| Part One Clinical and CTA features of different types of acute aortic dissectionObjectiveThere were 150 cases of newly diagnosed acute aortic dissection(AD)were retrospectively analyzed,and the clinical and CTA characteristics of Stanford A and Stanford B AD were compared,in order to improve the diagnosis and recognition ability of the disease,and provide strong support for improving the prognosis of acute AD.MethodFrom January 2011 to June 2020,150 patients with acute AD were selected.Clinical data were collected,including chest pain,back pain,abdominal pain,nature of pain(sudden pain,metastatic pain),disturbance of consciousness,limb disorders,etc.To investigate the patient’s past medical history,including whether there was a history of hypertension and recorded the systolic and diastolic blood pressure before CTA examination,understand whether there was a history of heart valves,whether there was a history of genetic diseases such as Marfan syndrome.Recorded the occurrence of complications at the onset: pericardial effusion,pleural effusion,and assess whether there was acute cardiac insufficiency and acute renal insufficiency.CTA evaluation items:(1)whether it could display the intimal tear;(2)identified the true and false lumen;(3)displayed the false lumen outlet;(4)the false lumen thrombosis;(5)the main branches of aorta involved.Result1.A total of 150 patients with acute AD were enrolled in this study,with an average age of 55.70 ± 14.36 years old;110 cases(73.3%)were male and 40 cases(26.7%)were female,and the ratio of male to female was 2.75:1;the average age of male patients was53.94 ± 14.21 years old,which was less than that of female(60.55 ± 13.80)years old,and the difference was statistically significant(P < 0.05).The ratio of male to female of Stanford type A and Stanford type B AD is different.The incidence rate of female in Stanford type A AD is higher than that of Stanford type B(P < 0.05).There were 114 cases(76.0%)with hypertension in acute AD patients,but there was no significant difference in the prevalence of hypertension between Stanford type A and Stanford type B AD(P >0.05).The incidence of heart valve history in Stanford type A AD patients was higher than that in Stanford type B patients(P < 0.05).2.The important symptom of acute AD was pain,with 88.7% of sudden pain and18.0% of metastatic pain.The incidence of chest pain in patients with Stanford type A AD(80.6%)was higher than that in patients with Stanford B(61.5%).The incidence of back pain in patients with Stanford type A AD(38.9%)was lower than that in patients with Stanford B(71.8%).The differences were statistically significant(P < 0.05).The incidence of acute cardiac insufficiency(23.6%)and pericardial effusion(26.4%)in Stanford type A AD patients were significantly higher than those in Stanford type B patients(5.1%,6.4%)(P < 0.05).3.The display rate of intimal tears in Stanford type A AD was 93.1%,which was slightly lower than that in Stanford type B(96.2%),but the difference was not statistically significant(P > 0.05).The false lumen outlet display rate and false lumen thrombosis rate of Stanford type A AD were 58.3% and 79.2%,respectively,which were higher than those of Stanford type B(33.3%,41.0%),and the differences were statistically significant(P <0.05).The incidence of branch vessel involvement in Stanford type A AD patients was45.8%,which was higher than that in Stanford type B patients(21.8%,54 vessels in total)(P < 0.05).Conclusion1.Patients with Stanford type A AD are more common in chest pain,Stanford B type is more in back pain.2.Patients with Stanford type A AD were more likely to have acute cardiac insufficiency and pericardial effusion than those with Stanford type B.3.Stanford type A AD has higher false lumen display rate and false lumen thrombosis rate,and is easy to involve branch vessels,and organ perfusion is reduced.Part Two CT evaluation of aortic remodeling with Stanford type A aortic dissection after surgeryObjectiveThe changes of aortic lumen remodeling after operation of acute Stanford type A AD were discussed,that is,the change characteristics of true and false lumen,and whether there is a certain correlation between the changes and aortic elastic parameters,in order to improve the understanding of the changes of postoperative imaging outcomes of the disease,and provide strong support for improving the prognosis of acute AD.MethodThirty nine patients with Stanford type A AD who underwent surgical treatment from January 2011 to June 2020 were enrolled in this study.Clinical and surgical data were collected,including operation time,operation method,detailed sun’s classification,intraoperative and postoperative complications.CTA evaluation items:(1)preoperative Stanford detailed classification,including the location of intimal tear,the extent of pseudolumen involvement,aortic branches;(2)preoperative reconstruction to assess the elastic parameters of the ascending aorta(AD,AC,ASI);(3)postoperative CTA according to whether there is thrombosis and occlusion of the false lumen;(4)postoperative CTA measurement and calculation of true lumen area ratio(TR)to evaluate aortic remodeling.Result1.A total of 39 patients with Stanford type A AD were enrolled,including 27 males(69.2%)and 12 females(30.8%).The ratio of male to female was 2.25:1.The location of intimal tears: ascending aorta in 21 cases(53.8%),aortic arch in 11 cases(28.2%),proximal descending aorta in 7 cases(17.9%).According to the classification principle,17cases(43.6%)of type A aortic dissection were the most common type,followed by 13cases(33.3%)of A2 C type,7 cases(17.9%)of A1 C type,2.5% of a1s1 cases and 1 case(2.5%)of A3 S type.Implementation of the operation: 26 cases were treated with ascending aorta and total arch replacement plus stent elephant trunk,7 cases were treated with Bentall and 4 cases were treated with Bentall operation,4 cases were treated with Bentall operation,2 cases were treated with ascending aorta and partial aortic arch replacement.2.Preoperative assessment of ascending aorta elasticity: there were significant differences in aortic elasticity parameters(AD,AC,ASI)between acute Stanford A ad group(Study Group)and control group(coronary CTA case)(P < 0.05).3.The correlation between the false lumen state of postoperative AD and the elasticity of ascending aorta before operation was analyzed: according to the results of CTA arterial phase and venous phase dual-phase scan results at the last postoperative scanning,the patients were divided into three groups according to the state of pseudolumen thrombosis:(1)group A: 3 cases(7.7%)with complete false lumen thrombosis;(2)group B: 7 cases(17.9%)with complete patency of false lumen;(3)group C: 12 cases(30.7%)with incomplete thrombosis of false lumen;and(4)group D: complete disappearance of false lumen 17 cases(43.6%).There were significant differences in the parameters of aortic elasticity(AD,AC,ASI)and false lumen involved segments(P<0.05).Correlation analysis showed that there was no correlation between aortic elasticity related parameters AD,AC,ASI and false lumen involved segments(|r|<0.3).4.Correlation analysis of postoperative re-examination of aortic remodeling state and preoperative ascending aortic elasticity: the increase of true lumen area ratio(TR)(>0)was positive,and TR increase(<0)was negative,and the TR positive plane count > 1/2 plane total count was met.Thrity-one cases were included in the positive aortic remodeling group,and 8 cases were included in the negative remodeling group.There were statistically significant differences in the parameters of aortic elasticity(AD,AC,ASI)among patients with different aortic remodeling status(P<0.05);correlation analysis showed that there was a moderate correlation between aortic remodeling status and aortic elasticity related parameters ad,AC,ASI(0.5 ≤|r|< 0.8)(P<0.05).Conclusion1.There was no correlation between aortic elasticity parameters,false lumen involved segments and different false lumen states.2.There was a moderate correlation between aortic remodeling status and aortic elasticity related parameters.3.Aortic elasticity may play a key role in the occurrence,development and prognosis of AD. |
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