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Aortic Dissection  Zahir Rahman MD 10/14/02
ED History – 9:55 A.M. ,[object Object],[object Object]
Neurosurgery PE – 10:30 AM ,[object Object],[object Object],[object Object],[object Object]
Neurosurgery A/P ,[object Object],[object Object],[object Object]
MRA  ,[object Object],[object Object],[object Object],[object Object],[object Object]
RCA RSC LCA INTIMA TRUE LUMEN FALSE LUMEN PULMONARY TRUNK RSC
THROMBUS IN FALSE LUMEN TRUE LUMEN
FALSE LUMEN LRA TRUE LUMEN
 
CV Fellow Called: 12:30 P.M. ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
PE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Labs: 7/30/02 9:35 AM  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EKG
Management ,[object Object],[object Object]
Intraoperative TEE Ascend Aorta
Intraoperative TEE – Aortic Arch
Descend Aorta – Communication back into true lumen
Descend Aorta – Multiple Intimal Flaps
Intraoperative TEE ,[object Object],[object Object],[object Object],[object Object]
Surgery  ,[object Object],[object Object],[object Object]
Course:  ,[object Object],[object Object],[object Object],[object Object]
Hospital Course ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aortic Dissection  Zahir Rahman MD 10/14/02
Classifications ,[object Object],[object Object],[object Object]
Common Classification Systems Braunwald
Common Classifications of Aortic Dissection
Variants of Aortic Dissection
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cystic Medial Degeneration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathogenesis ,[object Object],[object Object],[object Object],[object Object]
Proposed Mechanism of Initiation of Dissection
Natural History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms of Aortic Dissection  According to a report on 464 patients from the  International Registry of Acute Aortic Dissection. (Hagan et al. Jama 2000; 283:897-903)
Clues to Proximal Dissection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aortic Regurgitation ,[object Object],[object Object],[object Object],[object Object],[object Object],Hagan et al. IRAD. JAMA 2000;283:897-903.
Mechanisms of Aortic Regurgitation in Proximal AD
Hypotension with Proximal Dissection ,[object Object],[object Object],[object Object],[object Object],[object Object]
Predicting Death in Type A Aortic Dissection  (Mehta et al. Circulation. 2002;105:200-206) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Variables Associated with High In-Hospital Mortality Rates. (Mehta et al. Circulation. 2002;105:200-206)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clues to Distal Dissection
Clinical Prediction of Acute Aortic Dissection  (von Kodolitsch et al, Arch Intern Med 2000;160:2977-2982) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
(von Kodolitsch et al, Arch Intern Med 2000;160:2977-2982)
(von Kodolitsch et al, Arch Intern Med 2000;160:2977-2982)
[object Object],[object Object],[object Object],(von Kodolitsch et al, Arch Intern Med 2000;160:2977-2982)
EKG ,[object Object],[object Object],[object Object],[object Object]
CXR  ,[object Object],[object Object],[object Object]
Normal Aorta in CXR 3 years Prior
Enlargement of the Aortic Knob A Case of Proximal Aortic Dissection
Comparison of Imaging Modalities (Braunwald)
Aortography ,[object Object],[object Object],[object Object],[object Object]
Thoracic Aortagram in AP view
CT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contrast-Enhanced CT at level of Ventricle
Left Anterior Oblique View Contrast Enhanced CT Intimal Flap originates beyond Left SC Artery
TEE ,[object Object],[object Object],[object Object],[object Object],[object Object]
Descend Aorta – Communication back into true lumen
MRI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RCA RSC LCA INTIMA TRUE LUMEN FALSE LUMEN PULMONARY TRUNK RSC
Practical Assessment of Imaging Modalities
Smooth Muscle Myosin Heavy Chain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Suzuki et al. Circulation 1996;93:1244-1249)
MANAGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sodium Nitroprusside ,[object Object],[object Object],[object Object],[object Object]
Labetolol ,[object Object],[object Object],[object Object],[object Object]
Esmolol ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contraindications to BB ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cardiac Tamponade ,[object Object],[object Object],[object Object],[object Object],Isselbacher et al, Circulation 1994: 90;2375-2378.
Cardiac Tamponade ,[object Object],[object Object]
Indications for Definitive Surgical and Medical Therapy in AD
Surgical Repair of Proximal Dissections
Surgery ,[object Object],[object Object],[object Object]
Surgery with AR ,[object Object],[object Object],[object Object],[object Object]
Endovascular techniques ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long Term  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intramural Hematoma (H)
Crescenteric Hematoma that does not Enhance confirming a intramural Hematoma that does not communicate with the Aortic Lumen.
Evolution of a Penetrating atherosclerotic Ulcer of Aorta

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