Titre
Retrograde ascending aortic dissection: a diagnostic and therapeutic challenge
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Carrel, T.
Auteure/Auteur
Pasic, M.
Auteure/Auteur
Vogt, P.
Auteure/Auteur
von Segesser, L.
Auteure/Auteur
Linka, A.
Auteure/Auteur
Ritter, M.
Auteure/Auteur
Jenni, R.
Auteure/Auteur
Turina, M.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1010-7940
Statut éditorial
Publié
Date de publication
1993
Volume
7
Numéro
3
Première page
146
Dernière page/numéro d’article
50; discussion 151-2
Peer-reviewed
Oui
Notes
Journal Article
Résumé
Aortic dissection with an entrance tear in the transverse aorta is generally considered to have the highest acute fatality rate of any type of dissection and the direction of its extension is the most difficult to predict. In a prospective study, we evaluated 61 consecutive patients (mean age 56.7 years, ranging from 21 to 75 years), presenting with ascending aortic dissection during a 36-month-period and tried to clarify the incidence of retrograde ascending aortic dissection. In 49 patients (80.3%), the intimal tear was located in the ascending aorta, whereas the dissection originated in the transverse aorta in 12 patients (19.7%); in this latter group, extension was strictly retrograde in 5 patients and in both directions in 7 patients. Three patients died before operation; 58 patients underwent aortic replacement/repair under moderate hypothermia; if the primary tear extended into the transverse aorta or was not found in the ascending aorta, the aortic arch was explored during a brief period of deep hypothermic circulatory arrest. The overall operative mortality was 12.1% (7/58); it was 10.4% (5/48) in ascending aortic dissection and 20% (2/10) in dissection of the transverse aorta. Age (P < 0.005), concomitant coronary artery disease (P < 0.01) and the site of intimal tear (P < 0.01) were significant predictive factors of operative risk. A tear in the transverse aorta is almost always associated with retrograde dissection and may simulate dissection with the entrance tear in the ascending aorta. Localization of the entrance tear remains a diagnostic challenge in aortic dissection but Doppler-echocardiography had a high sensitivity in this series (96.7%).(ABSTRACT TRUNCATED AT 250 WORDS)
Sujets
PID Serval
serval:BIB_C6090B1CE8B9
PMID
Date de création
2008-02-14T13:16:04.974Z
Date de création dans IRIS
2025-05-21T00:51:33Z