Category: Aortic Dissection News Page 10 of 11

Anaesthetic challenges in emergency surgical repair of acute aortic dissection rupturing into the pericardium in a pregnant patient

Abstract: Mohammad Irfan Akhtar,Khalid Samad ( Department of Anaesthesia, Aga Khan University Hospital, Karachi. )

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy.

A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units of whole blood, fresh frozen plasma, platelets, calcium and cryoprecipitates.


As a last resort she was given low dose r FVIIa (1.2 mg containing 60 KIU of Factor VII). This stopped the bleeding and the haemodyramics were stabilized.
Keywords: Aortic dissection, pregnant patient, recombinant activated factor VII (r FVII a).

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How a Torn Aorta Can Do Lethal Damage

How a Torn Aorta Can Do Lethal DamageBy DENISE GRADY
Published: December 20, 2010
Article source

Richard C. Holbrooke, 1941-2010: Strong American Voice in Diplomacy and Crisis (December 14, 2010) He became ill on a Friday, and was dead by Monday. According to government officials, the cause was a tear in his aorta, the artery that carries blood from the heart to vessels that feed the rest of the body.

Mr. Holbrooke underwent 21 hours of surgery from Friday to Saturday to repair the damage, and then another seven-hour operation on Sunday, all at George Washington University Medical Center in Washington. But no amount of surgery could save him.

Aortic tears may be unfamiliar to most people, but they kill at least 2,000 Americans a year, and possibly more, because some of the deaths may be mistakenly attributed to heart attacks. Tears are more common in men than in women, and most likely in people from 40 to 70. Their causes include uncontrolled high blood pressure, atherosclerosis and a genetic tendency to have weak tissue or an abnormal valve in the aorta. There may be no warning signs before the tear occurs.

The aorta is the biggest artery in the body, more than an inch wide in some spots. It has three layers; most tears start in the innermost one. Blood can then force its way into the tear and separate the layers, or peel them apart — a type of damage called aortic dissection.

A flap and a “false channel” can form inside the aorta and impede blood flow. And the pressure from the blood can keep enlarging the tear and the flap. If the tear goes all the way through and the aorta ruptures, death can be almost immediate. That did not happen to Mr. Holbrooke, a spokeswoman said.

Tears are often — but not always — associated with aneurysms, which are bulging, weakened areas in the artery wall. High blood pressure may contribute to both problems.

It is not known whether Mr. Holbrooke had either of those conditions. His family has not been available for interviews, and his doctors were not given permission to speak to a reporter.

Surgeons not associated with his case said Mr. Holbrooke most likely had the most common type of tear, which occurs in the ascending aorta, the beginning of the vessel where it emerges from the top of the heart.

In their simplest form, such tears can be repaired “fairly easily,” said Dr. Timothy J. Gardner, a spokesman for the American Heart Association and a heart surgeon who is medical director of Christiana Care’s Center for Heart and Vascular Health in Newark, Del.

Dr. Gardner did not know the details of Mr. Holbrooke’s case, but he said, “We have to infer that he had a complicated aortic dissection where one or more of the branches of his aorta were involved and/or the tissue damage and the hemorrhage were extensive and very difficult to deal with.”

In that situation, he said, “it can be a really challenging surgical procedure.”

Dr. Robert Michler, surgeon in chief at Montefiore Medical Center in the Bronx, said that if he is in the operating room in the middle of the night, he is very likely to be repairing a torn aorta. Patients tend to show up with symptoms at night.

“Exactly why that is we don’t know,” he said.

A common symptom is sudden, severe pain in the chest, back or neck. Some people even say they feel a tearing or ripping sensation. Others have no pain. Some have shortness of breath, cold legs, abnormal pulses in their limbs or stroke symptoms like weakness or paralysis. Sometimes blocked circulation causes organs to fail.

The variation in symptoms can make it hard for doctors to figure out what is wrong and lead them to mistake the problem for a heart attack, collapsed lung or ulcer.

Delays in diagnosis can be deadly, because tears in the ascending aorta need emergency surgery. Some people die so quickly they never even make it to the hospital. Among those who do reach the hospital, if the condition is not diagnosed and treated within 48 hours, half will die.

From 80 to 90 percent survive surgery, which involves cutting out the damaged part of the aorta — several inches’ worth in most cases — and replacing it with a tube made of a synthetic material. The aortic valve may also need to be repaired or replaced, and coronary arteries may need to be bypassed.

The operations are long and complicated; the heart has to be stopped and the patient must be hooked up to a heart-lung machine that takes over the jobs of pumping blood and oxygenating it.

“You just operate until you’re done,” said Dr. Loren F. Hiratzka, a cardiothoracic surgeon and the medical director for cardiac surgery at Bethesda North and Good Samaritan hospitals in Cincinnati. “It’s not unusual to spend four to eight hours in there.”

A 21-hour operation, like the one Mr. Holbrooke had, can only be described as “heroic,” Dr. Hiratzka said, adding: “If they were in the operating room for 21 hours, I can’t imagine what they were running into. Sometimes it’s like you’re trying to repair wet tissue paper. The layers of the aorta just get shredded. The layers themselves can become very friable and hard to put back together.”

Sometimes, he and other surgeons said, the tissue is so weak that it will not hold a stitch, and they spend hours and hours sewing and trying to stop the bleeding.

In some cases it may be a genetic disorder that makes the tissue fragile and the aorta prone to tearing. Certain genetic conditions, like Marfan’s syndrome, are known to predispose people to these problems, but researchers think there are other mutations, not yet identified, that may also play a part.

Abnormalities in the aortic valve can also lead to tears. In most people, the valve has three leaflets that open and close to regulate blood flow, but in some it has only two — which can cause blood to squirt at the wall of the aorta in a jet spray, like water from a partly blocked hose. The spray can gouge pits in the artery wall.

“I have some extraordinary pictures of an aortic wall I removed from a patient with an aneurysm that showed moonlike craters in the wall of the aorta, where the aorta had been injured and tried to heal itself,” said Dr. Michler, the surgeon in chief at Montefiore. “It had happened in half a dozen places.”

CT scans and X-rays can detect aneurysms and identify people who are at risk for tears or ruptures, Dr. Michler said. If an aneurysm is developing, doctors can monitor it and operate if it gets too big. But it is not known whether Mr. Holbrooke had had X-rays or CT scans, or any reason to have had them.

Some experts believe that anyone with an aortic aneurysm or tear is likely to have some underlying genetic disorder. So whenever a patient has an aortic aneurysm, Dr. Hiratzka said, it is important for the immediate family — siblings, children and parents — to be tested for similar problems.

