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Acute Aortic Dissection Due to Cystic Necrosis: Four Cases of Emergency Replacement of the Ascending Aorta With Survival

Acute Aortic Dissection Due to Cystic Necrosis: Four Cases of Emergency Replacement of the... Abstract Four cases of successful emergency resection and prosthetic graft replacement of the ascending aorta for acute dissections are presented. Hypotensive medical therapy was either not applicable or was ineffectual in these patients. Although such therapy has been demonstrated to have a salutary effect in some cases, surgical evaluation should be a continuing process. The indications for surgery are failure to control progression of the dissection, continuing blood loss, instability of cardiac function, and continuing compromise of major aortic tributaries. In view of the dramatic results in these four critically ill patients and the poor results reported with simple repair, it is suggested that further consideration be given to resection and prosthetic graft replacement in patients with acute dissection of the ascending aorta. References 1. Osler, cited by Kampmeier RH: Saccular aneurysm of the thoracic aorta: A clinical study of 633 cases . Ann Intern Med 12:624-651, 1938.Crossref 2. Hirst AE Jr, Johns VJ Jr, Kime SW Jr: Dissecting aneurysm of the aorta: A review of 505 cases . Medicine 37:217-279, 1958.Crossref 3. Shennan T: Dissecting Aneurysms , publication 193. Special Report Series, His Majesty's Stationery Office, London, 1934. 4. Austen WG, DeSanctis RW: Surgical treatment of dissecting aneurysm of the thoracic aorta . New Eng J Med 272:1314-1317, 1965.Crossref 5. Gurin D, Gulmer JW, Derby R: Dissecting aneurysm of the aorta: Diagnosis and operative relief of acute arterial obstruction due to this cause . New York J Med 35:1200-1202, 1935. 6. Shaw RW: Acute dissecting aortic aneurysm: Treatment by fenestration of the internal wall of the aneurysm . New Eng J Med 253:331-333, 1955.Crossref 7. DeBakey ME, Cooley DA, Creech O Jr: Surgical considerations of dissecting aneurysm of the aorta . Ann Surg 142:586-612, 1955.Crossref 8. Hufnagel CA, Conrad PW: Dissecting aneurysms of the ascending aorta: Direct approach to repair . Surgery 51:84-89, 1962. 9. Johns TNP: Dissecting aneurysm of the abdominal aorta: Report of a case with repair of perforation . Ann Surg 137:232-235, 1953.Crossref 10. Muller, cited by Stonesifer GL Jr: Acute dissecting aortic aneurysms: Importance of emergency surgery . Maryland Med J 13:131-132, 1964. 11. DeBakey ME, Henly WS, Cooley DA, et al: Surgical management of dissecting aneurysms of the aorta . J Thorac Cardiovasc Surg 49:130-149, 1965. 12. Stonesifer GL Jr: Emergency correction of ascending aortic dissecting aneurysms . Surgery 56:594-600, 1964. 13. Wheat MW Jr, Palmer RF, Bartley TD, et al: Treatment of dissecting aneurysms of the aorta without surgery . J Thorac Cardiovasc Surg 50:364-373, 1965. 14. DeBakey ME, Henley WS, Cooley DA, et al: Surgical treatment of dissecting aneurysm of the aorta: Analysis of 72 cases . Circulation 24:290-303, 1961.Crossref 15. Rohman M, Goetz RH, State D: Surgical treatment of dissecting aneurysms of the aorta with cardiac tamponade . J Thorac Cardiovasc Surg 46:498-509, 1963. 16. DeBakey ME, Henly WS, Cooley DA, et al: Surgical management of dissecting aneurysm involving the ascending aorta . J Cardiovasc Surg 5:200-211, 1964. 17. Simon AL, Hipona FA, Stansel HC: Dissecting aortic aneurysm in Marfan's syndrome . JAMA 193:156-158, 1965.Crossref 18. Matloff JM, Wolfson S, Gorlin R, et al: Control of post-cardiac surgical arrhythmias with propranolol . Circulation 37 ( (suppl 2) ):133-138, 1968. 19. Hume M, Krosnick J: Dissecting aneurysm in pregnancy associated with aortic insufficiency: Report of a case with successful surgical repair . New Eng J Med 268:174-178, 1963.Crossref 20. Johns VJ Jr, Hirst AE Jr: Dissecting aneurysm of the aorta . Medicine . 37:282-651, 1958. 21. Spencer FC, Blake H: A report of the successful surgical treatment of aortic regurgitation from a dissecting aortic aneurysm in a patient with the Marfan syndrome . J Thorac Cardiovasc Surg 44:238-245, 1962. 22. Burchell HB: Aortic dissection (dissecting hematoma; dissecting aneurysm of the aorta) . Circulation 12:1068-1079, 1955.Crossref 23. Shuford WH, Sybers RG, Weens HS: Problems in the aortographic diagnosis of dissecting aneurysm of the aorta . New Eng J Med 280:225-231, 1969.Crossref 24. Harris PD, Bowman FO Jr, Main JR: The management of acute dissections of the thoracic aorta . Amer Heart J 78:419-422, 1969.Crossref 25. Starr A, in discussion, Rohman M, Goetz RH, State D.15 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Acute Aortic Dissection Due to Cystic Necrosis: Four Cases of Emergency Replacement of the Ascending Aorta With Survival

