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Giant Pseudoaneurysm of the Ascending Aorta Caused by Chronic Stanford Type A Aortic Dissection
Canadian Journal of Cardiology 27 (2011) 871.e3– 871.e4 www.onlinecjc.ca
Images in Cardiology
Giant Pseudoaneurysm of the Ascending Aorta Caused by Chronic Stanford Type A Aortic Dissection Alexander Weymann, MD, Bastian Schmack, MD, Matthias Karck, MD, PhD, and Gábor Szabó, MD, PhD Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
A 65-year-old woman presented with a 1-month history of chest pain and dyspnea. A grade 4/6 diastolic murmur was heard on auscultation. Physical examination revealed signs of congestive heart failure and poor peripheral perfusion. Echocardiography demonstrated a hypertrophied and dilated left ventricle with normal systolic function but a giant thrombus-filled pseudoaneurysm of the ascending aorta associated with moderate aortic regurgitation (Fig. 1, A). The computed tomography scan clearly disclosed a chronic stanford type A aortic dissection compressing the native aorta (Fig. 1, B). Intraoperatively, the huge pseudoaneurysm was removed (Fig. 1, C–E) and replaced through use of a bentall procedure. The patient had an uneventful postoperative recovery. The few patients who survive the initial phase of an un-
treated stanford type A aortic dissection have an extremely high long-term risk of mortality and often have clinical findings different from those of acute dissections. Meticulous diagnostic imaging and immediate surgical treatment are mandatory to improve survival.1-3 Disclosures The authors have no conflicts of interest to disclose. References 1. Carnevale D, Lembo G, Frati G. Chronic Type A aortic dissection: could surgical intervention be guided by molecular markers? J Cell Mol Med 2011;15:1615-9.
Received for publication June 6, 2011. Accepted August 28, 2011.
2. Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation 2006;114:2226-31.
Corresponding author: Dr Alexander Weymann, Department of Cardiac Surgery, University of Heidelberg, INF 110, 69120 Heidelberg, Germany. E-mail: [email protected] See page 871.e3 for disclosure information.
3. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg 2009;37:149-59.
0828-282X/$ – see front matter © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.cjca.2011.08.124
871.e4
Canadian Journal of Cardiology Volume 27 2011
Figure 1. (A) Transesophageal echocardiogram demonstrating a giant thrombus-filled pseudoaneurysm (arrow) of the ascending aorta caused by chronic type A dissection; (asterisk) indicates entry. (B) Axial computed tomography scan disclosing the huge pseudoaneurysm (maximum diameter 7.7 cm) of the ascending aorta compressing the native aorta; (asterisk) indicates entry. (C) Intraoperative view of the giant pseudoaneurysm (arrow). (D) A large thrombus mass is evident in the pseudoaneurysm (asterisk). (E) Removed pseudoaneurysm filled with thrombotic material (arrow). FL, false lumen; LVOT, left ventricular outflow tract; TL, true lumen.
Images in Cardiology
Giant Pseudoaneurysm of the Ascending Aorta Caused by Chronic Stanford Type A Aortic Dissection Alexander Weymann, MD, Bastian Schmack, MD, Matthias Karck, MD, PhD, and Gábor Szabó, MD, PhD Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
A 65-year-old woman presented with a 1-month history of chest pain and dyspnea. A grade 4/6 diastolic murmur was heard on auscultation. Physical examination revealed signs of congestive heart failure and poor peripheral perfusion. Echocardiography demonstrated a hypertrophied and dilated left ventricle with normal systolic function but a giant thrombus-filled pseudoaneurysm of the ascending aorta associated with moderate aortic regurgitation (Fig. 1, A). The computed tomography scan clearly disclosed a chronic stanford type A aortic dissection compressing the native aorta (Fig. 1, B). Intraoperatively, the huge pseudoaneurysm was removed (Fig. 1, C–E) and replaced through use of a bentall procedure. The patient had an uneventful postoperative recovery. The few patients who survive the initial phase of an un-
treated stanford type A aortic dissection have an extremely high long-term risk of mortality and often have clinical findings different from those of acute dissections. Meticulous diagnostic imaging and immediate surgical treatment are mandatory to improve survival.1-3 Disclosures The authors have no conflicts of interest to disclose. References 1. Carnevale D, Lembo G, Frati G. Chronic Type A aortic dissection: could surgical intervention be guided by molecular markers? J Cell Mol Med 2011;15:1615-9.
Received for publication June 6, 2011. Accepted August 28, 2011.
2. Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation 2006;114:2226-31.
Corresponding author: Dr Alexander Weymann, Department of Cardiac Surgery, University of Heidelberg, INF 110, 69120 Heidelberg, Germany. E-mail: [email protected] See page 871.e3 for disclosure information.
3. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg 2009;37:149-59.
0828-282X/$ – see front matter © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.cjca.2011.08.124
871.e4
Canadian Journal of Cardiology Volume 27 2011
Figure 1. (A) Transesophageal echocardiogram demonstrating a giant thrombus-filled pseudoaneurysm (arrow) of the ascending aorta caused by chronic type A dissection; (asterisk) indicates entry. (B) Axial computed tomography scan disclosing the huge pseudoaneurysm (maximum diameter 7.7 cm) of the ascending aorta compressing the native aorta; (asterisk) indicates entry. (C) Intraoperative view of the giant pseudoaneurysm (arrow). (D) A large thrombus mass is evident in the pseudoaneurysm (asterisk). (E) Removed pseudoaneurysm filled with thrombotic material (arrow). FL, false lumen; LVOT, left ventricular outflow tract; TL, true lumen.