1/14. Swinging motion of intimal flap through the aortic valve in acute aortic dissection.The purpose of this article is to present a very rare case of Stanford type A acute aortic dissection featuring a swinging motion of the cylinder-shaped intimal flap through the aortic valve. The patient was a 62-year-old male suffering from severe cardiogenic shock. A transthoracic echocardiogram revealed aortic dissection and severe aortic regurgitation. A transesophageal echocardiogram demonstrated that the aortic dissection in the ascending aorta was circumferential and the proximal portion of the intimal flap was swinging through the aortic valve, ie., falling into the left ventricle during the diastolic phase and being ejected back into the ascending aorta during the systolic phase. An emergency graft replacement of the ascending aorta was performed. During ventricular fibrillation under total cardiopulmonary bypass, we performed cardiac massage to prevent myocardial ischemia, because blood flow from a heart lung machine inverted the intimal flap, which might have disturbed the coronary circulation. The patient's postoperative course was uneventful, and his postoperative echocardiogram revealed only a trace of regurgitant flow through the aortic valve. back-and-forth movement of the cylinder-shaped intima requires coexistence of the following three conditions: severe aortic regurgitation, circumferential dissection, and complete transection of the intimal flap. We conclude that this movement of the intimal flap should be regarded as one of the most serious complications leading rapidly to cardiogenic shock. From a surgical point of view, it is most important to prevent myocardial ischemia during cardiopulmonary bypass especially in cases in which ventricular fibrillation has occurred. We describe the ways to prevent myocardial ischemia in this rare situation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/14. Clinical considerations in the chiropractic management of the patient with marfan syndrome.OBJECTIVE: To describe the chiropractic management of a patient with whiplash-associated disorder and a covert, concomitant dissecting aneurysm of the thoracic aorta caused by marfan syndrome or a related variant. CLINICAL FEATURES: A 25-year-old man was referred by his family physician for chiropractic assessment and treatment of neck injuries received in a motor vehicle accident. After history, physical examination, and plain film radiographic investigation, a diagnosis of whiplash-associated disorder grade I was generated. INTERVENTION AND OUTCOME: The whiplash-associated disorder grade I was treated conservatively. Therapeutic management involved soft-tissue therapy to the suspensory and paraspinal musculature of the upper back and neck. Rotary, manual-style manipulative therapy of the cervical and compressive manipulative therapy of the thoracic spinal column were implemented to maintain range of motion and decrease pain. The patient achieved full recovery within a 3-week treatment period and was discharged from care. One week after discharge, he underwent a routine evaluation by his family physician, where an aortic murmur was identified. Diagnostic ultrasound revealed a dissecting aneurysm measuring 78 mm at the aortic root. Immediate surgical correction was initiated with a polyethylene terephthalate fiber graft. The pathologic report indicated that aortic features were consistent with an old (healed) aortic dissection. There was no evidence of acute dissection. Six month follow-up revealed that surgical repair was successful in arresting further aortic dissection. CONCLUSION: The patient had an old aortic dissection that pre-dated the chiropractic treatment (which included manipulative therapy) for the whiplash-associated disorder. Manipulative therapy, long considered an absolute contraindication for abdominal and aortic aneurysms, did not provoke the progression of the aortic dissection or other negative sequelae. The cause, histology, clinical features, and management considerations in the treatment of this patient's condition(s) are discussed.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
3/14. Localized aortic dissection: unusual features by transesophageal echocardiography.Transesophageal echocardiography relies on the presence of an undulating intimal flap for the diagnosis of aortic dissection. Furthermore, to distinguish true dissection from echo artifacts, the flap has to be identified in more than one view, and it must have a motion independent of the aortic wall. We describe the transesophageal echocardiography appearance of a localized aortic dissection with atypical features for an intimal flap. awareness of this unusual echocardiographic appearance of an intimal flap will avoid misdiagnosis of the potentially serious acute aortic dissection.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
4/14. Transesophageal and transpharyngeal ultrasound demonstration of reversed diastolic flow in aortic arch branches and neck vessels in severe aortic regurgitation.In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
5/14. A child case of acute right coronary obstruction due to catheter-induced coronary dissection: successful reperfusion without stenting.We report on a 10-year-old child who suffered from acute right coronary obstruction due to catheter-induced coronary dissection. Immediate placement of a perfusion catheter into the obstructed right coronary artery and subsequent overnight reperfusion allowed successful recovery of the right coronary artery lumen without implantation of a stent. Follow-up angiography demonstrated spontaneous regression of the dissected coronary artery and normal right and left ventricular wall motion. The indication of stent implantation should be carefully determined in a child case of iatrogenic coronary dissection because stenting may induce coronary stenosis during growth.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
6/14. motion artifact simulating aortic dissection on CT.We recently imaged two patients clinically suspected of having aortic dissection whose contrast-enhanced CT examinations, obtained on a new scanner with a 1-sec scanning time, showed findings suggesting an ascending aortic dissection. The subsequent clinical course and evaluation implied that the CT findings were predominantly artifactual. We identified identical artifacts in 18% of 50 consecutive contrast-enhanced CT examinations performed for a variety of indications on the same scanner. The double-lumen artifact, simulating an intimal flap, occurs in the proximal ascending aorta and is limited to one or two contiguous transaxial images. The artifact was not detected on two other CT units. We believe the artifact arises from motion of the aortic wall and the surrounding pericardial recesses during image acquisition.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
7/14. Fast magnetic resonance in vascular diseases of the abdomen.Fast magnetic resonance (MR) imaging provides a consistent and predictable appearance of vascular abnormalities as shown by four patients with thrombi, dissection and aneurysm. Fast MR images are obtained during breath-holding, resulting in an absence of respiratory motion artifacts. The time of MR study is much less with fast MR than with spin echo sequences.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
8/14. Intermittent ischemia caused by dissection of the abdominal aorta through myxoid degeneration. Case report.Acute intermittent ischemia is generally caused by altered vasomotion and rarely by aortic dissection. There is reported a case of dissection of the abdominal aorta which presented a mixoid degeneration of the inner wall. The surgical finding was similar to a medio intimal aortic cylinder obtained generally during endarterectomy. Five years after the operation (endarterectomy of the mixoid cylinder) the patient presents a good patency of the aortoiliac area.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
9/14. Two-dimensional echocardiographic recognition of an aortic intimal flap prolapsing into the left ventricular outflow tract.A 59 year old man presented with dyspnea and a new murmur of aortic regurgitation. Two-dimensional echocardiography demonstrated a to and fro motion of the intimal flap as it prolapsed into the left ventricle and was thrust into the aorta during diastole and systole, respectively. At surgery, the echocardiographic and angiographic findings were confirmed and a proximal aortic dissection was identified. prolapse of an intimal flap from the aorta into the left ventricular outflow tract represents a new two-dimensional echocardiographic sign of aortic dissection.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
10/14. "Duplication" of aortic cusp. New M-mode echocardiographic sign of intimal tear in aortic dissection.M-mode and two-dimensional echocardiograms were obtained in a patient with acute dissecting aneurysm of the ascending aorta. The M-mode echocardiogram disclosed apparent "duplication" of the non-coronary aortic cusp. Two-dimensional echocardiograms showed this finding to be the result of the motion of a flap of torn aortic intima. This new M-mode finding appears to be a highly specific echocardiographic sign for aortic dissection.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
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