Download PDF
Int J Angiol 2019; 28(01): 031-033
DOI: 10.1055/s-0038-1675849
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Symptoms Matter: A Symptomatic but Radiographically Elusive Ascending Aortic Dissection

Dimitra Papanikolaou
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Mohammad A. Zafar
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Maryam Tanweer
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Mahnoor Imran
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Mohamed Abdelbaky
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Bulat A. Ziganshin
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
2   Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia
,
John A. Elefteriades
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations Source of Funding None.
Further Information

Publication History

Publication Date:
29 November 2018 (online)

    Permissions and Reprints

Abstract

Symptoms attributable to a thoracic aortic aneurysm (TAA) are a separate indication for prophylactic repair, irrespective of aortic size. We present the case of a 56-year-old female with a history of a thoracic ascending aortic aneurysm (TAAA) and four other heart and arch vessel abnormalities who presented to us with chest pain radiating to her back. Computed Tomography and echocardiography showed no evidence of a dissection and revealed a maximal ascending aortic diameter of 4.2 cm. The patient subsequently underwent root-sparing ascending aortic and hemiarch replacement due to her threatening symptomatology. A focal dissection was discovered intraoperatively, resembling a similar case previously reported by our team.

Keywords

thoracic aortic aneurysm - aortic dissection - aortic operation - symptomatic aneurysm - intervention criteria - genetic testing for thoracic aortic aneurysms - MYLK
 

  • references

  • 1 Davies RR, Goldstein LJ, Coady MA. , et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 2002; 73 (01) 17-27 , discussion 27–28
    CrossrefPubMedGoogle Scholar
  • 2 Zafar MA, Li Y, Rizzo JA. , et al. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg 2018; 155 (05) 1938-1950
    CrossrefPubMedGoogle Scholar
  • 3 Coady MA, Rizzo JA, Hammond GL. , et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms?. J Thorac Cardiovasc Surg 1997; 113 (03) 476-491 , discussion 489–491
    CrossrefPubMedGoogle Scholar
  • 4 Krüger T, Forkavets O, Veseli K. , et al. Ascending aortic elongation and the risk of dissection. Eur J Cardiothorac Surg 2016; 50 (02) 241-247
    CrossrefPubMedGoogle Scholar
  • 5 Ziganshin BA, Elefteriades JA. Guilt by association: a paradigm for detection of silent aortic disease. Ann Cardiothorac Surg 2016; 5 (03) 174-187
    CrossrefPubMedGoogle Scholar
  • 6 Elefteriades JA, Tranquilli M, Darr U, Cardon J, Zhu BQ, Barrett P. Symptoms plus family history trump size in thoracic aortic aneurysm. Ann Thorac Surg 2005; 80 (03) 1098-1100
    CrossrefPubMedGoogle Scholar
  • 7 Wang L, Guo DC, Cao J. , et al. Mutations in myosin light chain kinase cause familial aortic dissections. Am J Hum Genet 2010; 87 (05) 701-707
    CrossrefPubMedGoogle Scholar
  • 8 Kuzmik GA, Sang AX, Cai G, Tranquilli M, Elefteriades JA. Respecting symptoms in thoracic aortic aneurysm management: a case of symptomatic necrotizing granulomatous aortitis. Int J Angiol 2012; 21 (03) 151-154
    Article in Thieme ConnectPubMedGoogle Scholar