Dissection Flap Research Articles

Time of admission: images show dissection flap in ascending segment with intussuscepted flap at the arch

Time of admission: images show dissection flap in ascending segment with intussuscepted flap at the arch

Images at the time of admission show dissection flap in the ascending and descending aorta

Images at the time of admission show dissection flap in the ascending and descending aorta

Images at admission show evidence of AVR with a mechanical valve as part of a composite graft of the root and ascending aorta and the dissection flap of the native descending aorta beginning beyond the left subclavian artery

Images at admission show evidence of AVR with a mechanical valve as part of a composite graft of the root and ascending aorta and the dissection flap of the native descending aorta beginning beyond the left subclavian artery

Image shows extent of dissection flap, with compressed false lumen in the carotid arteries

Image shows extent of dissection flap, with compressed false lumen in the carotid arteries

Images of initial admission with type-A aortic dissection show the extensive dissection flap with prolapsed flap in the arch and small, compressed lumen in the descending thoracic and abdominal aorta. Also seen is involvement of the iliac arteries with stent on the left. Also seen is a moderate size hemorrhagic pericardial effusion

Images of initial admission with type-A aortic dissection show the extensive dissection flap with prolapsed flap in the arch and small, compressed lumen in the descending thoracic and abdominal aorta. Also seen is involvement of the iliac arteries with stent on the left. Also seen is a moderate size hemorrhagic pericardial effusion

Repeat scan (2 hours later) clearly shows the dissection flap in the ascending aorta

Repeat scan (2 hours later) clearly shows the dissection flap in the ascending aorta

The image shows the dissection flap of the ascending aorta and arch, with surrounding blood products in the mediastinum

The image shows the dissection flap of the ascending aorta and arch, with surrounding blood products in the mediastinum

The contrast scan shows type-A dissection with dissection flap beginning in the proximal ascending aorta and extending into the abdominal aorta

The contrast scan shows type-A dissection with dissection flap beginning in the proximal ascending aorta and extending into the abdominal aorta

Images on admission show the dissection flap beginning in the distal ascending aorta

Images on admission show the dissection flap beginning in the distal ascending aorta

Images show the dissection flap in the proximal and mid ascending segment with associated aneurysmal dilatation of the ascending aorta

Images show the dissection flap in the proximal and mid ascending segment with associated aneurysmal dilatation of the ascending aorta

A CT 1 month prior to current/index admission shows stable repair of type-A aortic dissection. Residual dissection flap beyond the surgical graft

A CT 1 month prior to current/index admission shows stable repair of type-A aortic dissection. Residual dissection flap beyond the surgical graft

Images on admission (chest) show evidence of a type-B dissection with dissection flap beginning at the left subclavian artery, with a tear beyond left subclavian

Images on admission (chest) show evidence of a type-B dissection with dissection flap beginning at the left subclavian artery, with a tear beyond left subclavian

The non-contrast scan shows the calcified dissection flap in the proximal descending aorta

The non-contrast scan shows the calcified dissection flap in the proximal descending aorta

First admission (chest): dissection flap ascending aorta, patent true lumen descending aorta

First admission (chest): dissection flap ascending aorta, patent true lumen descending aorta

Non-contrast CT. As expected the dissection flap is not identified

Non-contrast CT. As expected the dissection flap is not identified

A rare case of right pulmonary segmental artery dissection following pacemaker insertion

This paper describes a case of pulmonary segmental artery dissection following pacemaker insertion. The patient was admitted electively and was clinically well prior to admission. The patient had a history...

Early vascular responses to everolimus-eluting cobalt\u2013chromium stent in the culprit lesions of st-elevation myocardial infarction: results from a multicenter prospective optical coherence tomography study (MECHANISM-AMI 2-week follow-up study)

The use of cobalt–chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECHANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm2, p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm2, p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions—including a significant reduction of thrombus—that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks.

Surgical damage to the lymphatic system promotes tumor growth via impaired adaptive immune response

BackgroundBoth lymph nodes (LNs) and lymphatic channels from primary sites to regional LNs are critical for initiation of adaptive immunity. However, as LNs are common metastatic sites in skin cancers, LN biopsies or dissections are frequently performed. In addition, reconstructive skin flaps after tumor resection may damage lymphatic flow from primary sites to regional LNs. ObjectiveThis study was designed to investigate the effect on tumor progression by such surgeries. MethodsWe developed a mouse model that simulates LNs dissection or skin flap that blocks lymphatic flow from primary sites to regional LNs and monitored tumor progression. ResultsAs a poor immunogenic tumor line, the growth of inoculated B16F10 melanoma into syngeneic C57BL/6 mice was not affected by these surgeries. However, the growth of the same cell line in allogenic Balb/c mice was accelerated while immune cell infiltration (CD4+ and CD8+ T cells) into the tumor was reduced by these surgeries. In addition, both cytotoxicity against B16F10 melanoma and numbers of apoptotic tumor cells were diminished by these surgeries. Similarly, tumor growth of the immunogenic MC38 cell line in syngeneic C57BL/6 mice was accelerated and immune cell infiltration and apoptotic tumor cells were reduced by these surgeries. ConclusionThese results strongly indicate that surgical damage of the lymphatic system may promote tumor progression via impaired adaptive immune response.

Case Report: Type 1 aortic dissection presenting as acute pericarditis: the roles of POCUS and transthoracic echocardiography

Clinical Presentation: A 59 year old male presented with a 1 day history of non-exertional chest pain that was pleuritic in nature and aggravated by lying flat. His chest pain symptoms were preceded by a one week history of “flu-like” symptoms. Physical exam demonstrated a blood pressure of 114/55 mmHg, heart rate of 75 bpm, and a normal oxygen saturation on room air. Cardiac examination revealed a biphasic pericardial rub vs. to-and-fro murmur. EKG demonstrated diffused ST-elevation and PR depression consistent with acute pericarditis. Laboratory findings revealed a normal WBC of 11.2×109/L and hsTnT of 78 ng/L. Imaging Findings: A point of care ultrasound (POCUS) assessment demonstrated mild aortic insufficiency with a dilated ascending aorta with no pericardial effusion or wall motion abnormalities. An expedited transthoracic echocardiography (TTE) confirmed a bicuspid aortic valve with moderate aortic insufficiency. The aortic root and ascending aorta were dilated at 50 and 52 mm, respectively. There was evidence of an aortic dissection flap prolapsing across the left ventricular outflow tract. A dissection flap was also visualized within the abdominal aorta consistent with a Type 1 aortic dissection. Computed tomography of the aorta confirmed the Type 1 aortic dissection and the patient underwent an urgent valve-sparing aortic root replacement procedure. Discussion Points: Despite a typical clinical presentation for acute pericarditis, any unexpected physical exam or laboratory findings should lead to a POCUS assessment. This case demonstrates a rare presentation of aortic dissection which could have been easily missed without a POCUS assessment. Here we propose an algorithm for a POCUS examination in setting of pleuritic chest pain consistent with pericarditis.

A New Root-Strengthening Technique for Acute Aortic Dissection with a Weakened Aortic Root: The Neo-Adventitia Technique.

BackgroundDissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the “neo-adventitia” technique to strengthen the weakened aortic root.MethodsFrom 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS.ResultsThere were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period.ConclusionThis technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.