Archives of Surgery , Volume 101 (1) – Jul 1, 1970

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Publisher
American Medical Association
Copyright
Copyright © 1970 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1970.01340250010003
Publisher site
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Abstract

Abstract Four cases of successful emergency resection and prosthetic graft replacement of the ascending aorta for acute dissections are presented. Hypotensive medical therapy was either not applicable or was ineffectual in these patients. Although such therapy has been demonstrated to have a salutary effect in some cases, surgical evaluation should be a continuing process. The indications for surgery are failure to control progression of the dissection, continuing blood loss, instability of cardiac function, and continuing compromise of major aortic tributaries. In view of the dramatic results in these four critically ill patients and the poor results reported with simple repair, it is suggested that further consideration be given to resection and prosthetic graft replacement in patients with acute dissection of the ascending aorta. References 1. Osler, cited by Kampmeier RH: Saccular aneurysm of the thoracic aorta: A clinical study of 633 cases . Ann Intern Med 12:624-651, 1938.Crossref 2. Hirst AE Jr, Johns VJ Jr, Kime SW Jr: Dissecting aneurysm of the aorta: A review of 505 cases . Medicine 37:217-279, 1958.Crossref 3. Shennan T: Dissecting Aneurysms , publication 193. Special Report Series, His Majesty's Stationery Office, London, 1934. 4. Austen WG, DeSanctis RW: Surgical treatment of dissecting aneurysm of the thoracic aorta . New Eng J Med 272:1314-1317, 1965.Crossref 5. Gurin D, Gulmer JW, Derby R: Dissecting aneurysm of the aorta: Diagnosis and operative relief of acute arterial obstruction due to this cause . New York J Med 35:1200-1202, 1935. 6. Shaw RW: Acute dissecting aortic aneurysm: Treatment by fenestration of the internal wall of the aneurysm . New Eng J Med 253:331-333, 1955.Crossref 7. DeBakey ME, Cooley DA, Creech O Jr: Surgical considerations of dissecting aneurysm of the aorta . Ann Surg 142:586-612, 1955.Crossref 8. Hufnagel CA, Conrad PW: Dissecting aneurysms of the ascending aorta: Direct approach to repair . Surgery 51:84-89, 1962. 9. Johns TNP: Dissecting aneurysm of the abdominal aorta: Report of a case with repair of perforation . Ann Surg 137:232-235, 1953.Crossref 10. Muller, cited by Stonesifer GL Jr: Acute dissecting aortic aneurysms: Importance of emergency surgery . Maryland Med J 13:131-132, 1964. 11. DeBakey ME, Henly WS, Cooley DA, et al: Surgical management of dissecting aneurysms of the aorta . J Thorac Cardiovasc Surg 49:130-149, 1965. 12. Stonesifer GL Jr: Emergency correction of ascending aortic dissecting aneurysms . Surgery 56:594-600, 1964. 13. Wheat MW Jr, Palmer RF, Bartley TD, et al: Treatment of dissecting aneurysms of the aorta without surgery . J Thorac Cardiovasc Surg 50:364-373, 1965. 14. DeBakey ME, Henley WS, Cooley DA, et al: Surgical treatment of dissecting aneurysm of the aorta: Analysis of 72 cases . Circulation 24:290-303, 1961.Crossref 15. Rohman M, Goetz RH, State D: Surgical treatment of dissecting aneurysms of the aorta with cardiac tamponade . J Thorac Cardiovasc Surg 46:498-509, 1963. 16. DeBakey ME, Henly WS, Cooley DA, et al: Surgical management of dissecting aneurysm involving the ascending aorta . J Cardiovasc Surg 5:200-211, 1964. 17. Simon AL, Hipona FA, Stansel HC: Dissecting aortic aneurysm in Marfan's syndrome . JAMA 193:156-158, 1965.Crossref 18. Matloff JM, Wolfson S, Gorlin R, et al: Control of post-cardiac surgical arrhythmias with propranolol . Circulation 37 ( (suppl 2) ):133-138, 1968. 19. Hume M, Krosnick J: Dissecting aneurysm in pregnancy associated with aortic insufficiency: Report of a case with successful surgical repair . New Eng J Med 268:174-178, 1963.Crossref 20. Johns VJ Jr, Hirst AE Jr: Dissecting aneurysm of the aorta . Medicine . 37:282-651, 1958. 21. Spencer FC, Blake H: A report of the successful surgical treatment of aortic regurgitation from a dissecting aortic aneurysm in a patient with the Marfan syndrome . J Thorac Cardiovasc Surg 44:238-245, 1962. 22. Burchell HB: Aortic dissection (dissecting hematoma; dissecting aneurysm of the aorta) . Circulation 12:1068-1079, 1955.Crossref 23. Shuford WH, Sybers RG, Weens HS: Problems in the aortographic diagnosis of dissecting aneurysm of the aorta . New Eng J Med 280:225-231, 1969.Crossref 24. Harris PD, Bowman FO Jr, Main JR: The management of acute dissections of the thoracic aorta . Amer Heart J 78:419-422, 1969.Crossref 25. Starr A, in discussion, Rohman M, Goetz RH, State D.15

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1970

References