A version of this article appeared in print on December 21, 2010, on page D7 of the New York edition..

U.S. diplomat Holbrooke dies after tearing aorta

Richard Holbrooke, a veteran U.S. diplomat who was the architect of the 1995 Bosnia peace plan and served as President Barack Obama’s special envoy to Pakistan and Afghanistan, has died, NBC News reported, citing a U.S. official. He was 69.

Holbrooke’s forceful style earned him nicknames such as “The Bulldozer” or “Raging Bull.” He was admitted to George Washington University Hospital on Friday after he became ill. He had surgery on Saturday to repair a torn aorta.

“Tonight America has lost one of its fiercest champions and most dedicated public servants,” Secretary of State Hillary Clinton said after his death on Monday.

“Richard Holbrooke served the country he loved for nearly half a century, representing the United States in far-flung war-zones and high-level peace talks, always with distinctive brilliance and unmatched determination. He was one of a kind — a true statesman — and that makes his passing all the more painful.”

Hours before Holbrooke’s death Obama had called Holbrooke “a towering figure in American foreign policy” who was a critical player in developing the administration’s policy on Afghanistan.

more……

Holbrooke in critical condition following aortic surgery

Washington (CNN) — U.S. diplomat Richard Holbrooke was in critical condition at George Washington University Hospital on Saturday after undergoing surgery to repair a tear in his aorta, a State Department spokesman said.

Holbrooke, 69, the Obama administration’s special representative for Pakistan and Afghanistan, fell ill Friday morning during a meeting with Secretary of State Hillary Clinton and walked down to the department’s medical unit, a senior State Department official said. He was taken by ambulance to the hospital, the official said.

CNN’s Chief Medical Correspondent Sanjay Gupta said the tearing of one of the layers of the walls of the aorta “happens suddenly.” It typically is associated with blood pressure and typically occurs in men between the ages of 50 and 70.

Gupta said the biggest concern that blood leaving the heart and heading “to other places in the body may not be doing that as well.” The location of the tear “would determine what, if any, other side effects would occur.”

“This is different from a problem people think of with the heart where some of the blood vessels going to the heart become blocked,” he said.

An operation “typically involves bringing layers of the aorta back together so that no further dissection can occur. If that’s done quickly and the aorta is intact, meaning it hasn’t opened up, that can be a very good procedure and can take care of the problem.”

After doctors completed surgery on his aorta Saturday morning, Holbrooke was joined by his family, State Department spokesman P.J. Crowley said.

President Barack Obama called the diplomat’s wife, Kati, and told her he and first lady Michelle Obama have Holbrooke in their prayers, the White House said in a statement.

“Richard Holbrooke is a towering figure in American foreign policy, a critical member of my Afghanistan and Pakistan team, and a tireless public servant who has won the admiration of the American people and people around the world,” the president said.

Secretary Clinton visited Holbrooke at the hospital on Saturday, the State Department said.

Holbrooke is a career diplomat best known for brokering the peace agreement between Bosnian factions in 1995 that became the Dayton accords.

source of article here

What you can do still even after having an aorticdissection

Great inspirational story…

Heartosaurus.com

I got this from my friend, Dr. Alan Stewart at Columbia:

Allan Stewart, MD

Director, Aortic Surgery Program

Division of Cardiothoracic Surgery

Columbia University Medical Center

177 Fort Washinton Ave.

MHB 7GN-435

New York, NY 10032

Fax: 212 305-2439

Office (212) 305-4980

Rare heart surgery at Ruby Hall Clinic

Cardiac surgeons at Ruby Hall Clinic were faced with a dilemma when Shivaji Satpute, 45, was diagnosed with a tear in the main artery arising from the heart, leading to a condition called dissecting ascending aortic aneurysm. A surgery for such an acute aortic dissection is challenging and has an unpredictable outcome.

Despite a successful surgery, the patient can die from uncontrolled bleeding. Also, the surgery and the postoperative management can be quite expensive.

Thus, when Satpute was wheeled into the operating room, doctors faced a major challenge as the patient was unconscious and owing to the unpredictable nature of the recovery of the brain considering it was deprived of blood for 24 hours.

Satpute, an employee of the Maharashtra State Electricity Distribution Company Ltd (MSEDCL), Junnar, was at work when he experienced excruciating chest pain and fell unconscious. The tear had blocked off the origin of the blood supply to the brain and had also leaked into the pericardium (covering of the heart) compressing the heart, as diagnosed by cardiologist Dr Jagdish Hiremath.

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Cardiac surgeon Dr Sameer Bhate, to whom the case was referred, decided to go ahead with the surgery as the patient was relatively young, following a discussion with his relatives. By the time Satpute was brought into the operating room, his condition had deteriorated further and when the operation commenced, the aorta had completely ruptured and had also torn the aortic valve and the origin of the right coronary artery.

After an eight-hour operation where the aortic valve was replaced with the ascending aorta using an artificial valve and a Dacron graft and a bypass to the right coronary artery, the patient was shifted back to the intensive care unit. Though Satpute made good recovery from the surgery in terms of heart condition, he showed no neurological recovery and in fact was feared to be brain-dead.

The patient slowly recovered and was weaned off the respirator on the 15th day post the surgery. Satpute was discharged after 2 months of hospitalisation . “After three months, he is moving all his limbs and is walking with help and his memory is also fine,” Bhate said.

Adventist Hinsdale Hospital Awarded Prestigious “Blue Distinction” for Cardiac Care

Did you know Adventist Hinsdale Hospital is a designated Blue Distinction Center for Cardiac Care? Blue Cross and Blue Shield of Illinois grants this award only to hospitals committed to quality care that results in better overall outcomes for cardiac patients. More specifically, Blue Distinction Centers are required to thoroughly demonstrate low overall complications and mortality rates to qualify for this distinction.

This recognition is further evidence of our commitment to leading the way in cardiovascular health. But don’t take my word for it; testimonials from our patients go a long way in solidifying Adventist Hinsdale Hospital’s reputation here in Hinsdale and the surrounding community.

Take Larry Frait of Downers Grove. He was working at his desk in his Willowbrook office when a sharp spasm hit between his shoulder blades. Accustomed to strenuous workouts at the gym, Frait figured he overdid it the previous night and got up for a water bottle.

The moment he sat down again, stabbing pain overwhelmed him. He groggily told a fellow worker he was sick. Time blurred from there, but Frait remembers fellow workers gathering around him, paramedics saying, “We’re out of here in 45 seconds!” and the icy chill of February wind as he entered the ambulance.

