Document Detail


Late acute aortic dissection after coronary artery bypass.
MedLine Citation:
PMID:  18392846     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Late ascending aortic dissection after coronary artery bypass grafting (CABG) is an uncommon phenomenon, and treatment presents a complex clinical dilemma. MATERIALS AND METHODS: Between 1995 and 2005, eight patients were diagnosed with post-CABG late acute aortic dissection. Mean age was 61.7 (range 52-76), and mean period between CABG and late acute aortic dissection was 45.3 months (range 5 to 122 months). Three patients underwent surgical replacement of the ascending aorta. One patient died after surgery, and the other two had an uneventful recovery, with a successful mean 6.5-year follow-up. Five patients were treated conservatively, with a mean follow-up of 81.2 months (range 50-112 months). RESULTS AND DISCUSSION: Periodic computed tomography (CT) scans showed minor or no change in aortic diameter and satisfactory general condition. Late acute aortic dissection after CABG is rare. Only a few reports have been published, and no standard treatment guidelines exist. CONCLUSION: We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection and therefore suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial. Late ascending aortic dissection after CABG is rare, and treatment presents a clinical dilemma. We treated eight patients with post-CABG late acute aortic dissection. Three underwent surgical replacement of the ascending aorta. One died after surgery, and the other two had an uneventful recovery. Five patients were treated conservatively. No standard treatment guidelines exist for late acute aortic dissection after CABG. We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection, and suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial.
Authors:
Amihay Shinfeld; Ehud Raanani
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-04-08
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie     Volume:  394     ISSN:  1435-2451     ISO Abbreviation:  Langenbecks Arch Surg     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-02-03     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  345-8     Citation Subset:  IM    
Affiliation:
Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel. amihaysh@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aneurysm, Dissecting / diagnosis,  mortality,  surgery*
Antihypertensive Agents / therapeutic use
Aortic Aneurysm, Thoracic / diagnosis,  mortality,  surgery*
Aortography
Blood Vessel Prosthesis Implantation
Coronary Artery Bypass*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications / diagnosis,  mortality,  surgery*
Reoperation
Survival Rate
Tomography, X-Ray Computed
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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