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. 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) |
3/28. Ruptured sinus of a Valsalva aneurysm associated with autosomal-dominant polycystic kidney disease in an elderly patient: report of a case.We report herein the case of a 71-year-old woman with autosomal-dominant polycystic kidney disease (ADPKD), who was referred to our hospital for investigation of facial edema. echocardiography demonstrated a large aneurysm arising from the non-coronary sinus of valsalva, with a left to right shunt and jets of blood passing from the aneurysm toward the septal leaflet of the tricuspid valve. Surgical treatment was successfully carried out by resecting the aneurysmal wall and performing a patch closure of the orifice. It is well known that ADPKD predisposes patients to cardiovascular disease, and this case report serves to demonstrate that when a patient with ADPKD presents with progressive heart failure, the possibility of a ruptured sinus of a Valsalva aneurysm must be considered.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/28. 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) |
5/28. 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) |
6/28. Cardiovocal (Ortner's) syndrome left recurrent laryngeal nerve palsy associated with cardiovascular disease.Five patients with cardiovascular disease presented with hoarseness due to left recurrent laryngeal nerve palsy. One had secundum atrial septal defect, one had ventricular septal defect, two had mitral stenosis and the other had aortic aneurysm. All except the patient with aortic aneurysm had pulmonary artery dilatation and moderate to severe pulmonary hypertension. Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery. We postulate that the dilated pulmonary artery or aortic arch was responsible for the compression of the left recurrent laryngeal nerve.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
7/28. Accelerated atherosclerosis, aneurysmal disease, and aortitis: possible pathogenetic association with cocaine abuse.cocaine abuse and its association with vascular disease has become common in the medical literature. A variety of vascular problems have been described including neurovascular complications, cardiovascular complications, aortic dissection, venous thrombosis, mesenteric artery thrombosis, and renal infarction. The pathogenesis of these vascular complications has largely been related to increased adrenergic activity leading to vasospasm. Interaction of cocaine with the vascular endothelium resulting in thrombosis or vasculitis has also been suggested. We report a case of diffuse aneurysmal change of the aorta associated with an atypical inflammatory component consistent with possible cocaine induced vasculitis.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/28. Aortic root dilatation with sinus of valsalva and coronary artery aneurysms associated with ankylosing spondylitis.The HLA-B27-related spondyloarthopathies are associated with cardiovascular disease in 2% to 10% of cases. inflammation and sclerosis of the aortic root and ventricular septum have been linked to the development of isolated aortic regurgitation and conduction abnormalities; however, aneurysms of the aortic sinuses and coronary arteries have not been previously described. We report the case of a 58-year-old white man who presented for evaluation of dyspnea and was found to have aneurysms of the sinuses of Valsalva and the circumflex coronary artery. The patient underwent aortic root replacement. Approximately 3 months later, he presented with symptoms, radiographs, and laboratory data consistent with ankylosing spondylitis. To our knowledge, these particular cardiovascular manifestations of HLA-B27-related disease have not been previously reported. This case expands the clinical spectrum of the disease and should prompt the clinician to consider the possibility of HLA-B27-associated cardiovascular disease in patients who have aortic and coronary aneurysms.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
9/28. Pseudoaneurysm of the aortic root diagnosed by noninvasive imaging: report of a case.Pseudoaneurysm of the aortic root is a rare condition typically diagnosed by the use of cardiac catheterization and aortography or by surgical exploration. This case describes a patient who was shown to have a pseudoaneurysm of the aortic root without evidence of any acquired etiologic factors other than atherosclerotic vascular disease. Two new advanced techniques of noninvasive imaging were used in confirming the diagnosis: transesophageal echocardiography and gated magnetic resonance imaging. This case highlights the value of techniques such as these to reliably assess the heart and great vessels without the need for more invasive procedures.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/28. Intravascular ultrasound imaging of an acute dissecting aortic aneurysm: a case report.A case of acute dissecting aortic aneurysm is described in which intravascular ultrasonography was used at the time of aortography to produce real-time, 360 degree cross-sectional images of the aorta. The transmural vessel morphology visualized by this new catheter-based technology allowed confirmation of the diagnosis and identification of distal extension to the aortic bifurcation. The case demonstrates the unique potential of this modality in diagnosis and possible therapy in vascular diseases.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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