title: [Prognosis of postoperative aortic dissection. Assessment with magnetic resonance].
abstract: OBJECTIVE
  To evaluate operated type A aortic dissection by Magnetic Resonance Imaging (MRI), in order to detect long-term complications and identify prognostic indexes of evolution.
  
  
  METHODS
  Prospective study with a three-year period of follow-up. Prognosis evaluation.
  
  
  METHODS
  Outpatient Clinic at Hospital de Santa Maria and Magnetic Resonance Imaging Center at Hospital da Cruz Vermelha.
  
  
  METHODS
  A sample of 37 patients submitted to type A aortic dissection surgery, included sequentially, after exclusion of those with contraindication to MRI.
  
  
  METHODS
  Initial evaluation (clinical and MRI study) at 3 to 4 months and at 1, 2 and 3 years after surgery. The mean follow-up time was 39.3 +/- 2.9 months. We evaluated the following complications over the aorta (aortic graft and five segments of residual aorta) and the aortic valve: aneurysm, pseudoaneurysm, rupture, re-dissection, progressive aortic valve regurgitation, reoperation and death. The prognostic indexes analysed were: presence of residual flap; false lumen patency; presence of re-entry points; false lumen to aorta dimension ratio; initial aortic dimension; increase of aortic dimension.
  
  
  RESULTS
  All patients, with the exception of three that died, remained asymptomatic.
  
  
  RESULTS
  Aneurysm was detected in 45.9% of patients, located in one or more segments; rupture occurred in three patients, preceded by aneurysm and pseudoaneurysm development; moderate or severe aortic regurgitation was detected in 47.8% of patients. Prognostic indexes: 1. Aneurysm development in each segment yeilded a significant association with: presence of residual flap in the same and other segments; higher initial dimension of the same and other segments, with the exception of the abdominal segment; higher increase in dimension of the same and other segments, with the exception of the abdominal segment; 2. Moderate or severe aortic regurgitation development showed a tendency to association with higher increase in dimension of proximal ascending aorta. 3. No association was found between aneurysm and aortic regurgitation development.
  
  
  CONCLUSIONS
  Patients operated for type A aortic dissection had a high incidence of late complications which lead to reoperation and in some cases death. The presence of a residual flap, increased aortic dimensions and higher increase rate of aortic dimensions were associated with a complicated evolution. MRI was a very useful technique for long-term monitoring and to identify prognostic indexes of evolution.
authors: Clínica Universitária de Cardiologia da Faculdade de Medicina de Lisboa Serviços de Cardiologia e de Cirurgia Cardiotorácica do Hospital de Santa Maria, Lisboa, Portugal. ana.almeida@mail.telepac.pt
authors: A G
authors: AG
authors: Almeida
authors: H M
authors: HM
authors: Gabriel
authors: J
authors: J
authors: Françony
authors: L
authors: L
authors: Sargento
authors: J
authors: J
authors: Morais
authors: C
authors: C
authors: David
authors: F
authors: F
authors: Madeira
authors: A
authors: A
authors: Soares
authors: L
authors: L
authors: Beija
authors: L C
authors: LC
authors: Guimaräes
authors: M C
authors: MC
authors: Vagueiro
authors: R
authors: R
authors: de Lima
mesh_terms: D000784:Aortic Dissection / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies