Purpose
Aortic dissections (AD) are serious fatal aortic conditions.
Their treatment strategies largely depend on the extent of the dissection. Cases with aortic dissection involving the ascending aorta are fundamentally treated by prompt open surgical replacement of the ascending aorta or the aortic arch because of the high mortality rate during the onset of the disease.
Dissection of the descending aorta without complication has a relatively lower initial mortality rate,
with classical disease management being stand-alone medical therapy such as antihypertensive therapy.
However,
the mortality rate...
Methods and Materials
Patient selection
Seventeen consecutive cases with DeBakey type Ⅲ AD that underwent ECG-gated CT angiograms from January 2010 to June 2012 in our institute were enrolled in this evaluation (2 women,
15 men; mean age 61.5 years (range 46 - 77 years)).
The population constists of 2 cases with DeBakey type Ⅲa and 16 cases with DeBakey type Ⅲb. Six cases had a history of open replacements of the aorta (5 with ascending and total arch replacement and 1 with descending aortic replacement )and classification...
Results
Entry sites were located in zones 3 (n=2),
Th4 (n=5),
Th5 (n=3),
Th6 (n=1),
Th7 (n=3),
Th8 (n=2),
and L1 (n=1).
Single or multiple re-entry was detected in 15 cases while two cases had no re-entry.
The color map explaining the site locations of entry or re-entries in each case is shown in Fig. 4.
Quantitative analysis of the diameter of the true lumen
The average diameter of a true lumen during the cardiac cycle at every zone2 level of the aorta was shown in...
Conclusion
Discussion
Contrast-enhanced CT has been essential in the assessment of the condition of AD,
which includes the extent of dissection,
blood flow of the true and false lumen,
location of entry or re-entry sites,
and circulatory impairment of abdominal organs.
However,
it is well known that there is a complicated motion of the intimal flap during cardiac pulsation,
which leads to the inaccurate estimation of the entry site and diameter of the true lumen using conventional CT.
Recent adaptation of ECG-gated CT has merits not...
References
Umana JP,
Miller DC,
Itchell RS et al.Is medical therapy still theoptimal treatment strategy for patients with acute type B aortic dissections? J Thorac Cardiovasc Surg.2002; 124(5):896-910
Dake MD,
Kato N,
Mitchell RS et al.
Endovascular stent-graft placement for the treatment of acute aortic dissection.
N Engl J Med.
1999; 340(20):1546-52.
Nienaber CA,
Rousseau H,
Eggeberecht H et al.
Randomize comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection(INSTEAD) trial.
Circulation 2009: 120(25):2519-28
Brunk well J,
Lammer J,...