[Prognosis of postoperative aortic dissection. Assessment with magnetic resonance].
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.
Almeida
A G
AG
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
Gabriel
H M
HM
Françony
J
J
Sargento
L
L
Morais
J
J
David
C
C
Madeira
F
F
Soares
A
A
Beija
L
L
Guimaräes
L C
LC
Vagueiro
M C
MC
de Lima
R
R
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