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Unique Identifier 98220181
Authors: Iguchi A. Tabayashi K.
Institution: Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Title: Outcome of medically treated Stanford type B aortic dissection.
Source: Japanese Circulation Journal. 62(2)102-5, 1998 Feb.
Abstract: Optimal treatment for patients with uncomplicated type B dissection remains a matter of debate. From January, 1987, through June, 1996, 43 patients with acute type B dissection were treated exclusively by medical therapy according to our management guidelines. After discharge, aortography and enhanced computed tomography were performed every 6 months to evaluate the diameter of the dissected aorta. All 43 patients survived the acute phase and were discharged alive from the hospital. There was no death related to aortic dissection. Three patients underwent surgical treatment in the chronic phase because of aortic enlargement. Aortic enlargement in 3 additional patients was managed medically. The values for freedom from aortic enlargement for 43 patients at 1, 3, and 5 years were 100%, 91%, and 86%, respectively. The long-term survival rates of patients treated medically and discharged from the hospital are acceptable.

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Unique Identifier 96362949
Authors: Grajek S. Cieslinski A. Mitkowski P. Ochotny R. Pawlak B. Brocki Z. Ponizynski A. Lehman Z. Paradowski S.
Institution: Institute of Cardiology, University of Medical Sciences Poznan, Poland.
Title: Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.
Source: Journal of Human Hypertension. 9(12)987-92, 1995 Dec.
Abstract: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. In conclusion: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

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Unique Identifier 87299281
Authors: Hoshino T. Ohmae M. Sakai A.
Institution: Department of Pharmacology and Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, Scotland.
Title: Spontaneous resolution of a dissection of the descending aorta after medical treatment with a beta blocker and a calcium antagonist.
Source: British Heart Journal. 58(1)82-4, 1987 Jul.
Abstract: A 58 year old man experienced an attack of squeezing chest pain. A contrast enhanced computed tomographic scan showed acute dissection of the descending aorta. Treatment with metoprolol and nicardipine kept his blood pressure below 130/90 mm Hg while he was supine at rest and after walking. Serial contrast enhanced computed tomographic scans showed opacification of the false lumen (which was not opacified initially) on the 42nd day; moderate regression of the false lumen on the 67th day, and resolution of the false lumen on the 266th day. This is the first in vivo demonstration of spontaneous resolution of aortic dissection detected by serial contrast enhanced computed tomographic scans.

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