CT 검사에서 대동맥박리(aortic dissection)의 발생빈도에 관한 고찰

동경래(Kyung-Rae Dong),최성관(Sung-Kwan Choi),장영일(Young-Ill Jang),노상호(Sang-Ho Ro) 대한방사선과학회(구 대한방사선기술학회) 2008 방사선기술과학 Vol.31 No.2

  목 적: 혈관의 내층과 외층을 급속히 해리시키는 예후가 매우 위험한 질환으로 대동맥 박리증(aortic dissection)의 임상적 진단을 위해 CT를 시행하여 대동맥 박리 증으로 판명된 환자 수와 연령별로 발생 빈도를 조사하고자 하였다.<BR>  방법 및 대상: 2005년 1월부터 2006년 12월까지 2년간 C대학병원에 내원한 환자 중 CT를 시행한 환자 112명을 대상으로 연도별로 증감 추세를 조사해 보고, 성별, 연령별, 진료과별로 조사 해 보았으며, 정확한 관찰을 위해 CT scan 후의 재구성 영상인 MIP와 SSD 그리고 VRT영상을 획득하여 CT와 일반 Chest PA 상을 비교하여 결과를 조사 연구하였다.<BR>  결과 및 결론:<BR>  1. CT를 시행한 환자 112명을 대상으로 연도별 검사건수는 2005년도 37명으로 41.9%를 보였고, 2006년도는 65명으로 58.1%로 2005년에 비해 2006년에 1.4배 증가되었다.<BR>  2. CT를 시행한 환자의 성별분포는 남성이 45명으로 40.1%, 여성이 67명으로 59.9%를 차지하고 있고 남성 45명 중 대동맥 박리증 환자는 9명으로 20%, 여성은 67명 중 21명으로 31.3%로 대동맥 박리증 환자가 남성에 비해 여성이 1.6배 많이 발생되었다. 또한 검사자 수도 남성에 비해 여성이 1.5배 많은 것으로 나타났다.<BR>  3. CT를 시행한 환자의 연령별 분포는 30세 미만에서는 거의 볼 수 없었으며 41세에서 80세까지가 전체에 88.3%를 차지하였으며 연령이 높을수록 대동맥 박리증 질환의 발생빈도가 높게 나타났다. 연령별 발생빈도의 차이는 통계적으로 유의하였다(p<0.01).<BR>  4. CT를 의뢰한 과는 응급의학과에서 46명(41.1%), 순환기 내과에서 37명(33.0%), 흉부외과에서 13명(11.6%), 기타 과에서 16명(14.3%)으로 응급의학과와 순환기내과가 전체의 74.1%로 나타났다. 따라서 대동맥 박리증 질환의 환자는 주로 응급실로 내원하는 매우 위험한 질환이라는 것을 알 수 있다.<BR>  5. 대동맥 박리 환자 30명 중 22명(73.3%)은 일반 X-ray상 정상으로 판독되었고, 8명(26.7%)만이 일반 X-ray상 이상소견이 나왔다. 따라서 대동맥 박리 질환을 정확히 평가하기 위해서는 반듯이 CT를 시행해야 할 것으로 사료되었다.   Purpose: Aortic Dissection is very dangerous, prognostic disease, which the bloodstream flow out of the true lumen of the aorta by the bursting of aortic intima resulting in a rapid dissociation of inner and outer layer from the media. It is difficult to diagnose aortic dissection clinically by normal X-ray. This study was to investigate the occurrence frequency by age and number of patients who are identified to be aortic dissection by CT(Computed Tomography) scan.<BR>  Materials and methods: We investigated the trend of yearly fluctuation, gender, age, and department of clinical research of the 112 patients who conducted CT scan in C- University Hospital for two years from January 2005 to December 2006. The MIP and SSD which reconstructed CT image and the VRT image were obtained for the accurate observation. The result was investigated by comparing normal X-ray and CT scan.<BR>  Results and Conclusion:<BR>  1. The yearly check of 112 patients conducted CT scan showed 37 people(41.9%) in 2005, and it was increased to 65(58.1%) in 2006 by 1.4 times.<BR>  2. The gender distribution of patients given a CT scan showed 45 males(40.1%), and female 67(59.9 %). The aortic dissection patients were 9(20%) out of 45 males, 21(31.3%) out of 67 females and women were 1.6 times more than men. Women are also 1.5 times more than men in the number of examinee.<BR>  3. The age distribution of patient"s who conducted CT scan revealed that there was no patient under 30 years old while 88.3% of all patients were through 41 to 80 years old. The higher the age was, the higher the occurrence of aortic dissection was. The difference in the occurrence frequency of age was statistically significant(p<0.01).<BR>  4. The departments that requested CT scan were the emergency department 46(41.1%), circulatory internal medicine 37(33.0%), chest surgery 13(11.6%), and others 6(14.3%). The combined ratio of emergency medicine and circulatory internal medicine was 74.1% of all. The results show that the aortic dissection is a very dangerous disease whose patients visit mainly via the emergency room.<BR>  5. The aortic dissection patients had normal X-ray readings in 22(73.3%) out of 30, and only 8(26.7 percent) are abnormal in the X-ray diagnosis. Therefore, the CT scan needs to be enforced in order to assess accurately the disease of aortic dissection.

Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome

이석수,정태은,이동협 대한흉부외과학회 2012 Journal of Chest Surgery (J Chest Surg) Vol.45 No.6

Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

Atypical presentation of DeBakey type I aortic dissection mimicking pulmonary embolism in a pregnant patient: a case report

( Sou Hyun Lee ),( Ji Hee Hong ),( Chaeeun Kim ) 영남대학교 의과대학 2024 Yeungnam University Journal of Medicine Vol.41 No.2

Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.

해리성 대동맥류의 외과적 치료

오상준,변정욱,정재일,윤찬식,김창호 인제대학교 1999 仁濟醫學 Vol.20 No.1S

해리성 대동맥류는 매우 위급한 상태이며 사망률이 매우 높은 질환으로 신속한 응급치료 특히 외과적 수술이 필요한 질환이며, 수술방법은 아직도 꾸준히 고안되고 발전되어 고도의 기술을 필요로 한다. 1987년 1월부터 1997년 12월까지 총 73명의 해리성 대동맥류 환자가 내원하였으며 이중 수술적 치험을 한 31명을 대상으로 치료원칙, 수술방법, 결과 등을 검토하여 문헌 고찰과 함께 보고하고자한다. Aortic dissection is one of the true emergencies confronting cardiac surgeons. This study is to evacuate the results of operation for aortic dissection. Between Jan., 1987 and Dec., 1988, we operated on a total of 31 cases of aortic dissection at the Inje University Seoul Paik Hospital. There were 22 male and 9 female patients aged from 29 to 65 years(mean, 49.8 years). Eight patients(25.8%) had Marfan syndrome. 19 patients underwent an emergency operation for Stanford type A aortic dissection. Surgical technique for type A included graft replacement of ascending aorta in 6 cases, graft replacement and aortic valve resuspension in 5, Bentall operation in 4, modified Cabrol operation in 2, and ascending aorta and proximal aortic arch replacement under deep hypothermic circulatory arrest in 2. 12 patients of type B were operated on according to specific indications. The operative mortality accounts for 9.6% (3 out of 31). There were 6 late deaths as the results of cerebrovascular accident in 1, myocardial infarction in 1, and aortic rupture in 4. In conclusion, these patients of aortic dissection with type A or type B should be monitored on a long-term basis by the cardiac surgeon, because of the late aneuysmal deterioration. Immediate aggressive management and early surgical intervention for patients with aortic dissection is probably in responsible for the substantially improved results.

