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Influence of radiologically evident residual intimal tear on expansion of descending aorta following surgery for acute type I aortic dissection.

Kim YS, Kim JH, Kim JB, Yang DH, Kang JW, Hwang SK, Choo SJ, Chung CH - Korean J Thorac Cardiovasc Surg (2014)

Bottom Line: Two patients failed to achieve proximal tear exclusion by the surgery.Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation.A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.

Methods: This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).

Results: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.

Conclusion: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

No MeSH data available.


Related in: MedlinePlus

(A, B) The intimal tear (arrow) connecting the true and the false lumen in the dissected descending aorta.
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Figure 1: (A, B) The intimal tear (arrow) connecting the true and the false lumen in the dissected descending aorta.

Mentions: The baseline patients' demographics and clinical profiles, and the details of initial CT findings are presented in Table 1. Proximal intimal tears were identified in 34 patients (82.9%). Among them, 32 patients (78.0%) had the proximal intimal tears in the ascending aorta or the aortic arch, whereas 2 patients (4.9%) had the proximal tears beyond the aortic arch. Distal intimal tears were identified in 9 patients (22.0%) (Fig. 1). Multiple intimal tears were identified in 2 patients (4.9%): one had a proximal intimal tear at the proximal aortic arch and three distal intimal tears at the suprarenal and infra-renal abdominal aorta and the left common iliac artery, and the other had a proximal intimal tear at the ascending aorta and two distal intimal tears at the suprarenal and infra-renal abdominal aorta. Six patients (14.6%) were diagnosed with type I intramural hematoma without a definite intimal tear through the whole aorta. There was one patient who had a distal intimal tear without a proximal intimal tear.


Influence of radiologically evident residual intimal tear on expansion of descending aorta following surgery for acute type I aortic dissection.

Kim YS, Kim JH, Kim JB, Yang DH, Kang JW, Hwang SK, Choo SJ, Chung CH - Korean J Thorac Cardiovasc Surg (2014)

(A, B) The intimal tear (arrow) connecting the true and the false lumen in the dissected descending aorta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928268&req=5

Figure 1: (A, B) The intimal tear (arrow) connecting the true and the false lumen in the dissected descending aorta.
Mentions: The baseline patients' demographics and clinical profiles, and the details of initial CT findings are presented in Table 1. Proximal intimal tears were identified in 34 patients (82.9%). Among them, 32 patients (78.0%) had the proximal intimal tears in the ascending aorta or the aortic arch, whereas 2 patients (4.9%) had the proximal tears beyond the aortic arch. Distal intimal tears were identified in 9 patients (22.0%) (Fig. 1). Multiple intimal tears were identified in 2 patients (4.9%): one had a proximal intimal tear at the proximal aortic arch and three distal intimal tears at the suprarenal and infra-renal abdominal aorta and the left common iliac artery, and the other had a proximal intimal tear at the ascending aorta and two distal intimal tears at the suprarenal and infra-renal abdominal aorta. Six patients (14.6%) were diagnosed with type I intramural hematoma without a definite intimal tear through the whole aorta. There was one patient who had a distal intimal tear without a proximal intimal tear.

Bottom Line: Two patients failed to achieve proximal tear exclusion by the surgery.Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation.A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.

Methods: This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).

Results: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.

Conclusion: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

No MeSH data available.


Related in: MedlinePlus