scholarly journals Pitfalls in Suspected Acute Aortic Syndrome: Impact of Appropriate and If Required Repeated Imaging

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
C. Meier ◽  
M. Lichtenberg ◽  
P. Lebiedz ◽  
F. Breuckmann
Keyword(s):  
Aortic Surgery ◽  
False Negative ◽  
Ascending Aorta ◽  
Motion Artifacts ◽  
Acute Aortic Syndrome ◽  
Atypical Chest Pain ◽  
Spontaneous Course ◽  
Life Threatening ◽  
Enhanced Computed Tomography ◽  
Gated Imaging

The incidence of acute aortic syndrome is low, but the spontaneous course is often life-threatening. Adequate ECG-gated imaging is fundamental within the diagnostic workup. We here report a case of a 53-year-old man presenting with atypical chest pain, slight increase of D dimers at admission, and extended diameter of the ascending aorta accompanied by mild aortic regurgitation. Interpretation of an initial contrast-enhanced computed tomography was false negative due to inadequate gating and motion artifacts, thereby judging a tiny contrast signal in the left anterior quadrant of the ascending aorta as a pseudointimal flap. By hazard, cardiac magnetic resonance imaging demonstrated an ulcer-like lesion superior to the aortic root, leading to aortic surgery at the last moment. As sensitivity of imaging is not 100%, this example underlines that second imaging studies might be necessary if the first imaging is negative, but the clinical suspicion still remains high.

scholarly journals An acutely occluded Cabrol graft presenting as an acute coronary syndrome

2019 ◽  
Vol 12 (7) ◽  
pp. e229793
Author(s):  
Joshua Schulman-Marcus ◽  
Nicholas Cochran-Caggiano ◽  
Mohammad El-Hajjar ◽  
Chanderdeep Singh
Keyword(s):  
Acute Coronary Syndrome ◽  
Complex Disease ◽  
Aortic Surgery ◽  
Ascending Aorta ◽  
Aortic Graft ◽  
Synthetic Graft ◽  
Graft Thrombosis ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Threatening Situation

The Cabrol technique employs a synthetic graft to connect the coronary arteries to an aortic graft in patients with complex disease of the ascending aorta. Acute Cabrol graft thrombosis is a life-threatening situation that presents as acute coronary syndrome, as it leads to acute coronary hypoperfusion. We present a patient with unstable anginal symptoms who had undergone aortic surgery 6 months prior to presentation. Cardiac catheterisation was concerning for aortic dissection yet was later revealed to be acute occlusion of a Cabrol graft. The patient ultimately died of cardiogenic shock. We review the Cabrol technique, complications and management of acute graft thrombosis.

scholarly journals Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1122
Author(s):  
Jessica Graef ◽  
Bernd A. Leidel ◽  
Keno K. Bressem ◽  
Janis L. Vahldiek ◽  
Bernd Hamm ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Image Acquisition ◽  
Circulatory Arrest ◽  
Motion Artifacts ◽  
Current Standard ◽  
Ct Protocol ◽  
Life Threatening ◽  
Reconstruction Time

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

'Aorta code' implementation and preliminary results of a multidisciplinary protocol for patients with acute aortic syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Ferrera Duran ◽  
I Vilacosta ◽  
J Perez-Villacastin ◽  
P Busca ◽  
A Carrero ◽  
...  
Keyword(s):  
Emergency Room ◽  
Aortic Surgery ◽  
Referral Hospital ◽  
Acute Aortic Syndrome ◽  
Preliminary Results ◽  
Group I ◽  
Aortic Pathology ◽  
Number Of Patients ◽  
Group Ii ◽  
Patient’S Outcome

Abstract Background Expediting life-saving care for patients with acute aortic syndrome (AAS) through multi-disciplinary code protocols is a potential method to improve outcomes. Other code protocols for cardiovascular emergencies, such as ST-elevation myocardial infarction and stroke have shown excellent results. Aim To examine the implementation and preliminary results of a code protocol “Aorta Code” for patients with AAS in a healthcare framework of a 4-hospital network in our city by reviewing the number of patients detected, patient's transference time, aortic surgery and patient's outcome during a trial period of 10 months (April 2019-January 2020). A comparison with a previous 2-year period with standard of care management of AAS was performed. Methods “Aorta Code” uses a specific diagnostic algorithm to improve detection of patients with AAS at the emergency room, facilitates their quick transfer to the referral hospital by activating a paging system, and places acute cardiovascular care unit, operating room and surgeons specialized in aortic pathology on standby. Results Compared to a previous 2-year period (2017–2018) (group I), the current implementation of “Aorta Code” in a period of 10 months (group II) in our 4-hospital network involving the healthcare of 1.100000 inhabitants resulted in the detection of more patients with AAS (group-I: n=18 patients (0.8 patients/month), group-II: n=19 patients (1.9 patients/month); p=0.013). AAS detection in secondary hospitals importantly increased (33.3% vs 63.8%, p=0.07). The “Aorta Code” achieved a significant decrease in patient's transference time to referral hospital (group-I: median 259 min (IQR 150–1911), group-II: median 129 min (IQR 95.5–167.25); p=0.035). There was a marked reduction in the number of surgeons involved in the “Aorta Code” (group-I= 7 cardiac, 6 vascular, group-II= 2 cardiac, 2 vascular). Thirty-day mortality was lower in group-II in the whole AAS cohort (group-I= 22.2%, group-II= 12.5%; p=0.660) and in type A AAS (28.6% vs 18.2%, p=0.661). Misdiagnosis rate (false-calls): 11 patients (7 of them with non-acute aortic disease). Conclusion “Aorta Code” facilitates detecting patients with AAS at the emergency room, speeds them to the referral hospital center, allows patients to be treated by surgeons specialized in aortic surgery and improves patient's outcome. Further prospective studies examining the utility of “Aorta Code” are warranted. Funding Acknowledgement Type of funding source: None