Midterm Results of Aortic Arch Replacement in a Stanford Type A Aortic Dissection With an Intimal Tear in the Aortic Arch

조성호,성기익,박계현,양지혁,김욱성,전태국,이영탁,박표원 대한심장학회 2009 Korean Circulation Journal Vol.39 No.7

Background and Objectives: Stanford type A aortic dissection is a potentially catastrophic event that requires surgical repair, on an emergency basis. The extent of arch repair that should be carried out during emergency surgery of this type is controversial. This study was designed to evaluate the results of arch replacement carried out during acute type A dissection. Subjects and Methods: 28 patients with Stanford type A dissection and who underwent arch replacement between 1995 and 2006 were reviewed. Results: Hospital mortality was 3.6% (1 patient), and transient neurocognitive dysfunction was observed in 5 patients. During the follow-up period (mean 26±20 months; range 1 to 66 months), 3 patients underwent reoperation due to descending thoracic or abdominal aortic aneurysm. There was no late death. Follow up computed tomography was performed in 15 patients and false lumen disappeared totally or partially in 10 patients (66.7%). Conclusion: Arch replacement for acute Stanford type A dissection may decrease the risk of late complications related to false lumen and lead to an excellent midterm survival rate. Background and Objectives: Stanford type A aortic dissection is a potentially catastrophic event that requires surgical repair, on an emergency basis. The extent of arch repair that should be carried out during emergency surgery of this type is controversial. This study was designed to evaluate the results of arch replacement carried out during acute type A dissection. Subjects and Methods: 28 patients with Stanford type A dissection and who underwent arch replacement between 1995 and 2006 were reviewed. Results: Hospital mortality was 3.6% (1 patient), and transient neurocognitive dysfunction was observed in 5 patients. During the follow-up period (mean 26±20 months; range 1 to 66 months), 3 patients underwent reoperation due to descending thoracic or abdominal aortic aneurysm. There was no late death. Follow up computed tomography was performed in 15 patients and false lumen disappeared totally or partially in 10 patients (66.7%). Conclusion: Arch replacement for acute Stanford type A dissection may decrease the risk of late complications related to false lumen and lead to an excellent midterm survival rate.

정상 분만 후 발생한 대동맥 박리증

심민섭,송형곤,정연권,송근정 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Hypertension is a risk factor for developing fatal aortic dissection. Aortic dissection occurs 2~3 times as often in men than in women between ages of 50~70 years old. Among other risk factors, aortic dissection occurs especially in women below the age of 40 years old in pregnancy-related cases. In pregnancy-related cases, aortic dissection occurs n the third trimester and in puerperium, as well as in multiparous women. The writers experienced an aortic dissection related pregnancy. The patient was 32 years old, diagnosis of dissection occurred in the postpartum period. Although, aortic dissection is a rare complication of pregnancy, the knowledge of this may assist the emergency physician save the lives of patients.