Frait awakened 24 hours later in the Adventist Hinsdale Hospital intensive care unit. He learned that the previous day, Dr. Frank Lutrin, medical director of cardiothoracic surgery, repaired an acute type A aortic dissection and ascending aortic aneurysm on Frait, a life-threatening condition Lutrin sees only about four to six times a year.

“For critical patients like Mr. Frait, we have to move very quickly,” Lutrin said. “You don’t have the luxury of waiting.”

Because Frait was born with a bicuspid valve, he had a slightly increased risk for developing an aortic aneurysm. Lutrin replaced Frait’s ascending aorta and half of his aortic arch. He then replaced the aortic valve with a mechanical one. It is this type of life-saving procedure that inspired Lutrin to become a surgeon. Often, patients with acute aortic dissections don’t make it to the operating room.

“Mr. Frait can go back to living his normal life,” Lutrin said. “His prognosis is very good.”

Frait spent six days in the hospital and returned to work April 5. He also underwent cardiopulmonary rehabilitation. Because of Frait’s experiences, his friends now take their cardiac symptoms seriously. Frait praises the quick and expert actions of everyone who worked on him Adventist Hinsdale Hospital.

“It’s really incredible how quickly they found out what was happening,” Frait said. “I’m lucky to be alive.”

More than a million Americans will experience a first or recurrent heart attack this year alone, according to the American Heart Association. Through designating Blue Distinction Centers, Blue Cross and Blue Shield of Illinois expresses a commitment to working with hospitals that meet quality standards in cardiac care.

Adventist Hinsdale Hospital’s Rooney Heart Center provides state-of-the-art treatment and rehabilitation services for cardiac patients, including, coronary artery bypass surgery, valve repair and replacement and coronary angioplasty and stenting. It also includes an electrophysiology lab, which offers advanced technology in the management of cardiac arrhythmias.

In addition, the Rooney Heart Center is designed to speed heart attack patients from the emergency department to specialized treatment in the shortest time possible. The hospital has recorded some of the fastest cardiac emergency treatment times reported in the database of the American College of Cardiology.

The Rooney Heart Center is part of the Adventist Cardiovascular Network, which includes a team of more than 75 board-certified physicians with experience in a variety of cardiovascular specialties. Nursing staff members are specialists in cardiac care and provide a nurturing environment conducive to healing. The center also offers programs in cardiac care, cardiovascular rehabilitation and wellness designed to promote cardiac health.

No one wants to think they might have a heart attack or another adverse cardiac event. But it can be comforting to realize that if you do, Adventist Hinsdale Hospital is here for you.

Article source

Thoracic Endovascular Aortic Dissection May Benefit Non-Acute Patients

Researchers from Beth Israel Deaconess Medical Center (BIDMC) at Harvard Medical School in Boston have released findings about the use and mortality rate of thoracic endovascular repair type B aortic dissection (TBAD) in thoracic endovascular aortic repair (TEVAR) in the United States. This less-invasive dissection method is primarily used in non-acute aneurysm cases. Details of their research were published in the Society for Vascular Surgery’s® October issue of the Journal of Vascular Surgery®.

Using data from the Nationwide Inpatient Sample database between 2005 and 2007, researchers selected 10,466 patients who underwent either open or endovascular stent graft repair for a diagnosis of thoracic aortic dissection or thoracoabdominal aortic dissection. Patients with an aortic aneurysm (464), and those who had cardioplegia or in need of operations on heart vessels or valves (5,002), presumed to be Type A (acute) dissections were eliminated from the study.

The remaining 5,000 patients made up the TBAD group. Of them, 3,965 patients had thoracic dissections (1,081 TEVAR and 2,884 open repair) and 1,035 had thoracoabdominal dissection (300 TEVAR and 735 open repair.)


“In-hospital mortality was 19 percent for open repair vs. 10.6 percent for endovascular repair,” said Frank Pomposelli, MD, chief of Vascular and Endovascular Surgery at BIDMC and associate professor of surgery at Harvard Medical School. “The mortality rate was significantly higher with open repair for patients coded as emergent admissions (20.1 percent vs. 13.1 percent), but did not reach statistical significance for elective admissions (12.3 percent vs. 4.8 percent).”

Complications were more frequent in the open repair group, including cardiac (12.4 percent vs. 4.9 percent), respiratory (7.7 percent vs. 4.3 percent), genito-urinary (9.0 percent vs. 2.5 percent), hemorrhage (14.0 percent vs. 2.8 percent), and acute renal failure (32.1% vs. 17.2). Length of stay was also greater in the open repair group (Median length of stay: 10.7 days vs. 8.3 days).

“Although we do not have data available in this retroactive cohort study regarding midterm or long-term durability of TEVAR in these patients, previous mid-term follow-up studies for TEVAR in thoracic aortic aneurysms have shown that the greatest risk of death comes in the immediate perioperative period, which lends reliability to our findings,” noted Dr. Pomposelli.

“This study is valuable because it demonstrates that approximately 25 percent of repairs for TBAD are being performed by TEVAR,” added Dr. Pomposelli. “The endovascular approach is being used for older patients with greater comorbidities. Our study showed lower rates of complications and a reduction in mortality rates, cost and the length of hospital stay which is very encouraging. The durability of TEVAR for anatomically suitable patients needing non-acute aortic repair remains and area of interest that is worthy of further study.”

Source:
Society for Vascular Surgery

University of Luebeck Joins GeneGo’s Metaminer Cardiac Project

SOURCE GeneGo, Inc.

ST JOSEPH, Mich., July 20, /PRNewswire/ — GeneGo, Inc., a leading provider of databases, software and services in systems biology and chemistry, announced today that Dr. Salah Mohamed in Department of Cardio and Thoracic Vascular Surgery at the University of Luebeck and his team will be part of the Metaminer Cardiac Partnership. Dr. Mohamed is published within 6 different reputed Scientific American Journals in connection with Biomarker Discovery work performed for the American Heart Association.

Mohamed and colleagues theorized that the cause of acute aortic dissection lay in the interaction of other proteins with the protein MS FBN1. That protein is encoded by a mutated gene linked to Marfan syndrome. Researchers found 88 genes in the tissue of all 19 acute aortic dissection patients who had gene expression – the process that converts a gene’s encoded information into a protein -significantly different from the same genes in the Marfan patients and the control group. Further investigation revealed that the MS FBN1 protein interacted directly with the proteins of four of the 88 genes – fibulin 1 (FBLN1), fibulin 2 (FBLN2), Decorin (DCN) and microfibrillar associated protein 5 (MFAPS5).

