ANATOMY OF AORTIC DISSECTION IN THE PATIENT WITH MARFAN SYNDROME WHO UNDERWENT SURGERY: A CASE REPORT

Keywords: Aortic Aneurysm, Dissection, Computed Tomography, Aortic Repair

Abstract

Introduction. Aortic dissection is the most common acute aortic pathology. Acute ascending aortic dissection is a life-threatening condition and a surgical emergency which requires prompt visualization of the aortic anatomy. Various types of classification and assessment of the aorta are described.

Presentation of the case. Concurrent aortic dissection and Marfan syndrome (MS) followed by the aneurysm of aorta which required supracoronary aortic replacement (2012), Bentall procedure (2014) and urgent open thoracic descending aorta replacement (2017) are described in the case-report.

Discussion. Patients with the aortic dissection may have certain underlying conditions, such as MS, which can predispose to dissection. The aortic pathology is registered in almost 65-100% of the patients with MS. The prevalence of type A aortic dissection among the patients with MS at the age of 60 is approximately 50%. The most common pattern of repair is the proximal ascending aortic repair followed by the descending thoracic aneurysm surgery. The open surgery technique as well as the aortic dissection or aneurysm repairs may be safely used in the patients with MS.

Conclusion. Anatomical features of the aorta in the patients with MS are vitally important when carrying out the analysis of the computed tomography images; in particular, the schedule of the computed tomography follow-up for the patients with MS should be customized to each case.

Downloads

Download data is not yet available.

References

Task A, Erbel R, Germany C, Aboyans V, France C, France CB, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;(35):2873-926. https://doi.org/10.1093/eurheartj/ehu281

Loewe C. Acute Aortic Syndromes. In: Multislice CT. Springer International Publishing AG; 2019. p. 825-53. https://doi.org/10.1007/174_2017_23

Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. https://doi.org/10.4414/smw.2017.14561

Yusuf Beebeejaun M, Malec A, Gupta R, Alkhawam H. Conservative management of chronic aortic dissection with underlying aortic aneurysm. Heart Int. 2013;8(1):15-8. https://doi.org/10.4081/hi.2013.e4

Gionis MN, Kaimasidis G, Tavlas E et al. Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery. Am J Case Rep. 2013;14:52-7. https://doi.org/10.12659/AJCR.883793

Freeman LA, Young PM, Foley TA, Williamson EE, Bruce CJ, Greason KL. CT and MRI assessment of the aortic root and ascending aorta. Am J Roentgenol. 2013;200(6): 581-92. https://doi.org/10.2214/AJR.12.9531

Berretta P, Patel HJ, Gleason TG et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg. 2016;5(4):346-51. https://doi.org/10.21037/acs.2016.05.10

Radulescu B, Preda S, Valeanu L, Jurcut R, Iliescu VA. Acute aortic dissection - always surprising. 2016;26(4):479-84.

Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. DISSECT: A New Mnemonic-based Approach to the Categorization of Aortic Dissection. Eur J Vasc Endovasc Surg. 2013;46(2):175-90. https://doi.org/10.1016/j.ejvs.2013.04.029

Elsayed RS, Cohen RG, Fleischman F, Bowdish ME. Acute Type A Aortic Dissection Cardiac surgery Aortic dissection Diagnosis Management Outcomes. Cardiol Clin. 2017;35:90033. https://doi.org/10.1016/j.ccl.2017.03.004

Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, et al. Multimodality imaging of diseases of the thoracic aorta in adults. J Am Soc Echocardiogr. 2015;28(2):119-82. https://doi.org/10.1016/j.echo.2014.11.015

Patil TA, Ambli SK. Transesophageal Echocardiography Evaluation of the Aortic Arch Branches. Ann Card Anaesth. 2018;21(4):53-6.

Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD). 2000;283(7).

Wang S-W, Huang Y-B, Huang J-W, Chiu C-C, Lai W-T, Chen C-Y. Epidemiology, Clinical Features, and Prescribing Patterns of Aortic Aneurysm in Asian Population From 2005 to 2011. Medicine (Baltimore). 2015;94(41):e1716. https://doi.org/10.1097/MD.0000000000001716

Kim HJ, Lee HK, Cho B. A case of acute aortic dissection presenting with chest pain relieved by sublingual nitroglycerin. Korean J Fam Med. 2013;34(6):429-33. https://doi.org/10.4082/kjfm.2013.34.6.429

Silvestri V, Mazzesi G, Mele R. Postpartum aortic dissection. A case report and review of literature. Int J Surg Case Rep. 2019;56:101-6. https://doi.org/10.1016/j.ijscr.2019.02.018


Abstract views: 94
PDF Downloads: 38
Published
2020-04-14
How to Cite
1.
Pidvalna U, Beshley D, Mateshuk-Vatseba L, Averchuk V, Kulyk L. ANATOMY OF AORTIC DISSECTION IN THE PATIENT WITH MARFAN SYNDROME WHO UNDERWENT SURGERY: A CASE REPORT. Proc Shevchenko Sci Soc Med Sci [Internet]. 2020Apr.14 [cited 2020Aug.15];59(1). Available from: https://mspsss.org.ua/index.php/journal/article/view/270

Most read articles by the same author(s)