저체온순환정지와 역행성 뇌관류에 의한 대동맥궁을 침범한 급성 대동맥 박리증의 수술결과

이삼윤 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.1

Background: Acute thoracic aortic dissections involving the aortic arch differ in diagnosis, surgical procedures, and operative results compared to those that do not involve the aortic arch. In general cerebral perfusion under deep hypothermic circulatory arrest (HCA) is performed during the repair of the aortic arch dissection. Here, we report our surgical results of the aortic arch dissection repair using retrograde cerebral perfusion (RCP) and its safety. Material and Method: Between January 1996 and June 2002, 22 consecutive patients with aortic arch dissection underwent aortic arch repair. In 20 of them RCP was performed under HCA. RCP was done through superior vena cava in 19 patients and by systemic retrograde venous perfusion in 1, in whom it was difficult to reach the SVC. When the patient's rectal temperature reached 16 to 18oC, systemic circulation was arrested, and the amount of RCP amount was 481.1±292.9 ml/min with perfusion pressure of 20~30 mm Hg. Result: There were two in-hospital deaths (4.5%) and one late death (9.1%). Mean circulatory arrest time (RCP time) was 54.0±13.4 minutes (range, 7 to 145 minutes). RCP time has no correlation with the appearance of consciousness, recovery of orientation, or ventilator weaning time (p=0.35, 0.86, and 0.92, respectively). Ventilator weaning was faster in patients with earlier recovery of consciousness and orientation (r=0.850, r=926; p=0.000, respectively). RCP of more than 70 minutes did not affect the appearance of consciousness, recovery of orientation, ventilator weaning time, exercise time, or hospital stay (p= 0.42, 0.57, 0.60, 0.83, and 0.51, respectively). Conclusion: Retrograde cerebral perfusion time under hypothermic circulatory arrest during repair of aortic arch dissection may not affect recovery of orientation, ventilator weaning time, neurologic complications, and postoperative recovery. 배경: 급성 대동맥 박리증 중 대동맥궁의 박리 및 수술을 요하는 경우 진단, 수술방법, 수술결과에 있어 차이가 있을 수 있다. 대동맥궁의 박리를 교정하기 위해서 저체온순환정지하에서 뇌관류를 시행한다. 대동맥궁의 수술이 필요한 대동맥 박리증에서 역행성 뇌관류에 의한 수술결과를 조사하고 그 안정성을 알아보았다. 대상 및 방법: 1996년 1월부터 2002년 6월까지 대동맥궁을 침범한 급성대동맥 박리증의 수술 환자 22예를 대상으로 하였다. 22예 중 20예에서 저체온순환정지 하에 역행성 뇌관류를 시행하였다. 역행성 뇌관류를 시행한 20예 중 19예에서는 상대정맥을 통해 뇌관류를 시행하였고 1예에서는 상대정맥의 접근이 어려워 역행성 체정맥 관류를 시행하였다. 직장온도 16∼18도에서 순환정지를 시행했고 역행성 관류압 20∼30 mmHg에서 평균 관류량은 분당 481.1 292.9 ml이었다. 결과: 병원사망은 2예(9.1%)였으며 만기사망은 1예(4.5%)였다. 평균 순환정지(역행성 뇌관류) 시간은 54.0 13.4분(범위, 7∼145분)이었다. 역행성 뇌관류 시간은 의식 및 지남력 회복, 호흡기 탈거 시간과 상관관계가 없었고(각각 p=0.35, 0.86, 0.92), 의식출현과 지남력 회복이 빠른 환자에서 호흡기 탈거도 빨랐다(각각 r=0.850, r=926; p=0.000). 70분 이상의 역행성 뇌관류가 의식출현, 지남력 회복, 호흡기 탈거 시간, 운동력회복 및 입원기간에 영향을 주지 않았다(각각 p=0.42, 0.57, 0.60, 0.83, 0.51). 결론: 저체온순환정지하에 역행성 뇌관류로써 대동맥궁을 포함한 대동맥박리증 수술 시 뇌관류 시간은 의식회복과 호흡기 탈거, 신경학적 합병증, 수술 후 회복기간에 영향을 주지 않는다고 생각된다.

Long-Term Changes in the Distal Aorta after Aortic Arch Replacement in Acute DeBakey Type I Aortic Dissection

조광조,정재화,박종윤,윤성실,우종수 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.4

Background: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. Methods: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996–201 5). S eventy p ercent o f the cases were a scending aortic r eplacements, a nd 3 0% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of 6.6±4.6 years. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of 4.9±2.9 years. Results: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in t he a scending aortic r eplacement g roup, and 1 patient d ied of d istal a ortic rupture in t he t otal a rch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). Conclusion: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.

