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Acute aortic syndromes


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In the modern era, acute aortic syndromes include an acute aortic dissection, an intra¬mural hematoma (IMH), and a symptomatic penetrating aortic ulcer (PAU). An acute aor¬tic dissection requires an intimal tear, which is a disruption of the medial layer provoked by intramural bleeding, resulting in separation of the aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. An IMH develops in the media of the aortic wall in the absence of a false lumen and intimal tear. It is diagnosed by the presence of a circular or crescent-shaped 0.5-mm thickening of the aortic wall in the absence of detectable blood flow. A PAU is defined as ulceration of an aortic atherosclerotic plaque penetrating the internal elastic lamina into the media. Propagation of the ulcerative process may lead to an IMH, a pseudoaneurysm, an aortic rupture, or an acute aortic dissection. Recent developments in terms of diagnostic imaging and surgical treatment of acute aortic syndromes have made early diagnosis even more relevant, espe¬cially in terms of survival. This book presents a comprehensive examination of the three pathologies that fall within acute aortic syndromes, with a special focus on diagnostics and surgical treatment.


Pathophysiology, epidemiology, and classification

Federica Jiritano, Giuseppe Filiberto Serraino, Pasquale Mastroroberto

Natural history, clinical manifestation, and guidelines

Antonio di Virgilio

Imaging for diagnosis

Luigi Lovato

Management of Type A aortic dissection

Massimo Chello, Mario Lusini

Management of Type B aortic dissection

Thierry Carrel, Paul Vogt, Martin Czerny

Management of intramural hematoma and penetrating aortic ulcer

Giuseppe Santarpino, Emanuele Malta, Pasquale Mastroroberto

Anesthesia and postoperative intensive care

Demetrio Pittarello

Cerebral protection in aortic arch surgery

Luca Di Marco, Carlo Mariani, Giacomo Murana, Chiara Nocera, Alessandro Leone, Davide Pacini

Operative technique: surgery of the aortic root in acute type A aortic dissection

Alessandro Leone, Luca Di Marco, Davide Pacini, Roberto Di Bartolomeo

Operative technique: Frozen Elephant Trunk operation

Giuseppe Santarpino, Ferdinand Vogt, Stefano Sechi, Pasquale Mastroroberto

Operative technique: thoracoabdominal aortic surgery

Pasquale Mastroroberto, Massimo Chello

Operative technique: endovascular treatment

Giuseppe Santarpino, Caterina Golini Petrarcone, Pasquale Mastroroberto

New biomarkers and perspectives

Giuseppe Filiberto Serraino, Pasquale Mastroroberto

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