ASCENDING AORTIC ANEURYSM – A CASE REPORT

2020 ◽  
Vol 1 (3) ◽  
pp. 54-55
Author(s):  
Prathap Kumar. J.
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Case Report ◽  
Aortic Aneurysm ◽  
Ascending Aorta ◽  
Leg Pain ◽  
Ultrasound Screening ◽  
Ascending Aortic Aneurysm ◽  
Risk Of Mortality ◽  
Abdominal Aortic ◽  
Life Threatening

An aortic aneurysm is an abnormal dilation of the aorta to greater than 1.5 times its normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be symptoms like abdominal, back, or leg pain. They are most commonly located in the abdominal aorta, but can also be located in the thoracic aorta, rarely in arch of aorta. Abdominal aortic aneurysm is more common in men, a disease that is often asymptomatic and has up to a 90% risk of mortality if the aneurysm ruptures. It can be easily diagnosed by an ultrasound screening, and if the aneurysm is > 5.5 cm, it can be surgically repaired to prevent a life-threatening rupture. Aneurysm of the ascending aorta is rare but can be easily diagnosed by echocardiogram.

scholarly journals Serologic and Molecular Diagnosis of Anaplasma platys and Ehrlichia canis Infection in Dogs in an Endemic Region

Pathogens ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 488
Author(s):  
Bianca Lara ◽  
Anne Conan ◽  
Mary Anna Thrall ◽  
Jennifer K. Ketzis ◽  
Gillian Carmichael Branford ◽  
...  
Keyword(s):  
Early Stage ◽  
Point Of Care ◽  
False Negative ◽  
Ehrlichia Canis ◽  
Test Results ◽  
Anaplasma Platys ◽  
Endemic Region ◽  
Life Threatening ◽  
Improve Patient Management ◽  
Antibody Levels

Anaplasma platys and Ehrlichia canis are obligate intracellular, tick-borne rickettsial pathogens of dogs that may cause life-threatening diseases. In this study, we assessed the usefulness of PCR and a widely used commercial antibody-based point-of-care (POC) test to diagnose A. platys and E. canis infection and updated the prevalence of these pathogens in dogs inhabiting the Caribbean island of Saint Kitts. We detected A. platys in 62/227 (27%), E. canis in 84/227 (37%), and the presence of both in 43/227 (19%) of the dogs using PCR. POC testing was positive for A. platys in 53/187 (28%), E. canis in 112/187 (60%), and for both in 42/187 (22%) of the samples tested. There was only a slight agreement between A. platys PCR and POC test results and a fair agreement for E. canis PCR and POC test results. Our study suggests that PCR testing may be particularly useful in the early stage of infection when antibody levels are low or undetectable, whereas, POC test is useful when false-negative PCR results occur due to low bacteremia. A combination of PCR and POC tests may increase the ability to diagnose A. platys and E. canis infection and consequently will improve patient management.

scholarly journals The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mark J. Russo ◽  
John Gnezda ◽  
Aurelie Merlo ◽  
Elizabeth M. Johnson ◽  
Mohammad Hashmi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Aortic Root ◽  
Plate Fixation ◽  
Aortic Surgery ◽  
Case Series ◽  
Ascending Aorta ◽  
The Body ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Novel Approach

Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system.Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together.Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n=2), aortic root replacement (n=3), valve sparing root replacement (n=3), and replacement of the ascending aorta (n=11) and/or hemiarch (n=2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections.Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.

scholarly journals Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

2019 ◽  
Vol 04 (02) ◽  
pp. 092-094
Author(s):  
Ravi Kumar Kathi ◽  
Amaresh Rao Malempati ◽  
Goutham Kollapalli ◽  
Chaitra Krishna Batt ◽  
Sayyad Sohail Tarekh
Keyword(s):  
Rare Complication ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Muscle Flap ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Chronic Hypertension ◽  
Pulsatile Mass ◽  
Fatal Hemorrhage ◽  
Femorofemoral Bypass

AbstractPseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.

scholarly journals Ascending aortic dissection in a pregnant patient with neonatally repaired coarctation of aorta and bicuspid aortic valve

2019 ◽  
Vol 12 (12) ◽  
pp. e233367
Author(s):  
Mark Philip Cassar ◽  
Asad Shabbir ◽  
Elizabeth Orchard ◽  
James Stirrup
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Aortic Surgery ◽  
Pregnant Patient ◽  
Haemodynamic Instability ◽  
Coarctation Of Aorta ◽  
Blurred Vision ◽  
Life Threatening ◽  
History Of

Aortic dissection is characterised by a tear in the intimal and medial layers of the endovascular aortic wall which propagates distally. Here, we discuss the case of a 35-year-old woman who was 37 weeks pregnant and presented with dizziness and blurred vision. She had a history of a neonatal end-to-end repair of a coarctation of aorta, a known bicuspid aortic valve and a dilated ascending aorta under surveillance. A transthoracic echocardiogram revealed an ascending aortic dissection. An emergency CT aortogram was performed which confirmed the diagnosis. The patient underwent emergency caesarean section and aortic surgery, with a good outcome for mother and baby. The case highlights the atypical nature of presentation and the absence of haemodynamic instability. Atypical and unexplained symptoms on a background of congenital heart disease should trigger a referral to cardiology with thorough investigation, often with echocardiography, to exclude rare and life-threatening complications.

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