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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3925_Библиотеки_им_академика_М_И_Перельмана
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xiv Acknowledgments
Above all, thanks go to the thousands of aortic disease patients who have
entrusted their care to the Yale Center for Thoracic Aortic Disease and whose
clinical material forms the substrate for many of the investigations reported in
this book.
John A. Elefteriades
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xv
Contents
Introduction Samuel Z. Goldhaber . . . . v
Foreword Denton A. Cooley . . . . vii
Preface . . . . ix
Acknowledgments . . . . xiii
Contributors . . . . xix
Section I: The Clinical Entities
1. Classification of Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Christoph A. Nienaber and Hüseyin Ince
Section II: Imaging and Diagnosis
2. The Symptoms and Signs of Acute Aortic Dissection:
Clinical Diagnosis of “The Great Masquerader” . . . . . . . . . . . . . . . . . 29
Eric M. Isselbacher
3. Imaging of Aneurysms and Dissections: Chest X-Ray,
Echo, Computed Tomography, Magnetic Resonance Imaging. . . . . . 39
Peter G. Danias
4. Putting It All Together: Symptoms, Signs, and Images. . . . . . . . . . . . 67
Arun Raghupathy and Kim Eagle
Section III: The Biology of Acute Aortic Conditions
5. Epidemiology: Incidence, Prevalence, and Trends . . . . . . . . . . . . . . . 89
John A. Elefteriades and John A. Rizzo
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6. Genetic Basis of Thoracic Aortic Aneurysms and Dissections . . . . . . 99
Dianna M. Milewicz, Hariyadarshi Pannu, Nili Avidan,
Dong-chuan Guo, and Van Tran-Fadulu
7. Mechanical Properties of the Aorta—6 cm Is “Special” . . . . . . . . . . 125
John A. Elefteriades and George Koullias
8. Matrix Metalloproteinases in Aortic Aneurysm and Dissection. . . . 131
Donald M. Botta, Jr., John A. Elefteriades, and George Koullias
9. Inflammation and Remodeling in the Thoracic Aorta . . . . . . . . . . . 147
Donald M. Botta, Jr., Paul C. Y. Tang, John A. Elefteriades, and
George Tellides
10. Weight Lifting and Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . 161
John A. Elefteriades
11. Timing of Acute Aortic Events: How Does Dissection
Pick a Date, Time, and Moment to Occur? . . . . . . . . . . . . . . . . . . . . 169
John A. Elefteriades
Section IV: Treatment of Acute Aortic Conditions
12. The Natural History of Thoracic Aortic Aneurysms:
Etiology, Pathogenesis, and Evidence-Based Decision Making
for Surgical Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Michael A. Coady and John A. Elefteriades
13. Treatment of Ruptured Aortic Aneurysms. . . . . . . . . . . . . . . . . . . . . 205
Ali Shahriari and Emily A. Farkas
14. Acute Aortic Dissection: Anti-impulse Therapy. . . . . . . . . . . . . . . . . 229
Javier Sanz, Andrew J. Einstein, and Valentin Fuster
15. Surgical Procedures: A Primer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
John A. Elefteriades and Randall Griepp
16. Endovascular Thoracic Aortic Stent Grafting in Acute
Aortic Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Derek R. Brinster, Wilson Y. Szeto, and Joseph E. Bavaria
17. Long-Term Suppressive Therapy: Clinical Reality
and Future Prospects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Amy E. Hackmann, Robert W. Thompson, and Scott A. LeMaire
xvi Contents
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Section V: Litigation in Aortic Aneurysm Disease
18. Legal Considerations in Acute Aortic Diseases . . . . . . . . . . . . . . . . . . . 331
John A. Elefteriades
Section VI: Prospects for the Future
19. Future Prospects: Molecular Diagnosis, Enhanced Imaging,
Molecular-Based Conventional Drugs, and Gene Therapy. . . . . . . . 347
John A. Elefteriades
Section VII: Synthesis
20. The Key Lessons of This Book—In a Nutshell. . . . . . . . . . . . . . . . . . 353
John A. Elefteriades
Index . . . . 361
Contents xvii
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xix
Contributors
Nili Avidan Division of Medical Genetics, Department of Internal Medicine,
University of Texas Medical School, Houston, Texas, U.S.A.
Joseph E. Bavaria Division of Cardiac Surgery, University of Pennsylvania
Medical Center, Philadelphia, Pennsylvania, U.S.A.
Donald M. Botta, Jr. Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
Derek R. Brinster Division of Cardiothoracic Surgery, Virginia
Commonwealth University Medical Center/Medical College of Virginia,
Richmond, Virginia, U.S.A.
Michael A. Coady Harvard University, Landmark Hospital, Boston,
Massachusetts, U.S.A.
