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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Aortic Regurgitation III: Medical Management01:25

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Acute type A aortic dissection following TAVI.

David Frumkin1, Gaik Nersesian2, Sebastian Spethmann1

  • 1Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.

International Journal of Cardiology
|November 23, 2025
PubMed
Summary
This summary is machine-generated.

Acute or very early type A aortic dissection (ATAAD) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. This study found a 0.15% incidence, with high mortality, emphasizing the need for awareness and planning.

Keywords:
ATAADAortic dissectionTAVITAVRValvular heart diseaseVascular complications

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Aortic Diseases

Background:

  • Acute or very early type A aortic dissection (ATAAD) following transcatheter aortic valve implantation (TAVI) is a rare yet critical complication.
  • Existing data on ATAAD post-TAVI is limited, necessitating further investigation into its incidence, mechanisms, and management.

Purpose of the Study:

  • To analyze the incidence, outcomes, and potential mechanisms of ATAAD after TAVI.
  • To evaluate different management strategies for ATAAD in a large two-center cohort.

Main Methods:

  • Retrospective analysis of 10,238 patients who underwent TAVI between 2008 and 2023.
  • Assessment of ATAAD incidence, in-hospital mortality, treatment approaches, and suspected causal mechanisms.

Main Results:

  • The incidence of ATAAD post-TAVI was 0.15% (15 patients), with most cases occurring periprocedurally.
  • In-hospital mortality for ATAAD was 47%, with 67% of patients treated surgically and 27% interventionally.
  • Suspected mechanisms included annular stress from balloon/valve expansion (47%) and catheter/wire trauma (20%), with anatomical factors like ascending aorta dilation also contributing.

Conclusions:

  • ATAAD following TAVI is a rare but severe complication associated with high mortality.
  • Increasing TAVI volumes and complex patient anatomies are likely to raise ATAAD incidence.
  • Enhanced awareness, pre-procedural planning, and tailored management are crucial for mitigating risks and improving outcomes.