Aneurysm, Dissecting/complications* ; Coronary Artery Disease/complications* ; Dyspnea/complications* ; Humans ; Syncope/etiology*

OBJECTIVE: To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis. METHODS: We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture.The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared. RESULTS: Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture.Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers.Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture ( < 0.05);lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus.Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR ( < 0.05). CONCLUSIONS Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.
Aneurysm, Dissecting ; complications ; Aortic Aneurysm ; complications ; Cardiopulmonary Resuscitation ; adverse effects ; Forensic Pathology ; Heart Rupture ; etiology ; pathology ; Heart Rupture, Post-Infarction ; pathology ; Humans ; Myocardial Contusions ; complications

Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Computed Tomography Angiography ; methods ; Conservative Treatment ; methods ; Coronary Angiography ; methods ; Coronary Vessels ; diagnostic imaging ; pathology ; Electrocardiography ; methods ; Heart Injuries ; complications ; Humans ; Magnetic Resonance Imaging, Cine ; methods ; Male ; Multimodal Imaging ; methods ; Myocardial Infarction ; diagnosis ; etiology ; therapy ; Treatment Outcome ; Wounds, Nonpenetrating ; complications

Acupuncture Therapy ; Aged ; Aneurysm, Dissecting ; complications ; Brain ; diagnostic imaging ; pathology ; Cerebral Infarction ; etiology ; therapy ; Female ; Glasgow Coma Scale ; Humans ; Postoperative Complications ; etiology ; therapy ; Tomography, X-Ray Computed

To observe the mid- and long-term result of intentional coverage of celiac artery in thoracic endovascular aortic repair (TEVAR) surgery for aortic dissection.
 Methods: We retrospectively analyzed 21 cases who received TEVAR with celiac artery coverage during the operation. The existence of collaterals between celiac artery (CA) and superior mesenteric artery (SMA) was confirmed by preoperative CT angiography (CTA) or digital substract angiography (DSA) for each patient. We used the stent-graft precisely above the orifice of SMA. Follow-ups were carried out at 2 weeks, 1 month, 3 months, 6 months, 1 year after the operation, and once per year thereafter.
 Results: No signs of visceral artery ischemic syptoms such as liver dysfunction, abdominal pain or distention were observed after the operation. There was no signs of spinal cord ischemia (SCI). Seven cases showed type II endoleak upon completion DSA but stopped automatically within 3 months. CTA in follow-ups showed thrombosis formation in false lumen.
 Conclusion: The intentional coverage of CA during the TEVAR for aortic dissection is safe and effective. The incidence of post-operative SCI or visceral artery ischemia is low. Type II endoleak is a major complication but it can be ceased automatically after medication.
Aneurysm, Dissecting ; surgery ; Angiography, Digital Subtraction ; Angioplasty ; methods ; Aorta, Thoracic ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; methods ; Celiac Artery ; surgery ; Computed Tomography Angiography ; Endoleak ; etiology ; Endovascular Procedures ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Mesenteric Artery, Superior ; surgery ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Stents ; adverse effects ; Thrombosis ; etiology ; Treatment Outcome

No abstract available.
Aneurysm, Dissecting/diagnosis/*etiology/physiopathology/therapy ; Anticoagulants/therapeutic use ; Aortic Aneurysm/diagnosis/*etiology/physiopathology/therapy ; Behcet Syndrome/*complications/diagnosis/drug therapy ; Cerebral Infarction/diagnosis/etiology ; Diffusion Magnetic Resonance Imaging ; Echocardiography, Doppler, Color ; Electrocardiography ; Hemodynamics ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; *Sinus of Valsalva/physiopathology/ultrasonography ; Thrombosis/diagnosis/drug therapy/*etiology/physiopathology ; Ventricular Septal Rupture/diagnosis/*etiology/physiopathology/therapy

PURPOSE: To compare the outcomes of thoracic endovascular aortic repair (TEVAR) with those of open repair for descending thoracic aortic aneurysms (DTAA). MATERIALS AND METHODS: We compared the outcomes of 114 patients with DTAA and proximal landing zones 3 or 4 after TEVAR to those of 53 patients after conventional open repairs. Thirty-day and late mortality were the primary endpoints, and early morbidities, aneurysm-related death, and re-intervention were the secondary endpoints. RESULTS: The TEVAR group was older and had more incidences of dissecting aneurysm. The mean follow-up was 36+/-26 months (follow-up rate, 97.8%). The 30-day mortality in the TEVAR and open repair groups were 3.5% and 9.4% (p=0.11). Perioperative stroke and paraplegia incidences were similar between the groups [5.3% vs. 7.5% (p=0.56) and 7.5% vs. 3.5% (p=0.26), respectively]. Respiratory failure occurred more in the open repair group (1.8% vs. 26.4%, p<0.01). The incidence of acute kidney injury requiring dialysis was higher in the open repair group (1.8% vs. 9.4%, p<0.01). The cumulative survival rate was higher in the TEVAR group at 2 to 5 years (79.6% vs. 58.3%, p=0.03). The free from re-intervention was lower in the TEVAR group (65.3% vs. 100%, p=0.02), and the free from aneurysm-related death in the TEVAR and open repair groups were 88.5% and 86.1% (p=0.45). CONCLUSION: TEVAR is safe and effective for treating DTAAs with improved perioperative and long-term outcomes compared with open repair.
Age Factors ; Aged ; Aneurysm, Dissecting/*epidemiology/surgery ; Aortic Aneurysm, Thoracic/mortality/*surgery ; Aortic Rupture/mortality/*surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea ; Stroke/etiology ; Survival Rate ; Time Factors ; Treatment Outcome

