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Diagnosis of asymptomatic aortic dissection during pregnancy using contrast echocardiography.

ABSTRACT: Spontaneous aortic dissection in pregnancy is rare and life-threatening for both the mother and the fetus. It is commonly associated with connective tissue disorders or aortic valvular abnormalities. We describe a case of a hypertensive pregnant woman in whom a dilated ascending aorta was identified in a routine transthoracic echocardiogram. Careful interrogation of the ascending aorta, with the use of intravenous contrast, revealed the presence of a type A aortic dissection flap. The particulars of the case are presented and the literature regarding acute aortic dissection in pregnancy is reviewed. <Learning objective: Challenges in diagnosis of aortic dissection in pregnancy.>.

SUBMITTER: Abo-Salem E

PROVIDER: S-EPMC6277942 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Aortic dissection during transoesophageal echocardiography: a case report.

Project description:BackgroundTransoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure.Case summaryA 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery.DiscussionTransoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk-benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.

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Feasibility and accuracy of bedside transthoracic echocardiography in diagnosis of acute proximal aortic dissection.

Project description:The purpose of the present study was to establish the accuracy of transthoracic echocardiography (TTE) in diagnosis of acute type A aortic dissection in comparison to computed tomography (CT), with reference to the intraoperative image.The retrospective analysis included 178 patients referred to the cardiac surgery unit in our center due to acute type A dissection between 01-01-2008 and 31-12-2013, who underwent both TTE and CT. Intraoperative image was considered as a reference.Statistical analysis did not show any significant differences between computed tomography and echocardiography in the detection of the proximal aortic dissection. In patients with aortic valve abnormalities, procedure of choice was replacement by a composite graft (77,59%), whereas patients with a normal image of aortic valve were more likely to have the valve sparing procedure (50,88%). The R-Spearman statistics shows a strong positive correlation between maximum diameter of ascending aorta measured by TTE and CT (cc 0.869) and TTE and intraoperative measurement (cc 0.844).Our data confirm that transthoracic echocardiography is a reliable method for diagnosis of proximal aortic dissection. TTE provides a reliable value of maximum diameter of the ascending aorta in comparison to both CT and direct intraoperative measurement. Moreover, transthoracic echocardiography gives the additional information that influences the operative technique of choice and identifies the high-risk patients (cardiac tamponade, severe aortic dilatation, severe aortic regurgitation). Our retrospective analysis confirms the pivotal role of TTE in the evaluation of the patients with suspected proximal aortic dissection in emergency room setting.

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Asymptomatic chronic type A aortic dissection.

Project description: Not available

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Aortocoronary Saphenous Vein Graft Aneurysm: Diagnosis Using Color Doppler and Contrast Transesophageal Echocardiography.

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Aortic dissection or spontaneous renal artery dissection, a rare diagnosis?

Project description:Spontaneous renal artery dissection (SRAD) is a rare entity causing muscle spasm due to acute low back pain, back pain, or flank pain symptoms or misleading clinical diagnosis such as renal colic. A 25-year-old Syrian male refugee presented to the emergency department with sudden onset of left-sided flank pain in the evening. Physical examination results were normal except left-sided costovertebral angle sensitivity. Abdominal, pelvic and thoracic contrast computed tomography angiography (CTA) was performed to evaluate aortic dissection, which was our urgent preliminary diagnosis. Left renal artery dissection was detected in CTA. The patient was treated with medical conservative treatment and spontaneous recovery was observed during the follow-up period. Early detection of SRAD in the emergency department can be difficult due to the fact that the clinical presentation is misleading.

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Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis.

Project description:BackgroundThe aim of this study was to evaluate the relationship between aortic valve area (AVA) obtained by Doppler echocardiography and outcome in patients with severe asymptomatic aortic stenosis and to define a specific threshold of AVA for identifying asymptomatic patients at very high risk based on their clinical outcome.Methods and resultsWe included 199 patients with asymptomatic severe aortic stenosis (AVA ?1.0 cm(2)). The risk of events (death or need for aortic valve replacement) increased linearly on the scale of log hazard with decreased AVA (adjusted hazard ratio 1.17; 95% CI 1.06-1.29 per 0.1 cm(2) AVA decrement; P=0.002). Event-free survival at 12, 24, and 48 months was 63±6%, 51±6%, and 34±6%, respectively, for AVA 0.8 to 1 cm(2); 49±6%, 36±6%, and 26±6%, respectively, for AVA 0.6 to 0.8 cm(2); and 33±8%, 20±7%, and 11±5%, respectively, for AVA ?0.6 cm(2) (Ptrend=0.002). Patients with AVA ?0.6 cm(2) had a significantly increased risk of events compared with patients with AVA 0.8 to 1 cm(2) (adjusted hazard ratio 2.22; 95% CI 1.41-3.52; P=0.001), whereas patients with AVA 0.6 to 0.8 cm(2) had an increased risk of events compared with those with AVA 0.8 to 1 cm(2), but the difference was not statistically significant (adjusted hazard ratio 1.38; 95% CI 0.93-2.05; P=0.11). After adjustment for covariates and aortic valve replacement as a time-dependent variable, patients with AVA ?0.6 cm(2) had a significantly greater risk of all-cause mortality than patients with AVA >0.6 cm(2) (hazard ratio 3.39; 95% CI 1.80-6.40; P<0.0001).ConclusionsPatients with severe asymptomatic aortic stenosis and AVA ?0.6 cm(2) displayed an important increase in the risk of adverse events during short-term follow-up. Further studies are needed to determine whether elective aortic valve replacement improves outcome in this high-risk subgroup of patients.

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Quantification of Aortic Valve Calcifications Detected During Lung Cancer-Screening CT Helps Stratify Subjects Necessitating Echocardiography for Aortic Stenosis Diagnosis.

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