Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome

Neri, Eugénio; Toscano, Thomas; Papalia, Ugo; Frati, Giacomo; Massetti, Massimo; Capannini, Gianni; Tucci, Enrico; Buklas, Dimitrios; Muzzi, Luigi; Oricchio, Luca; Sassi, Carlo

doi:10.1067/mtc.2001.112534

Cited by 215 publications

(220 citation statements)

References 10 publications

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“…36) Coronary obstruction is caused mostly by compression of ostium or proximal portion of coronary artery due to an expanded false lumen 36,37) or uncommonly by intimal flap 38) or disruption of the intima at the orifice. 36) Until recently, CAG has been the only measure for making the diagnosis of coronary artery involvement. Ramanath et al retrospectively analyzed 1343 AAAD cases and reported that preoperative CAG did not significantly increase in-hospital mortality (25.6% with CAG vs. 20.6% without CAG, P = 0.14).…”

Section: Coronary Arterymentioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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Section: Coronary Arterymentioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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“…Several case reports of a Stanford type A aortic dissection in combination with a myocardial infarction have been published. [1][2][3][4][5][6][7] In almost all cases the right coronary artery was involved. [1][2][3] We report a case of anterior myocardial infarction due to a Stanford type A aortic dissection involving the left main trunk of the coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction due to an acute type A aortic dissection involving the left main coronary artery

Zegers¹,

Gehlmann²,

Verheugt³

2007

NHJL

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Acute myocardial infarction due to an acute type A aortic dissection involving the left main coronary arteryWe report a case of anterior myocardial infarction due to a Stanford type A aortic dissection involving the left main trunk of the coronary artery. Acute myocardial infarction due to extension of an acute Stanford type A aortic dissection is an infrequent but devastating situation. In our case a spontaneous aortocoronary dissection involving the Valsalva sinus and the ascending aorta with a history of hypertension is the most plausible cause. Emergent aortic replacement and revascularisation was performed. (Neth Heart J 2007;15:263-4.)

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“…In terms of mechanism, Neri et al 2) reported 3 types of coronary malperfusion. In the first case described above, the right coronary artery was classifi ed as type C malperfusion, namely, detachment of the coronary orifi ce, and the left main trunk was classifi ed as type B malperfusion, namely, dissection of the coronary artery.…”

Section: Case Reportmentioning

confidence: 99%

“…However, acute myocardial ischemia associated with aortic dissection is relatively rare and results in a critical condition of the patient [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Acute Type A Aortic Dissection Involving Malperfusion of Bilateral Coronary Arteries

et al. 2017

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Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome

Abstract: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

Cited by 215 publications

References 10 publications

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute myocardial infarction due to an acute type A aortic dissection involving the left main coronary artery

Acute Type A Aortic Dissection Involving Malperfusion of Bilateral Coronary Arteries

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