Purpose
Due to advances in imaging diagnostic methods and surgical techniques, nowadays, more than 80% of patients who undergo emergency surgery for type A aortic dissection recover from it. However, fatal late complications are common.Our aim is to show the advantages of MR imaging for the long-term follow up of these patients, illustrating the normal postoperative appearance and different complications.
Methods and Materials
MR examinations were performed in 15 patients (12 men and 3 women aged 26-67 years) who underwent emergency surgery for type A aortic dissection between March 1995 and February 2002. After composite graft replacement of the ascending aorta and, when necessary, the aortic valve, MR imaging was performed within the first month, and subsequently at six months and once a year thereafter. Spin-echo and gadolinium-enhanced 3D MRI series were performed with 1.5 or 1 Tesla MR units. The prosthetic aortic segment, the anastomoses and periprosthetic...
Results
In most cases we achieved a good image quality of the prothesis, the anastomoses, aorta and proximal segments of the main vessels. Two of the 15 patients died in the soon after surgery; one because of cerebral bleeding and the other because of progressing dissection in the supraaortic vessels.Absence of complications. Three patients did not have postoperative complications.Postoperative complications: Ten patients showed one or more of the following complitations:Peri-prosthetic pseudoaneurysms: Five patients presented periprosthetic hematoma : in 4 cases it either regressed or remained stable,...
Conclusion
MR imaging is an optimal modality for a long-term follow up of patients who have survived ascending aortic replacement after type A aortic dissection.It allows early detection and elective reoperation of late complications, which many times are life-threatening but difficult to detect clinically because of absence of symptoms.
References
1. Gaubert JY, Moulin G, Mesana T, et al. Type A dissection of the thoracic aorta: use of MR imaging for long term follow-up . Radiology. 1995;196:363-9.2. Kaminaga T, Yamada N, Takamiya M, et al. Sequential MR signal change of the thrombus in the false lumen of thoracic aortic dissection. Magn Reson Imaging. 1995;13:773-9.3. Fattori R, Nienaber CA. MRI of acute and chronic oartic pathology: preoperative and postoperative evaluation. J Magn Reson Imaging.1999;10: 741-50.4. Vincent B. Ho, MD, Martin R. Prince, MD. Thoracic MR aortography:...
Personal Information
M. SANTAMARIA PEA, A. BUSTOS GARCIA DE CASTRO, A. GARCIA PEREZ, J. BORREGO GOMEZ, J. FERREIROS DOMINGUEZDEPARTMENT OF RADIOLOGY. HOSPITAL CLINICO SAN CARLOS. MADRID. SPAIN