Pocket flashlight-elicited Quincke pulse for aortic dissection diagnosis.
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ABSTRACT:
SUBMITTER: Mizuno A
PROVIDER: S-EPMC3759775 | biostudies-literature | 2013 Sep
REPOSITORIES: biostudies-literature
Publications
Pocket flashlight-elicited Quincke pulse for aortic dissection diagnosis.
Mizuno Atsushi A Niwa Koichiro K
The Korean journal of internal medicine 20130814 5
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Project description:The purpose of the present study was to establish the accuracy of transthoracic echocardiography (TTE) in diagnosis of acute type A aortic dissection in comparison to computed tomography (CT), with reference to the intraoperative image.The retrospective analysis included 178 patients referred to the cardiac surgery unit in our center due to acute type A dissection between 01-01-2008 and 31-12-2013, who underwent both TTE and CT. Intraoperative image was considered as a reference.Statistical analysis did not show any significant differences between computed tomography and echocardiography in the detection of the proximal aortic dissection. In patients with aortic valve abnormalities, procedure of choice was replacement by a composite graft (77,59%), whereas patients with a normal image of aortic valve were more likely to have the valve sparing procedure (50,88%). The R-Spearman statistics shows a strong positive correlation between maximum diameter of ascending aorta measured by TTE and CT (cc 0.869) and TTE and intraoperative measurement (cc 0.844).Our data confirm that transthoracic echocardiography is a reliable method for diagnosis of proximal aortic dissection. TTE provides a reliable value of maximum diameter of the ascending aorta in comparison to both CT and direct intraoperative measurement. Moreover, transthoracic echocardiography gives the additional information that influences the operative technique of choice and identifies the high-risk patients (cardiac tamponade, severe aortic dilatation, severe aortic regurgitation). Our retrospective analysis confirms the pivotal role of TTE in the evaluation of the patients with suspected proximal aortic dissection in emergency room setting.
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Project description:With the acceleration of population aging, the detection rate of aortic dissection has increased. The incidence rate of aortic dissection has increased year by year and has become a serious threat to human health. However, the current clinical treatment of aortic dissection is mainly limited to surgery (including intracavity), but the complexity of the disease and the high risk of surgery seriously affect the overall treatment effect of the disease. Therefore, an in-depth study of the pathogenesis of aortic dissection and the development of early diagnosis methods is not only expected to control the development of aortic dissection but also to improve the existing clinical treatment effect. Based on the bioinformatics analysis of the related mRNA sequence data of aortic dissection in GEO database, the gene expression regulatory network of aortic dissection was constructed. Through the screening of key node genes, the key factors (molecular markers) that may affect the occurrence of aortic dissection were obtained, and their functions were tested in human aortic smooth muscle cells (HAoSMC). Finally, it was concluded that SERPINE1 gene is a reliable molecular marker for the early diagnosis of aortic dissection.
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Project description:BackgroundWorse outcomes have been reported for women with type A acute aortic dissection (TAAD). We sought to determine sex-specific operative approaches and outcomes for TAAD in the current era.MethodsThe Interventional Cohort (IVC) of the International Registry of Acute Aortic Dissection (IRAD) database was queried to explore sex differences in presentation, operative approach, and outcomes. Multivariable logistic regression was performed to identify adjusted outcomes in relation to sex.ResultsWomen constituted approximately one-third (34.3%) of the 2823 patients and were significantly older than men (65.4 vs 58.6 years, P < .001). Women were more likely to present with intramural hematoma, periaortic hematoma, or complete or partial false lumen thrombosis (all P < .05) and more commonly had hypotension or coma (P = .001). Men underwent a greater proportion of Bentall, complete arch, and elephant trunk procedures (all P < .01). In-hospital mortality during the study period was higher in women (16.7% vs 13.8%, P = .039). After adjustment, female sex trended towards higher in-hospital mortality overall (odds ratio, 1.40; P = .053) but not in the last decade of enrollment (odds ratio, 0.93; P = .807). Five-year mortality and reintervention rates were not significantly different between the sexes.ConclusionsIn-hospital mortality remains higher among women with TAAD but demonstrates improvement in the last decade. Significant differences in presentation were noted in women, including older age, distinct imaging findings, and greater evidence of malperfusion. Although no distinctions in 5-year mortality or reintervention were observed, a tailored surgical approach should be considered to reduce sex disparities in early mortality rates for TAAD.
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