By Christoph A. Nienaber (auth.), Christoph A. Nienaber, Rossella Fattori (eds.)
`References are either entire and strangely present. this is often a very good quantity to discover information regarding aortic pathology, relatively of the thoracic aorta. It additionally has an excellent dialogue of contemporary diagnostic options ... might be of so much worth to cardiologists, interventionalists, and pathologists instead of surgeons.'
Journal of Vascular surgical procedure (March 2000)
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Additional resources for Diagnosis and Treatment of Aortic Diseases
Interestingly, in the Anglo-American society labetolol acting both as an alpha- and beta-andrenergic receptor blocker has recently attracted interest and is recommended as a drug of first use in the initial management of aortic dissection. Again, also labetolol needs to be titrated towards its desired hemodynamic effects. The fast and short acting beta-blocker esmolol may also be useful in patients with dissection and arterial hypertension, especially if immediate surgery is anticipated since there will be no carry-over effect to the post-surgical period due to its short half life.
Transesophageal echocardiographic display of a type B dissection with separation between the true lumen (TL) and the false lumen (FL) which is partially thrombosed by layers of thrombus (Thr). There is a small rim of non-thrombosed false lumen. diagnosis of dissection since between 42 and 68 percent of patients tum out to be negative for dissection, irrespective of the suggestive chest pain syndrome. In one half of these patients echocardiography is helpful to establish the correct diagnosis ranging from myocardial infarction, unstable angina to pulmonary embolism.
Technical aspects of surgery In patients with proximal dissections without involvement of the sinuses of valsalva, an acute supracoronary insertion of a tubular graft is recommended [ 106, 107, 113, 114] . Sometimes aspects of the split aortic layers have to be sutured before the supracoronary graft is implanted. When the aortic valve commissures are involved in the dissecting process, aortic regurgitation is usually present. An attempt should be made to reconstruct the components of the aortic val ves, however, if acutely dissected leaflets cannot be resuspended the valve has to be entirely replaced with preservation of the coronary ostia.