“Interestingly, one of these four proteins is considered as a candidate in the development of Marfan syndrome,” Mohamed said. “The study was also aimed at the future development of a clinical test for monitoring patients with a high risk of acute aortic dissection. Most acute aortic dissection patients do not have a known connective tissue disorder. The identification of the four genes could be a starting point to develop a diagnostic tool, and we plan to utilize GeneGo’s tools to further this study.”

“Dr. Mohamed and his group are going to bring a lot of domain knowledge to the MetaMiner Cardiac Project which is essential to its success,” said Julie Bryant, VP Business Development of GeneGo. “Cardiac disease reconstruction pathway maps are unique to GeneGo and we have been pioneers in this field. We are also looking for more Pharmaceutical members with domain expertise.”

About GeneGo, Inc.

GeneGo, Inc. develops systems biology technology such as compound based pathway analysis, cheminformatics & bioinformatics software for life science research.

First patient treated with Medtronic’s Valiant thoracic stent graft in aortic dissection trial

Marking a major milestone toward expanding the use and utility of minimally invasive endovascular procedures, Medtronic, Inc. announced the enrollment of the first patient in the Medtronic Dissection Trial, which is evaluating the clinical performance of the Valiant Thoracic Stent Graft with the Captivia Delivery System for the treatment of acute, complicated Type B aortic dissection – a serious cardiovascular condition associated with high morbidity and mortality. The study is being conducted under an Investigational Device Exemption (IDE) in the United States.

Medtronic initiated its Dissection Trial in May 2010 and will enroll a total of 50 patients across 25 centers in the United States. Dr. Zvonimir Krajcer, M.D., co‐director of the Peripheral Vascular Disease Service at St. Luke’s Episcopal Hospital in Houston, treated the trial’s first patient with Type B aortic dissection. “Patients with acute, complicated Type B aortic dissection require immediate treatment, and the Valiant Captivia system holds great promise as a minimally invasive treatment for this challenging patient group,” said Dr. Krajcer. “This trial will help to determine if the Valiant Captivia system is a safe and effective alternative to invasive surgery for these patients.”

An aortic dissection is a potentially life‐threatening condition in which there is bleeding into and along the wall of the aorta, which carries blood for the entire body. Aortic dissections are classified as Type A or Type B depending on where they occur. Type A aortic dissections begin in the ascending aorta, the segment closest to the heart, and require surgery to repair. Type B aortic dissections begin in the descending aorta, may extend into the abdomen and, if uncomplicated by rupture or malperfusion, can be treated with medication as a first‐line intervention. Patients with acute, complicated Type B aortic dissections are reported to have a greater than 50% likelihood of dying from this disease and as such often require emergent treatment.

The exact cause of aortic dissection is unclear. Risk factors include atherosclerosis (hardening of the arteries) and hypertension (high blood pressure); however, the condition also can occur as the result of surgical complications, rare disorders (Marfan’s syndrome, for example) or traumatic injury. Type B aortic dissections have historically been treated with medication or through invasive surgical techniques.

Stent grafts are tubular medical devices that endovascular interventionalists deliver through a catheter inserted in the patients’ femoral arteries (a large artery that runs from the groin down the inner leg). Once deployed, the grafts conform to the wall of the aorta, the body’s main artery, creating a new path for blood flow. Endovascular stent grafting is an effective way to treat some aortic conditions, such as aneurysms (a bulge in the wall of the aorta).

The Valiant Thoracic Stent Graft received the CE Mark in 2005 and is available in more than 90 countries outside the United States. Indicated for the treatment of a variety of thoracic aortic lesions, the device has been used to treat more than 15,000 patients worldwide. Both the Valiant Thoracic Stent Graft and the Captivia Delivery System are investigational in the United States, where their use is limited to clinical trials approved by the U.S. Food and Drug Administration.

Source: Medtronic, Inc.

Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches. A Scientific Statement From the American Heart Association

Perspective: The following are 10 points to remember from the American Heart Association (AHA) Scientific Statement on surgical management of descending thoracic aortic disease (TAD).

1. Descending TAD is increasingly recognized, composed of distinct etiologies with predictable and well defined clinical behaviors.

2. Historically, surgical intervention for descending TAD has been associated with high rates of paraplegia and mortality. However, in recent years, particularly at high-volume centers, mortality (4-9%) and paraplegia (<3%) rates have improved. 3. Endovascular thoracic aortic stent grafts are an attractive treatment option in descending TAD due to lower published risks of mortality and paraplegia, particularly in the high surgical risk groups (i.e., the elderly and those with significant chronic obstructive pulmonary disease). 4. Though technically feasible in a variety of clinical settings, some considerations for the broad application of stent grafting in descending TAD include: * Lack of long-term data on durability (>5 years).
* Lack of prospective randomized trials to directly compare open and endovascular therapy.
* Re-intervention rates, primarily for endoleak, are not insignificant.
* Risk of stroke approaches 4%.
* Frequent need for left subclavian bypass procedures in order to secure adequate landing zones.

5. Patients with the Marfan syndrome or other connective tissue diseases were excluded from stent-graft trials and are not ideal candidates for stent grafting.

6. Though feasible in most cases, stent graft therapy of thoracic aortic aneurysm should not be performed at aortic sizes smaller than what is recommended for traditional surgery. Patient selection should be based on lack of candidacy for open surgery, life expectancy, and anatomic suitability.

7. Traditional surgery for complicated acute type B dissection carries significant morbidity and mortality. Endovascular therapy is emerging as an alternative with high rates of technical success, false lumen thrombosis, and low complication rates.

8. Prophylactic stent grafting to prevent complications of chronic type B dissection is compared to medical management in the INSTEAD and ABSORB trials, but long-term data are not yet available.

9. Stent grafting can be performed as an alternative to high-risk surgery in intramural hematoma and penetrating atherosclerotic ulcers (PAUs) in the descending aorta. Stent grafting of PAU is associated with higher complication rates due to the diffuse nature of atherosclerotic disease. The risk of endoleak is higher in these patients.

10. Treatment of traumatic aortic transaction with stent grafts is an alternative to surgery in high-risk cases. However, in this younger population, questions remain regarding graft durability, impact of frequent imaging, and radiation exposure, and long-term consequences of left subclavian coverage (required in an estimated 80% of cases). Anna M. Booher, M.D.

New Guidelines Aim to Prevent Unnecessary Death from Thoracic Aortic Disease

This is worth a repost!!

