Learning objectives
To review the most life-threatening manifestations of Marfan’s syndrome (MS) in the cardiovascular system.
To demonstrate the importance of images for choosing the appropriate surgical approach.
To present computed tomography (CT)-signs, which are indicative to the next stage surgical aortic repair in case of type A acute aortic dissection (AAD) in patients with MS.
To describe and illustrate imaging after surgical procedure.
Background
Keynotes:
•The incidence of Acute Aortic Dissection (AAD) is estimated to be 3 cases per 100.000 people per year with mortality of 1-2 % per hour without surgical treatment.
•Aortic Dissection (AD) with a type A prevalence is linked in 65%+ to patients with Marfan Syndrome (MS).
•Contrast-enhanced computed tomography (CT) is the gold standard in the diagnosis of AD.
•According to the American Heart Association (AHA) guidelines, every fifth patient with type A AD needs the next stage surgical treatment within 5 years after...
Findings and procedure details
CT scans have been collected on patients with MS and Acute Aortic Syndrome who underwent aortic repair during the past 7 years in the Department of Cardiac Surgery.
The appropriate surgical approach was based on the localization of tear, extend of the flap, patency of true and false lumens, perfusion.
In all cases, an initial intimal tear was available in ascending aorta. The majority of patients had second or third surgeries for a reason of dissections at other sites or aneurysms.
Proximal part of the...
Conclusion
This analysis shows that patients after the first stage surgery of AAD should be examined with CT scan at least once per year. Patients must be scheduled for surgery in case of verification that normal dimensions of the aorta are exceeded or dilatation of true or false lumens. The most common pattern of the repair was proximal ascending aortic repair, followed by descending thoracic aneurysm surgery.
Personal information and conflict of interest
Uliana Pidvalna, MD, PhD
Assistant Professor. Department of Normal Anatomy, Danylo Halytsky Lviv National Medical University
Resident in training. Department of Radiology, Danylo Halytsky Lviv National Medical University
Pekarska, 69
79010 Lviv, Ukraine
Email:
[email protected]
Dmytro Beshley, MD, MMSc
Cardiac Surgeon. Department of Cardiac Surgery, Lviv Regional Clinical Hospital
Cardiovascular Imaging Consultant. Ukrainian-Polish Heart Center “Lviv”
Chernihivska, 7
79010 Lviv, Ukraine
Email:
[email protected]
The authors have no conflicts of interest to declare.
References
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3.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;14:52–57. doi:10.12659/AJCR.883793
4.Freeman LA, Young PM, Foley TA, Williamson EE, Bruce CJ, Greason KL. CT and MRI Assessment of...