1/28. Aortic dissection in young patients with chronic hypertension.We describe four patients aged 14 to 21 years who developed acute aortic dissection. In three of the four patients, the course was fatal, despite aggressive medical and surgical intervention. All four patients had sustained systemic hypertension related to chronic renal insufficiency. The patients had no other identifiable risk factors for aortic dissection, including congenital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma, pregnancy, or family history of aortic dissection. Although aortic dissection is rare in individuals younger than 40 years of age, young patients with sustained systemic hypertension are at increased risk for this serious and often fatal condition. physicians must be aware of this rare complication of hypertension and consider aortic dissection in the differential diagnosis of unusual chest, abdominal, and back pain in hypertensive children, adolescents, and young adults.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/28. A giant dissecting aneurysm mimicking serpentine aneurysm angiographically. Case report and review of the literature.Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm. A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically. Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/28. Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/28. Dissecting aneurysms of the posterior inferior cerebellar artery: report of four cases and review of the literature.Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those exclusively on the posterior inferior cerebellar artery (pica) represent only 24 cases in the literature, including the four cases discussed in this article. The clinical diagnosis lacks pathognomonic signs or symptoms, with presentations such as subarachnoid haemorrhage or ischaemia of the brain stem or the cerebellum, and the management is controversial. Wrapping, clipping and embolisation of the aneurysms were tried in this series with different outcomes. Exclusion of the pathological segment should be performed, as shown by rebleeding from our case which was wrapped or by progression of the vascular disease in cases where treatment was delayed. Surgical or endovascular occlusion are well tolerated in our cases and in those reported from the literature, which implies the absence of normal perforating branches to the brain stem arising from the proximal dissected segment of the pica and a good collateral circulation. A revascularisation procedure using the occipital artery can be performed in order to prevent infarction if an endovascular test occlusion is not tolerated.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/28. Spontaneous coronary artery dissection in a healthy postmenopausal woman.Spontaneous coronary artery dissection (SCAD) is rare and when it occurs is most commonly seen in young females following childbirth. We report a case of a 55-year-old female who was found dead at her home. She had no history of cardiovascular disease. She smoked approximately 10 cigarettes per day. She complained of mild chest discomfort the night before her death, lasting for 10 minutes, for which no medical attention was sought. She had been seen and appeared well 15 minutes before death. At autopsy, the only abnormality was in the left anterior descending coronary artery, which showed a two cm segment with periluminal blood in the wall of the vessel compressing the lumen. Histologically, a dissection was seen between the media and the external elastic lamina of the affected artery. There was a mixed inflammatory infiltrate including eosinophils and very occasional giant cells. alcian blue staining was negative. The appearances were those of a localised dissection. The remaining coronary arteries were free of atheroma. SCAD should be suspected in young females in their postpartum period presenting with chest pain since emergency treatment can greatly increase survival.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/28. The initial Trinidad experience with Cine MRI in clinical cardiology.We describe the initial Trinidad experience with magnetic resonance imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI trinidad and tobago Ltd. Selected patients underwent angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/28. Intraoperative aortic dissection--a case report.Intraoperative aortic dissection is a rare but potentially fatal complication of cardiac surgery. Prompt recognition and repair are necessary to limit the extent of dissection to minimize morbidity and mortality. Here, we present a case of acute type A dissection of ascending aortic artery occurring after removal of aortic cannula at the end of cardiopulmonary bypass. The surgeon immediately recannulated him at the femoral artery and repaired the dissection under deep hypothermia. Ascending aorta was replaced with Hemashield graft and venous graft was reimplanted. Unfortunately, the patient expired the following day due to cardiac tamponade resulting from uncontrolled bleeding. Long-standing severe hypertension, severe atherosclerotic change of the aortic wall, thin and dilating ascending aorta and cystic medial necrosis or collagen vascular disease were thought to predispose him to this complication. Gentle manipulation and surgical discreetness to forestall aoratic injury could minimize the risk of intraoperative aortic dissection. Once aortic dissection has been suspected, prompt application of transesophageal echocardiography to confirm the diagnosis, and rapid as well as appropriate surgical management are necessary to grasp a better outcome.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/28. Renovascular hypertension secondary to spontaneous renal artery dissection and treatment with stenting.Renovascular disease is the cause of less than 1% of patients with hypertension; within this group aneurysm and dissection in renal artery are even rarer causes. It may be not only iatrogenic or traumatic, but may also develop spontaneously from fibromuscular disease or atherosclerotic lesions. We present a 26-year-old male patient with recently developed and progressive hypertension in whom renal angiography showed aneurysmal dilatation and dissection of the right renal artery. With the implantation of two stents in the true lumen, normal renal blood flow and thrombosis of the aneurysmal sac was established. As a result, stent implantation to renal artery dissection is effective, reliable and easy and can be an alternative to surgical treatment.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/28. Spontaneous rupture of a left gastroepiploic artery aneurysm in a patient with autosomal-dominant polycystic kidney disease.Autosomal-dominant polycystic kidney disease (ADPKD) has been known to be associated with a variety of vascular diseases. We present a hemodialysis patient with ADPKD who died of a massive intraperitoneal hemorrhage caused by the spontaneous rupture of a left gastroepiploic artery aneurysm. A 64-year-old male was admitted to our hospital with acute upper abdominal pain and hemorrhagic shock. An abdominal angiography showed three aneurysms and the source of hemorrhage was assumed to be the left gastroepiploic artery aneurysm. The patient died of severe metabolic acidosis and disseminated intravascular coagulation (DIC) on the second hospital day. At autopsy, there was massive bleeding into the abdominal cavity, and pathological examination of the left gastroepiploic artery aneurysm revealed a dissecting aneurysm. This is the first case describing a rupture of a gastroepiploic aneurysm in a patient with ADPKD.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/28. Successful angiographic stent-graft treatment for spontaneously dissecting broad-base pseudoaneurysm of the superior mesenteric artery.Visceral arterial aneurysm is an uncommon form of vascular disease that has a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Superior mesenteric artery (SMA) aneurysms are especially rare, comprising only 5-8% of all visceral arterial aneurysms. Traditionally, the most common treatment for SMA aneurysms has been simple surgical ligation of the proximal and distal vessel. Herein, we report the case of a 53-year-old man with a dissecting pseudoaneurysm of the SMA, demonstrated by multi-slice computed tomography and angiography. The patient was successfully treated with percutaneous transluminal angioplasty and stenting.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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