Brian

New Guidelines Aim to Prevent Unnecessary Death from Thoracic Aortic Disease
ScienceDaily (Mar. 16, 2010) — When actor John Ritter died suddenly in 2003 from a tear in his thoracic aorta — the large artery that carries blood from the heart to the rest of the body — that tragedy brought attention to a rare but deadly condition that takes the lives of an estimated 10,000 Americans each year.

Now, new clinical guidelines spearheaded by the American College of Cardiology (ACC) and the American Heart Association (AHA) not only offer new recommendations for the diagnosis and management of thoracic aortic disease (TAD), they deliver a powerful message to physicians and patients: Early diagnosis and treatment can save lives.

“If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable,” said Loren F. Hiratzka, M.D., who chaired the guidelines writing committee and is the medical director of cardiac surgery for TriHealth, Inc. (Bethesda North and Good Samaritan Hospitals) in Cincinnati, OH. “The results of treatment for stable disease are far better than for acute — and often catastrophic — aortic rupture or dissection.”

The new guidelines appear in the April 6, 2010, issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, as well as on web sites of the ACC (http://www.acc.org) and the AHA (http://www.americanheart.org). They were developed in collaboration with the American Association for Thoracic Surgery (AATS), American College of Radiology (ACR), American Stroke Association (ASA), Society of Cardiovascular Anesthesiologists (SCA), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of Thoracic Surgeons (STS), and Society for Vascular Medicine (SVM). The American College of Emergency Physicians (ACEP) and the American College of Physicians (ACP) were also represented on the writing committee.

Recent scientific and clinical advances drove the development of guidelines to aid physicians in the diagnosis and management of aortic dissection, aortic aneurysm and other forms of TAD, said Kim A. Eagle, M.D., director of the University of Michigan Cardiovascular Center in Ann Arbor and co-author of the guidelines.

“We now have a deeper understanding of the genetic underpinnings of TAD, and we continue to expand our knowledge in this area,” he said. “There have been rapid advances in noninvasive imaging. Medical therapy is much better. Open surgical techniques with anesthesia have improved dramatically. We can even use endovascular (minimally invasive, catheter-based) approaches in some patients.”

An aortic aneurysm occurs when a portion of the aorta balloons out, increasing the diameter of the blood vessel by at least 50 percent at that spot. Although the wall of the aorta can become dangerously thin, patients with an aortic aneurysm often have no symptoms unless the aneurysm ruptures.

In the case of aortic dissection, a tear in the inner lining of the aorta (the intima) allows blood to invade the middle layer (the media), creating a false passageway through which blood can flow. This false passageway steals a portion of the blood supply from the rest of the body. Classical symptoms include the sudden onset of intense pain in the chest, back, shoulder or abdomen. However, patients often experience less definite symptoms, which makes diagnosis difficult.

In aortic rupture, all three layers of the aortic wall burst, resulting in massive bleeding inside the body.

Risk factors for TAD include poorly controlled high blood pressure, advancing age, male gender, atherosclerosis, inflammatory diseases that damage the blood vessels, and certain genetic conditions that weaken connective tissue, such as Marfan syndrome. In addition, people whose aortic valve has only two leaflets (bicuspid valve) instead of the normal three leaflets may be at increased risk for an aortic aneurysm. Pregnancy, intense weight lifting and cocaine use increase the risk of aortic dissection.

One of the most important messages in the guidelines is that TAD often runs in families. As a result, family history is a critical tool for uncovering undiagnosed cases of TAD. Patients should tell their physicians not only about close relatives with aortic aneurysm, dissection, or rupture, but also about any family history of unexplained sudden death. “Family history is very important,” Dr. Eagle said. “Sudden cardiovascular collapse could have been a heart attack, but it could also have been sudden catastrophic aortic dissection.”

Additional highlights from the TAD guidelines include:

  • Imaging of the thoracic aorta by computed tomography (CT), magnetic resonance imaging (MRI) or, in some cases, echocardiography is the best way to detect TAD and determine future risk. A chest x-ray alone is not sufficient.
  • Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.
  • All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating, or widening.
    The symptoms of acute aortic dissection, which can mimic those of a heart attack or another cause of chest pain, often make it difficult to arrive at a prompt diagnosis and may delay life-saving treatment. Physicians should keep aortic dissection in mind when asking questions about medical history, family history, and the type and pattern of pain, and when examining the patient.
  • Aortic dissection involving the ascending aorta (the portion nearest the heart) is a life-threatening emergency that should be treated surgically.
  • Aortic dissection involving the descending thoracic aorta may often be managed with medications that control the blood pressure and heart rate, unless life-threatening complications develop. Additional medical therapy may include statins to lower elevated blood cholesterol levels.
  • Minimally invasive endovascular techniques are an option in some patients with aneurysm or dissection of the descending thoracic aorta.
  • All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.
    Not all health insurers pay for aortic imaging in high-risk asymptomatic patients, particularly based on family history, Dr. Hiratzka said.

“I hope the new guidelines will change that,” he said. “It could be lifesaving.”

“People with aortic disease do not have to die prematurely; they can live a long lifespan if they are diagnosed and receive treatment,” said Carolyn Levering, president and chief executive officer of the National Marfan Foundation, which convened the TAD (Thoracic Aortic Disease) Coalition of nonprofit, patient and professional groups. “That’s why the TAD Coalition has come together to launch a comprehensive public and medical awareness campaign to help maximize the impact of the new guidelines. Our first initiative is the dissemination of Ritter Rules, named to honor John Ritter. The purpose of Ritter Rules is to help people remember the important facts about aortic dissection so they can avoid the same kind of tragedy that took the life of the beloved actor.”

Dissecting aorta: A simple explanation

This was from the PI. I actually lived there for 2 years when I was in 2nd and 3rd grade.

Dissecting aorta: A simple explanation
By Dr. Willie Ong (The Philippine Star) Updated March 28, 2010 12:00 AM

MANILA, Philippines – The aorta is the largest artery in the body, around 3 centimeters in diameter. It is shaped like a walking cane, which starts from the heart, curves up a bit and goes on a u-turn down to the chest cavity and abdomen area. Unlike a walking cane, however, the aorta is softer and fleshier in consistency, which is important for it to withstand the powerful surge of blood pumped by the heart.

The upper part of the aorta (the “u” part) is called the ascending aorta. The middle part in the chest area is called the thoracic aorta, while the aorta in the abdomen area is called the abdominal aorta.

