Actually, I am concerned with the association between the use of contrast agents and rupture of thoracic aortic dissection (Stanford A type).
Here is the case I experienced recently. A 57-year-old male with a history of hypertension and atrial fibrillation visited our department with a complaint of chest pain. His consciousness was clear and his systolic blood pressure was 100 mmHg. TTE revealed dilated ascending aorta along with moderate aortic regurgitation. Immediately, contrast-CT was performed. Contrast enhanced CT revealed Stanford A type aortic dissection. There was no retention of pericardial effusion. Within a few minutes after that, he fell into CPA. TEE revealed massive retention of pericardial effusion. PCPS was introduced. However, PCPS did not work efficiently probably because of collapse in the right heart. Immediately, pericardial drainage was performed; drainage was not effective because of coagulated blood.
In this case,
Should we have performed pericardiotomy to save this patient?
May contrast agents trigger the rupture of thoracic aortic dissection (Stanford A type)? Actually, I know several cases that thoracic aortic dissection ruptured immediately after contrast CT. I want a paper discussing this point.
There is evidence, that CM administration could increase the heart rate, but I don't know about influence on BP. On the other hand, it is questionable if the small volume (cca 150 ml...CM + saline) injected in short time could jump the BP. Despite it can not be excluded, I am convinced that there is no direct relation.
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=106819
Dr. Baxa,
Thank you for a kind reply.
As far as I concerned, there is no article referring to the relation. I think that it is a good point to consider the change in heart rate.
Some cardiologists and cardiovascular surgeons said that there is no direct relation, but one cardiologist suggested the relationship. The most important thing with this patient, I think, is sudden changes in blood pressure and heart rate. Before moving this patient to a CT room, it may be a good idea to administrate sedative drugs, such as propofol or midazolam, prevent the patient from becoming agitated.
I will delve into this problem. Thanks again for a kind help!
Nobuhiro
Higher iodine containing contrast agents can cause mild tachycardia but anxiety and agitation of the patient after acute aortic dissection are having contributions. Rupture due to to contrast injection is unlikely rather it should be considered as progress of dissection , which is the harbinger of death in 24 hours of acute type A dissection.
Pericardiocentesis or pericardial drainage is contra indicated as it would hasten the death of the patient . Any patient with type A Acute dissection with pericardial temponade should be subjected to CPR and immidiately taken to OR where emergency
1- I doubt it's the contrast media (it can be catheter) 2- In my >50 yrs experience, I know of several cases of rupture of aneurysms in X-ray. In fact, we long noted that with acute traumatic rupture of the aortic isthmus, the Radiology Department (& transportation) is very dangerous! 3- Acute intrapericardial rupture of a dissection is VERY unlikely to benefit from pericardiotomy outside the OR.
Thanks, Dr Bhat, Dr Pate!
Your answers are helpful. I appreciate your cooperation.
Nobuhiro
Dear Fellow,
Your work and question is very valuable.I think from different observations that contrast some times causes tachycardia leading to raise the BP which may exert increased pressure in aortic wall which is relatively weak and can cause the rupture of the aeurysmal weak part.
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