Acute Aortic Disease (Fundamental and Clinical Cardiology) by John Elefteriades

By John Elefteriades

Masking the pathophysiology, imaging, analysis, and remedy of numerous aortic aneurysms and dissections, this resource is helping physicians successfully learn and assessment affected contributors in scientific or emergency care settings. delivering a wide range of illustrations, x-rays, and operative pictures to stress key anatomic observations, this advisor includes state of the art perception at the most up-to-date biologic, radiologic, medical, and surgical advancements that experience taken position within the box. offered in a reader-friendly structure, this resource offers end-of-chapter questions and a point-counterpoint structure to research differing views from popular specialists on those illnesses. The Q & A and counterpoint contain the reader in an interactive interchange by means of opinion leaders.

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Various mechanisms may explain the inverse relationship between the anatomic proximity of the entry site and the outcome in patients with acute dissection. First, the more proximal the origin of the dissected aortic layer, the more likely is a mechanical obstruction of coronary ostia, rupture within the pericardial sac (79), and/or new aortic regurgitation. Second, loss of elasticity in proximal aortic segments may predispose to aortic wall disintegrity preferentially adjacent to the sinuses of valsalva (80).

Once distal or type B dissections reach the chronic phase, without complications, they usually enjoy a clinically stable course for months or years. However, from careful observational evidence, it is obvious that with time late aneurysmal expansion does develop—usually at the proximal segment of the descending thoracic aorta near the subclavian artery. This chronic dilatation confers an increasing risk of late rupture as a function of an expanding false lumen. Other complications in the chronic phase include compression of vital structures in the vicinity of an expanding false lumen aneurysm, late malperfusion syndrome, and peripheral emboli.

Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117:1271–1278. 70. Miller DC. The continuing dilemma concerning medical versus surgical management of patients with acute type B dissection. Semin Thorac Cardiovasc Surg 1993; 5:33–46. 71. Bogaert J, Meyns B, Rademakers FE, et al. Follow-up of aortic dissection: contribution of MR angiography for evaluation of the abdominal aorta and its branches. Eur Radiol 1997; 7:695–702. 72. Glower DD, Speier RH, White WD, et al. Management and long-term outcome of aortic dissection.

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