Its elastic wall is made up of three protecting linings. The inner and thinner wall is called intima, the middle wall is termed media, and the outer wall is called adventitia.

What is an aortic dissection?

If there is too much pressure inside the aorta (like a blood pressure of 180/100), the inner part of the aorta (the intima wall) can tear up, thereby causing the blood to flow through a flap created by the loosening of the inner wall. This condition is known as an aortic dissection, a dangerous situation needing urgent medical and possible surgical treatment.

Depending on the location of the tear in the aorta, the condition is named appropriately, like thoracic aortic dissection, if the tear is in the thoracic part of the aorta.

Not a heart attack?

A common mistake, even by doctors, is to label an aortic dissection as a heart attack. Although the patient may complain of the same back and chest pain, the two diseases are very different.

A heart attack involves a blockage in the small arteries attached to the heart, while an aortic dissection involves a tear in the wall of the largest artery of the body. In some unfortunate situations, the patient can have both conditions especially if the tear in is the ascending part of the aorta.

Who are at risk?

Usually, an aortic dissection does not occur spontaneously but is brought about by years of wear and tear on the aorta. The most important risk factor is high blood pressure. If the blood pressure is constantly above the upper limit of 140 over 90, this can initially lead to a ballooning of the aorta (called an aortic aneurysm), and later to an aortic dissection.

The peak incidence of aortic dissection occurs between 50 to 65 years old. Other risk factors include high cholesterol, smoking, cocaine use and traumatic injuries to the chest or abdomen.

How to detect and treat aortic dissection?

The main symptom of aortic dissection is excruciating pain in the back or abdominal area, depending if the dissection is in the thoracic or abdominal aorta, respectively. Since the aorta supplies the arteries to the arms and legs, the patient may have weak pulses and unequal blood pressures. Dizziness, loss of consciousness, and numbness and paralysis of various parts of the body may also occur.

To diagnose aortic dissection, doctors request a CT Scan or an MRI of the chest and/or abdomen. If this test is negative, a more invasive test called an aortography may be carried out. Aortography involves inserting a special wire inside the aorta and uses contrast dye to detect the dissection.

Treatment of aortic dissection involves two strategies: aggressive medical therapy to lower the blood pressure and possible surgical intervention to repair the defect.

Since the most crucial factor that favors dissection is the systolic blood pressure (the first number of the blood pressure), doctors prescribe drugs called beta-blockers to decrease the force of the heart’s pumping.

Surgery may be needed in complicated cases, such as blockage in the arteries of the limbs, persistent pain, and ballooning of the aorta with danger of a full-blown rupture. That is why this condition is sometimes called a “walking time bomb” since we don’t know when the rupture will occur.

Dissecting aorta by the numbers?

Since no one can determine when a dissecting aorta will happen, doctors rely on data showing the percentages of such occurrence.

Around 1 in 5 patients with aortic dissection die before reaching the hospital. Without treatment, the mortality rate is 25 percent in one day, 50 percent in one week, 75 percent in one month, and 90 percent in three months.

When the patient reaches the hospital, the mortality rate is about 30 percent for a dissection of the ascending and thoracic aorta, and 10 percent for the abdominal aorta.

For the patients who survive the acute episode, survival rate is around 60 percent in 5 years and 40 percent in 10 years.

The most important late complications are redissection and formation of a localized weakness in the aorta. These conditions are serious and may need surgical repair.

You can really see the importance of needed to get to the hospital quickly. And then hope for the proper help once you get there. Going to an emergency ward that is extremely busy, I don’t wish that upon anyone as time is critical.

Thanks,
Brian

Patient Saved After Hospitals, Surgeons Near His Home Decline Care

I discovered this amazing story today and a true miracle. What a truly amazing and kind surgeon.

PALM BEACH GARDENS, Fla. —

Confessor Correa had an aortic dissection, but he was almost denied a life-saving surgery because hospitals and surgeons near his home believed he had no health insurance.

Correa, of North Miami, had chest pains earlier this month. When the concrete-cutter lost the ability to talk, he went next door with a written note asking his neighbor to call 911.

Unconscious, the staff at his local hospital assumed he had no health insurance. They needed to transfer him to a hospital that did open heart surgeries to repair an aortic dissection. But without coverage, no hospital or surgeon could be found in Miami-Dade County that was willing to take him on as a patient.

Palm Beach Gardens Medical Center agreed to have Correa transferred there. Dr. Arthur Katz signed on to do a life-saving seven-hour surgery.

“To me it’s the most abhorrent, shameful, unconscionable thing I’ve ever heard of,” Katz said.

By the time Correa arrived, he was near death, Katz said.

“How could you ever think of allowing a 40-year-old — any age, but especially someone as young as him — to potentially succumb to a life-threatening, potentially curable problem?” Katz said.

Correa’s prognosis looks good, but it’ll be months before he is back to normal.

“I’m just very grateful,” Correa said.

There are getting to be too many of these stories about people with legitimate issues and not able to get the care with our almost having to darn near die while waiting to get it.

Brian Tinsley

Penn Hospital Sued Over Alleged Failure to Admit Uninsured Patient

I was searching my Google Reader this morning and discovered this story at Penn Hospital. It’s a sad story, and from reading it, I would say that the surgeon at Penn was just too lazy to take the patient. And, that it was approaching midnight. I don’t know all the circumstance but I smell a “rat” here. Perhaps Mr. Woo is an incompetent surgeon who perhaps couldn’t handle the surgery himself and decided to “brush” it off and essentially run from having to do his job? Who really knows? It’s the classic he said, she said, but….. after reading this article.  Here’s another version of the story as well. Again, you have to essentially have someone else watching out for you when you experience a dissection.

There are so many obstacles that almost surely present a “negative” outcome…UNLESS, you have another force watching out for you. It’s amazing all the things that have to happen to ensure that you get the proper diagnosis and that you have a well trained hospital, staff and especially a surgeon who knows what he/she is doing. This sounds like a complicated surgery and I honestly don’t even know if the CT images has been sent to Penn or it was just a phone conversation from one doc to another that I have what appears to be “x” situation and we don’t have the surgeons/capabilities here.. Oh.. BTW.. you are running out of time as well, every hour, your chance of survival is heading straight down hill. That’s why, you must have some awareness about this type of disease and know yourself that time is NOT on your side when it’s a type A or for that matter a type B, you need immediate medical attention by well trained individuals.

Here’s information on the actual law passed upon which this suit is being brought up against Penn.

