title: Evaluation and Influence of Brachiocephalic Branch Re-entry in Patients With Type A Acute Aortic Dissection.
abstract: Stanford type A acute aortic dissection (A-AAD) extends to the brachiocephalic branches in some patients. After ascending aortic replacement, a remaining re-entry tear in the distal brachiocephalic branches may act as an entry and result in a patent false lumen in the aortic arch. However, the effect of brachiocephalic branch re-entry concomitant with A-AAD remains unknown.
  
  
  
  Eighty-five patients with A-AAD who underwent ascending aortic replacement in which both preoperative and postoperative multiple-detector computed tomography (MDCT) scans could be evaluated were retrospectively studied. The presence of a patent false lumen in at least one of the brachiocephalic branches on preoperative MDCT was defined as brachiocephalic branch re-entry, and 41 patients (48%) had this. Postoperatively, 47 of 85 (55%) patients had a patent false lumen in the aortic arch. False lumen remained patent after operation in 34 out of the 41 (83%) patients with brachiocephalic branch re-entry, as compared to that in 13 of the 44 (30%) patients without such re-entry (P<0.001). Brachiocephalic branch re-entry was a significant risk factor for a late increase in the aortic arch diameter greater than 10 mm (P=0.047).
  
  
  
  Brachiocephalic branch re-entry in patients with A-AAD is related to a patent false lumen in the aortic arch early after ascending aortic replacement and is a risk factor for late aortic arch enlargement.
authors.affiliation: Cardiovascular Center, Yokohama City University Medical Center.
authors.forename: Shota
authors.initials: S
authors.lastname: Yasuda
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Imoto
authors.forename: Keiji
authors.initials: K
authors.lastname: Uchida
authors.forename: Norihisa
authors.initials: N
authors.lastname: Karube
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Minami
authors.forename: Motohiko
authors.initials: M
authors.lastname: Goda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D014057:Tomography, X-Ray Computed