A Case of Repeated Transcatheter Arterial Chemoembolization in a Patient with Hepatocellular Carcinoma Accompanying Incidental Aortic Dissection

( Sungkeun Kim ),( Hee Yeon Kim ),( Chang Wook Kim ),( Ji Young Kim ),( Aran Hong ),( Su Lim Lee ),( Yoo Dong Won ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with aortic dissection is a potentially risky and demanding technique. Access to the true aortic lumen might not be allowed by the arterial entry route chosen. Methods: Here we report a case of repeated sessions of TACE through true and false lumens in a HCC patient with chronic aortic dissection. Results: A 56-year old male presented with infiltrative HCC with right portal vein tumor thrombosis. Abdominal computer tomography scan also revealed an incidental asymptomatic aortic dissection involving descending aorta from proximal segment to superior mesenteric artery (SMA) origin level. Celiac trunk was supplied by false lumen, and SMA was supplied by true lumen. On SMA angiography, right hepatic artery was originated from SMA. HCC was supplied by segment 7 and 8 branch of right hepatic artery. Infusion of adriamycin and lipiodol mixture and subsequent embolization was performed to superior branches of right hepatic artery. Catheterization to celiac axis was failed due to its origin from pseudolumen caused by aortic dissection. Complete response was achieved after sequential radiation therapy. After 1 year, nodular HCC recurred at segment 4. On this session of repeated TACE, catheterization to false lumen was successful. Left hepatic angiography showed tumor stain supplied by segment 4 branch, and embolization was performed. One year later, viable portion was noted in infiltrative HCC at segment 7. Repeated TACE was performed to embolize segment 7 branch supplying infiltrative tumor. Conclusions: In this case, we presented our experience with selective hepatic angiography and SMA angiography in a HCC patient with descending aortic dissection. To our knowledge, this is the first description of hepatic angiography using true and false lumen in a HCC patient with a concomitant aortic dissection.

Adventitial Fibroblast Abormality in Thoracic Aortic Aneurysms and Aortic Dissections

Jong Hui Suh,Jeong-Seob Yoon,Hwan Wook Kim,Keon Hyon Jo 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.6

Development of thoracic aortic aneurysms and aortic dissections (TAAD) is attributed to unbearable wall tension superimposed on defective aortic wall integrity and impaired aortic repair mechanisms. Central to this repair mechanisms are well-balanced and adequately functional cellular components of the aortic wall, including endothelial cells, smooth muscle cells (SMCs), inflammatory cells, and adventitial fibroblasts. Adventitial fibroblasts naturally produce aortic extracellular matrix (ECM), and, when aortic wall is injured, they can be transformed into SMCs, which in turn are involved in aortic remodeling. We postulated the hypothesis that adventitial fibroblasts in patients with TAAD may have defects in ECM production and SMC transformation. Materials and Methods: Adventitial fibroblasts were procured from the adventitial layer of fresh aortic tissues of patients with TAAD (Group I) and of multi-organ donors (Group II), and 4-passage cell culture was performed prior to the experiment. To assess ECM production, cells were treated with TNF-α (50 pM) and the expression of MMP-2 / MMP-3 was analyzed using western blot technique. To assess SMC transformation capacity, cells were treated with TGF-β1 and expression of SM α-actin, SM-MHC, Ki-67 and SM calponin was evaluated using western blot technique. Fibroblasts were then treated with TGF-β1 (10 pM) for up to 10 days with TGF-β1 supplementation every 2 days, and the proportion of transformed SMC in the cell line was measured using immunofluorescence assay for fibroblast surface antigen every 2 days. Results: MMP-3 expression was significantly lower in group I than in group II. TGF-β1-stimulated adventitial fibroblasts in group I expressed less SM α-actin, SM-MHC, and Ki-67 than in group II. SM-calponin expression was not different between the two groups. Presence of fibroblast was observed on immunofluorescence assay after more than 6 days of TGF-β1 treatment in group I, while most fibroblasts were transformed to SMC within 4 days in group II. Conclusion: ECM production and SMC transformation are compromised in adventitial fibroblasts from patients with TAAD. This result suggests that functional restoration of adventitial fibroblasts could well be a novel approach for the prevention and treatment of TAAD.