EMT-what-A? The federal anti-patient dumping law

The Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 by Congress and signed into law by President Ronald Reagan. The act was intended to prevent hospitals from turning away uninsured patients who needed emergency care or women in labor, so-called “patient dumping.” Entire article here.

Well, it’s 5:50am and I am going to get my son up, he’s got a Lacrosse game 2 hours away this morning and we have to get ready.

Have a great day!

Brian Tinsley

Malignant hypertension and acute aortic dissection associated with caffeine-based ephedra-free dietary supplements: a case report

Abstract

The use of weight loss dietary supplements is prevalent in the United States, and over the past decade, there has been tremendous growth of the use of these products. It is well documented that ephedra-based products are associated with various cardiovascular adverse effects. With new restrictions placed on such products, companies are now manufacturing caffeine-based ephedra-free herbal supplements. We present the case of 36-year old, previously healthy female who developed malignant hypertension and aortic dissection while taking various caffeine-based dietary supplements. Given the lack of research studies in regards to their safety and efficacy, judicious care should be taken with the use of dietary supplements, including those designated as ephedra-free.

Read the rest of the case study here!

Stay off those Dietary Supplements! Not good for the Aorta due to High BP associated with taking that crap!

Thanks!

Brian

Inflammation Critical In Aortic Dissection: UTMB

Great Article:

The aorta, the body’s largest artery, stretches from the chest to below the kidneys, expanding and contracting with the pressure of blood driven directly into it by the heart. Although its walls are extraordinarily strong, like other blood vessels the aorta can sometimes develop bulges, called aneurysms. Like other aneurysms, those in the aorta sometimes give way, and the result is what doctors refer to as an “aortic dissection” – a clinical way of saying that the largest artery in your body has just started leaking, and you may well be on your way to becoming one of the nearly 16,000 Americans killed by the phenomenon annually.

Aortic dissection has traditionally been viewed as a simple structural failure, albeit one with poorly understood causes. Certain genetic diseases, such as Marfan syndrome, have been directly linked to the condition; the actor John Ritter inherited a different genetic defect that contributed to his sudden death from aortic dissection in 2003. But the mechanisms that turn a worrisome aortic aneurysm into a catastrophic aortic dissection have remained mysterious.

Now, though, University of Texas Medical Branch at Galveston researchers have uncovered what seem to be the key biochemical processes that chip away at the aorta from within until it finally tears. In a paper to be published online Nov. 16 in the Journal of Clinical Investigation, the UTMB investigators present evidence that implicates inflammatory processes centered on the signaling molecule interleukin-6 in producing the disastrous aortic weakening.

“We found that inflammation is critical in aortic dissection, and IL-6 – which has been recognized for years as a marker of inflammation and also an important cardiovascular risk factor – plays the central role in the process,” said UTMB professor Allan Brasier, senior author of the study. “Without it, you don’t have dissection.”

The UTMB team – graduate students Brian C. Tieu and Xiaoxi Ju, research associates Chang Lee, Hong Sun and Wanda LeJeune, assistant professors Adrian Recinos and Heidi Spratt and professor Ronald Tilton – arrived at its conclusions through experiments with mice and work with human samples provided by their collaborators and co-authors at the University of Texas Health Science Center at Houston, assistant professor Dong-Chuan Guo and professor Dianna Milewicz.

To profile the inflammatory attack that produces aortic dissection, Brasier’s group injected the hormone angiotensin into both ordinary lab mice and those genetically modified to “knock out” IL-6 or a cellular receptor for another molecule also involved, known as MCP-1. The human samples, used to substantiate a link between the mouse findings and human disease, came from volunteers undergoing surgical aortic dissection repair without a family history of the disease.

“Angiotensin is a blood-pressure regulating hormone – people who have what we call essential high blood pressure have increased production of angiotensin, and it’s the target for anti-hypertension therapies,” Brasier said. “What we’ve found in earlier studies is that it has an inflammatory role as well, causing cells in blood vessel walls to produce IL-6 as well as MCP-1. And this study showed us that MCP-1 helps recruit monocytes [a type of white blood cell] to the vessel where IL-6 activates them.”

Playing host to a large number of cells meant for immune defense is bad news for an aorta already strained by an aneurysm, since activated white blood cells produce proteins that destabilize the structure of the vessel. At the same time, signals produced by the activated white blood cells encourage the blood vessel to generate more IL-6.

“Our data suggest that interleukin-6 and MCP-1 secretion are codependent – without interleukin-6 you get less MCP-1,” Brasier said. “But with interleukin-6 it’s like throwing more gasoline on the fire, you keep bringing in still more monocytes and activating them, amplifying the effect.”

A similar feedback loop kicked into action when human monocytes and cells grown from the human aortic dissection samples were brought together, generating both IL-6 and MCP-1. Once again, though, removing IL-6 damped the response. And microscopic studies of human aortic dissection samples showed substantial levels of IL-6 in the same layer of the aortic wall where the inflammatory molecules were most densely concentrated in mice.

“Our collaboration with the UT-Houston group allowed us to make an important translational linkage between using a mouse model and validating our model by seeing interleukin-6 in human sporadic aortic dissections,” Brasier said. “I think this kind of team-oriented collaboration is a model to make significant clinically relevant discoveries in the future.”

The National Heart Lung and Blood Institute, the National Institute of Environmental Health Sciences and the James W. McLaughlin Fellowship Fund supported this research.

Source: UTMB Media Relations
University of Texas Medical Branch at Galveston

Thanks,

Brian

New Guidelines Aim To Prevent Unnecessary Death From Thoracic Aortic Disease

Great Article:

Multidisciplinary team of experts weighs in on diagnosis and management

Source: American College of Cardiology

When actor John Ritter died suddenly in 2003 from a tear in his thoracic aorta—the large artery that carries blood from the heart to the rest of the body—that tragedy brought attention to a rare but deadly condition that takes the lives of an estimated 10,000 Americans each year. Now, new clinical guidelines spearheaded by the American College of Cardiology (ACC) and the American Heart Association (AHA) not only offer new recommendations for the diagnosis and management of thoracic aortic disease (TAD), they deliver a powerful message to physicians and patients: Early diagnosis and treatment can save lives.

“If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable,” said Loren F. Hiratzka, M.D., who chaired the guidelines writing committee and is the medical director of cardiac surgery for TriHealth, Inc. (Bethesda North and Good Samaritan Hospitals) in Cincinnati, OH. “The results of treatment for stable disease are far better than for acute—and often catastrophic—aortic rupture or dissection.”