Peter G. Danias Department of Medicine, Tufts University Medical School,
Boston, Massachusetts, U.S.A., and Cardiac MR Center, Hygeia Hospital,
Maroussi, Athens, Greece
Kim Eagle Division of Cardiovascular Medicine, University of Michigan,
Ann Arbor, Michigan, U.S.A.
Andrew J. Einstein The Zena and Michael A. Wiener Cardiovascular Institute
and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health,
Mount Sinai School of Medicine, New York, New York, U.S.A.
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John A. Elefteriades Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
Emily A. Farkas Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
Valentin Fuster The Zena and Michael A. Wiener Cardiovascular Institute and
Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai
School of Medicine, New York, New York, U.S.A.
Randall Griepp Department of Surgery, Mt. Sinai School of Medicine,
New York, New York, U.S.A.
Dong-chuan Guo Division of Medical Genetics, Department of Internal
Medicine, University of Texas Medical School, Houston, Texas, U.S.A.
Amy E. Hackmann Departments of Surgery (Section of Vascular Surgery),
Radiology, and Cell Biology and Physiology, Washington University School of
Medicine, St. Louis, Missouri, U.S.A.
Hüseyin Ince Division of Cardiology, University Hospital Rostock, Rostock
School of Medicine, Rostock, Germany
Eric M. Isselbacher Department of Medicine, Harvard Medical School and
Thoracic Aortic Center, Massachusetts General Hospital, Boston,
Massachusetts, U.S.A.
George Koullias Department of Thoracic and Cardiovascular Surgery,
AHEPA University Hospital, Aristotle University Medical School,
Thessaloniki, Greece
Scott A. LeMaire Division of Cardiothoracic Surgery, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, and Cardiovascular
Surgery Service, The Texas Heart Institute at St. Luke’s Episcopal Hospital,
Houston, Texas, U.S.A.
Dianna M. Milewicz Division of Medical Genetics, Department of Internal
Medicine, University of Texas Medical School, Houston, Texas, U.S.A.
Christoph A. Nienaber Division of Cardiology, University Hospital Rostock,
Rostock School of Medicine, Rostock, Germany
Hariyadarshi Pannu Division of Medical Genetics, Department of Internal
Medicine, University of Texas Medical School, Houston, Texas, U.S.A.
xx Contributors
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Arun Raghupathy Division of Cardiovascular Medicine, University of
Michigan, Ann Arbor, Michigan, U.S.A.
John A. Rizzo Department of Epidemiology, State University of New York at
Stony Brook, Stony Brook, New York, U.S.A.
Javier Sanz The Zena and Michael A. Wiener Cardiovascular Institute and
Marie-Josee and Henry R. Kravis Center for Cardiovascular Health,
Mount Sinai School of Medicine, New York, New York, U.S.A.
Ali Shahriari Section of Cardiothoracic Surgery, Yale University, New Haven,
Connecticut, U.S.A.
Wilson Y. Szeto Division of Cardiac Surgery, University of Pennsylvania
Medical Center, Philadelphia, Pennsylvania, U.S.A.
Paul C. Y. Tang Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
George Tellides Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
Robert W. Thompson Departments of Surgery (Section of Vascular Surgery),
Radiology, and Cell Biology and Physiology, Washington University School of
Medicine, St. Louis, Missouri, U.S.A.
Van Tran-Fadulu Division of Medical Genetics, Department of Internal
Medicine, University of Texas Medical School, Houston, Texas, U.S.A.
Contributors xxi
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1
1
Classification of Aortic Dissection
Christoph A. Nienaber and Hüseyin Ince
Division of Cardiology, University Hospital Rostock,
Rostock School of Medicine, Rostock, Germany
INTRODUCTION
Since aortic dissection is one of the most challenging (and most rewarding)
medical emergencies, with a spectrum of heterogeneous clinical features, the
small community of experts in this field has tended to categorize and structure the
complex appearances of aortic dissection. Interestingly, but also typically, those
categorization attempts were made from the viewpoint of various disciplines,
from surgery to genetics to epidemiology. The goal has always been to better
comprehend the disorder, improving communication and education (1–4). This chap-
ter deals with the four most common domains of classification and introduces the
most popular and relevant stratification schemes for classifying aortic dissection.
CLASSIFICATION ACCORDING TO ETIOLOGY
Connective Tissue Disease
All mechanisms weakening the aorta’s medial layers via micro-apoplexy of the
vessel wall and encompassing many different disease entities lead to higher wall
stress, which can induce aortic dilatation and aneurysm formation. Intramural
hemorrhage, aortic dissection, or rupture of aortic wall layers may result. Three
major inherited connective tissue disorders are currently known to affect the
arterial wall: Marfan’s syndrome (MFS), Ehlers-Danlos syndrome (EDS), and
familial thoracic aneurysm and dissection.
SECTION I: THE CLINICAL ENTITIES
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