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Dissection of the aorta: particularities of the clinical presentation, diagnosis and prognosis


Author: Cuzor Tatiana
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2009
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Scientific consultant: Aureliu Batrînac
doctor, associate professor (docent), State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Scientific council: D 51-14.00.06
Public Medico-Sanitary Institution Moldavian Institute of Cardiology

Status

The thesis was presented on the 15 October, 2009
Approved by NCAA on the 17 December, 2009

Abstract

Adobe PDF document0.37 Mb / in romanian

Keywords

dissection of the aorta, aorta aneurysm, acute aortic syndrome, transthoracic echocardiography, aortic valve insuficiency, predictors of early mortality.

Summary

Structure of theses: introduction, 4 chapters, bibliography from 168 sources, 138 pages, 27 figures, 31 tables. The results of the study have been presented in 12 scientific publications. Domain of research: cardiology and rheumatology.

Aim and objectives of research: the study of clinical and paraclinical parameters of patients with dissection of the aorta and aorta aneurysm, which correlate with an unfavorable prognosis in hospital and at follow up. The main points were the analysis of clinical profile of the patient with dissection of the aorta in correlation with the data obtained from emergency transthoracic echocardiography, the estimation of sensibility and specificity of transthoracic echocardiography in comparison with other imagistic methods (computer tomography, magnetic resonance, aortography), active follow up of patients with different clinical evolution forms of aneurysm and chronic dissection of aorta, the analysis of indications for surgical treatment of aneurysm and dissection of aorta.

Novelty and originality of research:In the national premiere of the Republic of Moldova have been estimated the surviving indicators of patients with chronic dissection and aorta aneurysm in a 4 years follow up, it has been realized the first try to estimate different imagistic methods for emergency diagnosis and follow up of patients with acute aorta syndrome. The results of the study clearly differentiated the risk factors for the development of complications in patients with acute and chronic dissection of the aorta and in those with aorta aneurysm and demonstrated the early surgical treatment reason.

Theoretical and applied value: The use of different modern imagistic methods, differentiation of some clinical and paraclinical unfavorable indicators allowed to establish the early mortality predictors and optimal time for surgical correction. It has been gave reason for necessity of urgent surgical treatment in the case of dissection type A, to demonstrate a high performance of emergency transthoracic echocardiography in detection of aortic intimal flap (a sensibility of 92% and a specificity of 90,5%).

Practical implementation:The elaborated recommendations have been implemented in the examination and treatment decision of patients with aortic syndrome in hospital period and at follow up in the Intensive Care department of Institute of Cardiology and at the Cardiology chair of Residency faculty of the State Medical and Pharmacy University „N. Testemitanu”.