The new guidelines appear in the April 6, 2010, issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, as well as on web sites of the ACC (www.acc.org) and the AHA (www.americanheart.org). They were developed in collaboration with the American Association for Thoracic Surgery (AATS), American College of Radiology (ACR), American Stroke Association (ASA), Society of Cardiovascular Anesthesiologists (SCA), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of Thoracic Surgeons (STS), and Society for Vascular Medicine (SVM). The American College of Emergency Physicians (ACEP) and the American College of Physicians (ACP) were also represented on the writing committee.

Recent scientific and clinical advances drove the development of guidelines to aid physicians in the diagnosis and management of aortic dissection, aortic aneurysm and other forms of TAD, said Kim A. Eagle, M.D., director of the University of Michigan Cardiovascular Center in Ann Arbor and co-author of the guidelines.

“We now have a deeper understanding of the genetic underpinnings of TAD, and we continue to expand our knowledge in this area,” he said. “There have been rapid advances in noninvasive imaging. Medical therapy is much better. Open surgical techniques with anesthesia have improved dramatically. We can even use endovascular (minimally invasive, catheter-based) approaches in some patients.”

An aortic aneurysm occurs when a portion of the aorta balloons out, increasing the diameter of the blood vessel by at least 50 percent at that spot. Although the wall of the aorta can become dangerously thin, patients with an aortic aneurysm often have no symptoms unless the aneurysm ruptures.

In the case of aortic dissection, a tear in the inner lining of the aorta (the intima) allows blood to invade the middle layer (the media), creating a false passageway through which blood can flow. This false passageway steals a portion of the blood supply from the rest of the body. Classical symptoms include the sudden onset of intense pain in the chest, back, shoulder or abdomen. However, patients often experience less definite symptoms, which makes diagnosis difficult.

In aortic rupture, all three layers of the aortic wall burst, resulting in massive bleeding inside the body.

Risk factors for TAD include poorly controlled high blood pressure, advancing age, male gender, atherosclerosis, inflammatory diseases that damage the blood vessels, and certain genetic conditions that weaken connective tissue, such as Marfan syndrome. In addition, people whose aortic valve has only two leaflets (bicuspid valve) instead of the normal three leaflets may be at increased risk for an aortic aneurysm. Pregnancy, intense weight lifting and cocaine use increase the risk of aortic dissection.

One of the most important messages in the guidelines is that TAD often runs in families. As a result, family history is a critical tool for uncovering undiagnosed cases of TAD. Patients should tell their physicians not only about close relatives with aortic aneurysm, dissection, or rupture, but also about any family history of unexplained sudden death. “Family history is very important,” Dr. Eagle said. “Sudden cardiovascular collapse could have been a heart attack, but it could also have been sudden catastrophic aortic dissection.”

Additional highlights from the TAD guidelines include:

  • Imaging of the thoracic aorta by computed tomography (CT), magnetic resonance imaging (MRI) or, in some cases, echocardiography is the best way to detect TAD and determine future risk. A chest x-ray alone is not sufficient.
  • Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.
  • All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating, or widening.
  • The symptoms of acute aortic dissection, which can mimic those of a heart attack or another cause of chest pain, often make it difficult to arrive at a prompt diagnosis and may delay life-saving treatment. Physicians should keep aortic dissection in mind when asking questions about medical history, family history, and the type and pattern of pain, and when examining the patient.
  • Aortic dissection involving the ascending aorta (the portion nearest the heart) is a life-threatening emergency that should be treated surgically.
  • Aortic dissection involving the descending thoracic aorta may often be managed with medications that control the blood pressure and heart rate, unless life-threatening complications develop. Additional medical therapy may include statins to lower elevated blood cholesterol levels.
  • Minimally invasive endovascular techniques are an option in some patients with aneurysm or dissection of the descending thoracic aorta.
  • All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.

 Not all health insurers pay for aortic imaging in high-risk asymptomatic patients, particularly based on family history, Dr. Hiratzka said.

“I hope the new guidelines will change that,” he said. “It could be lifesaving.”

“People with aortic disease do not have to die prematurely; they can live a long lifespan if they are diagnosed and receive treatment,” said Carolyn Levering, president and chief executive officer of the National Marfan Foundation, which convened the TAD (Thoracic Aortic Disease) Coalition of nonprofit, patient and professional groups. “That’s why the TAD Coalition has come together to launch a comprehensive public and medical awareness campaign to help maximize the impact of the new guidelines. Our first initiative is the dissemination of Ritter Rules, named to honor John Ritter. The purpose of Ritter Rules is to help people remember the important facts about aortic dissection so they can avoid the same kind of tragedy that took the life of the beloved actor.”

 ###

 The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 37,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.acc.org.

The American Heart Association, founded in 1924, is the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. To help prevent, treat and defeat these diseases — America’s No. 1 and No. 3 killers — we fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit americanheart.org.

Thanks,

Brian

John Ritter Legacy Lives in “Ritter Rules”

New Guidelines Help Point to Risk Factors for Thoracic Aortic Aneurysm, Which Killed the “Three’s Company” Star

Read the rest of the article here.

Thanks,
Brian Tinsley

Thanks for stopping by to view our stories. Please help me keep the site going by shopping at Amazon.com-It’s very much appreciated. Brian Tinsley founder of AorticDissection.com (please book mark the link once you get to Amazon.com for future purchases!)

Best Care News Update-Tyler Kahle’s legacy live on!

February 9, 2010

Methodist’s Aortic Bundle Adopted by EpicCare Emergency Department Software

EpicCare is the third leading supplier of emergency department information system (EDIS) software to agree to hardwire thoracic aortic dissection into the differential diagnosis of chest pain in response to a joint appeal from Methodist Health System and Deb McMillan, mother of Tyler Kahle. Tyler was just 19 when he died of undiagnosed thoracic aortic dissection after coming to Methodist Hospital’s emergency department for treatment of chest pain. His tragic death is one of the estimated 15,000 annual fatalities due to aortic dissection.
 
The aortic dissection bundle was developed by Anton Piskac, MD, vice president of performance improvement for Methodist Health System. The bundle includes a series of prompts to consider aortic disruption as a cause of life-threatening pain among at-risk populations that can be incorporated into clinical decision software templates, helping physicians to identify patient populations at increased risk of aortic aneurysm and dissection and order appropriate tests.

At Methodist’s request, the organization’s EDIS provider, Cerner FirstNet, incorporated the aortic dissection bundle into its system for all clients. McKesson Horizon Emergency Care followed suit, and is incorporating the bundle into its next software update.

We need to get this at every ER room possible!

Nice work!

Brian Tinsley

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