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[Prognosis of postoperative aortic dissection. Assessment with magnetic resonance]
A G Almeida1, H M Gabriel, J Françony
1Clínica Universitária de Cardiologia da Faculdade de Medicina de Lisboa Serviços de Cardiologia e de Cirurgia Cardiotorácica do Hospital de Santa Maria, Lisboa, Portugal. ana.almeida@mail.telepac.pt
Objective:
To evaluate operated type A aortic dissection by Magnetic Resonance Imaging (MRI), in order to detect long-term complications and identify prognostic indexes of evolution.
Design:
Prospective study with a three-year period of follow-up. Prognosis evaluation.
Settings:
Outpatient Clinic at Hospital de Santa Maria and Magnetic Resonance Imaging Center at Hospital da Cruz Vermelha.
Patients:
A sample of 37 patients submitted to type A aortic dissection surgery, included sequentially, after exclusion of those with contraindication to MRI.
Methods:
Initial evaluation (clinical and MRI study) at 3 to 4 months and at 1, 2 and 3 years after surgery. The mean follow-up time was 39.3 +/- 2.9 months. We evaluated the following complications over the aorta (aortic graft and five segments of residual aorta) and the aortic valve: aneurysm, pseudoaneurysm, rupture, re-dissection, progressive aortic valve regurgitation, reoperation and death. The prognostic indexes analysed were: presence of residual flap; false lumen patency; presence of re-entry points; false lumen to aorta dimension ratio; initial aortic dimension; increase of aortic dimension.
Results:
All patients, with the exception of three that died, remained asymptomatic.
Complications:
Aneurysm was detected in 45.9% of patients, located in one or more segments; rupture occurred in three patients, preceded by aneurysm and pseudoaneurysm development; moderate or severe aortic regurgitation was detected in 47.8% of patients. Prognostic indexes: 1. Aneurysm development in each segment yeilded a significant association with: presence of residual flap in the same and other segments; higher initial dimension of the same and other segments, with the exception of the abdominal segment; higher increase in dimension of the same and other segments, with the exception of the abdominal segment; 2. Moderate or severe aortic regurgitation development showed a tendency to association with higher increase in dimension of proximal ascending aorta. 3. No association was found between aneurysm and aortic regurgitation development.
Conclusions:
Patients operated for type A aortic dissection had a high incidence of late complications which lead to reoperation and in some cases death. The presence of a residual flap, increased aortic dimensions and higher increase rate of aortic dimensions were associated with a complicated evolution. MRI was a very useful technique for long-term monitoring and to identify prognostic indexes of evolution.
Insights
Magnetic Resonance Imaging (MRI) effectively monitored patients after type A aortic dissection surgery, revealing high rates of late complications. Key prognostic indicators for adverse outcomes include residual flaps and increased aortic dimensions.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Radiology
Context:
- Type A aortic dissection requires surgical repair, but long-term complications remain a concern.
- Post-operative monitoring is crucial for detecting complications and guiding patient management.
Purpose:
- To evaluate the long-term complications of operated type A aortic dissection using Magnetic Resonance Imaging (MRI).
- To identify prognostic indexes that predict the evolution of the disease after surgery.
Summary:
- A 3-year prospective study followed 37 patients after type A aortic dissection surgery, utilizing MRI for evaluations.
- Complications included aneurysm (45.9%), rupture (3 patients), and moderate/severe aortic regurgitation (47.8%).
- Residual flap, increased aortic dimensions, and higher dimension increase rates were associated with complicated evolution.
Impact:
- MRI is effective for long-term surveillance of patients with operated type A aortic dissection.
- Identifying prognostic indexes can help predict patient outcomes and inform clinical decision-making.
- Findings highlight the need for vigilant monitoring due to the high incidence of late complications.