OBJECTIVETo report two cases of chronic disseminated intravascular coagulation associated (DIC) with aortic dissecting aneurysm, and discuss the treatment strategy.

METHODSThe clinical data of two patients with chronic DIC associated with aortic dissecting aneurysm were analyzed and the related literature was reviewed.

RESULTSCase 1: female, 53 years old, she had gingival bleeding, skin ecchymosis and haematuria for 2 months, the laboratory test revealed PLT 48 × 10⁹/L, APTT 38.0 s and fibrinogen 0.53 g/L; Case 2: male 86 years old, he had skin petechia and ecchymosis,gingival bleeding for 2 weeks, the laboratory test revealed PLT 17×10⁹/L, APTT 37.5 s and fibrinogen 0.51 g/L. CT scan for both cases revealed aortic aneurysm. They were diagnosed as aortic aneurysm associated chronic DIC. Both of them received blood component transfusion. After the treatment, they showed improvement in bleeding symptoms and laboratory data. They gave up operation, and were discharged from the hospital at last.

CONCLUSIONBlood replacement can alleviate bleeding tendency in those patients with chronic DIC associated with aortic dissecting aneurysm.

Aged, 80 and over ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm ; complications ; Blood Coagulation Disorders ; etiology ; Female ; Hemorrhage ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVESTo analyze risk factors associated to acute renal failure (ARF) post deep hypothermia circulatory arrest (DHCA) surgery of type A aorta dissection patients, researching correlations to hospital mortality rate.

METHODSThere were 273 samples of type A aorta dissection patients collected between September 2011 and May 2013 , all of which had surgery done under DHCA. Categorize the samples into two groups based on whether postoperative ARF happened: non-ARF group(n = 163) and ARF group(n = 110). Conducted regression analysis correlations between postoperative ARF and mortality and one or more risk factors of gender, age, history of illness, type of aorta dissection, heart functional class, pre- and post-operative serum creatinine (sCr), DHCA time, blood loss and blood transfusion volume, postoperative complications, etc.

RESULTSAmong the 110 samples of ARF group (40.3%), 21 (7.7%) conducted continuous renal replacement therapy (CRRT). Among 16 (5.9%) died in hospital, 3 (1.8%) died with functional renal, 13 (11.8%) died with ARF. Single factor analysis: male (χ(2) = 6.075, P = 0.014), preoperative sCr (t = 2.955, P = 0.004), dissection extended to renal artery(χ(2) = 5.103, P = 0.024), cardiopulmonary by-pass (CBP) time (t = 2.435, P = 0.017), DHCA time (t = 2.215, P = 0.031), average lower limb artery blood pressure during CBP (t = -2.832, P = 0.007), during surgery and 24 h postoperative blood loss (t = 2.157, P = 0.034) and blood transfusion (t = 2.426, P = 0.018), postoperative acute respiratory dysfunction (χ(2) = 36.307, P = 0.000), postoperative endotracheal reintubation (χ(2) = 9.167, P = 0.002), postoperative low blood pressure (χ(2) = 10.202, P = 0.001), postoperative temporary neurological deficits (χ(2) = 7.512, P = 0.006), postoperative infection (χ(2) = 11.088, P = 0.001) were the risk factors for ARF. The logistic regression analysis revealed that preoperative sCr (P = 0.023) and acute respiratory dysfunction (P = 0.011) were independent determinants of ARF; preoperative ARF (P = 0.022), CRRT (P = 0.003) and permanent neurological deficits were independent determinants for hospital mortality.

CONCLUSIONSARF is a common complication of post Type A aorta dissection surgery under DHCA, and is the risk factor of hospital mortality. It is important to enhance peri-operative protection of the renal function.

Acute Kidney Injury ; etiology ; Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology

No abstract available.
Acute Disease ; Aneurysm, Dissecting/complications/*diagnosis/physiopathology ; Aortic Aneurysm/complications/*diagnosis/physiopathology ; Aortic Valve Insufficiency/*diagnosis/etiology/physiopathology ; Fingers/*blood supply ; Humans ; Light/*diagnostic use ; Male ; Middle Aged ; Predictive Value of Tests ; *Pulse