnosis and Management

Clinical Features and Prognosis of Acute Aortic Intramural Hemorrhage Compared with Those of Acute Aortic Dissection. A Single Center Experience.

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