Share
array:24 [ "pii" => "S2341192917301518" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.001" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "821" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:585-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617301081" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.03.015" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "821" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2017;64:585-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 72 "formatos" => array:2 [ "HTML" => 63 "PDF" => 9 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "585" "paginaFinal" => "589" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Type A chronic aortic dissection with obesity and preeclampsia" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2029 "Ancho" => 2500 "Tamanyo" => 398341 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se observa el <span class="elsevierStyleItalic">flap</span> de la disección por ecografía. En las imágenes 1 y 2 se aprecia la doble luz aórtica verdadera y falsa. En las imágenes 3 y 4 se observan los puntos comunicantes entre la doble luz.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Santana-Ortega, S. Urso, A. Rodríguez-Pérez, T. Sarmiento, L. Morales, G. Hernanz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Santana-Ortega" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Urso" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Pérez" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Sarmiento" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Morales" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Hernanz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192917301518" "doi" => "10.1016/j.redare.2017.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301518?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301081?idApp=UINPBA00004N" "url" => "/00349356/0000006400000010/v1_201711141119/S0034935617301081/v1_201711141119/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192917301506" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.03.009" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "822" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:590-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Ceftazidime-induced thrombocytopenia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "590" "paginaFinal" => "593" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombocitopenia inducida por ceftazidima" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1164 "Ancho" => 1600 "Tamanyo" => 99400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolution over time of the platelet count in relation to the antibiotic treatment administered. Preoperative, immediate postoperative and admission (day 0) levels are shown. Cef: ceftazidime; Lev: levofloxacin; Imm. Postop. Immediate postoperative; Preop: preoperative; PT: piperaziline/tazobactam; TP: Platelet transfusion; Tobram: tobramycin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Domingo-Chiva, M. Díaz-Rangel, J.Á. Monsalve-Naharro, P. Cuesta-Montero, J.V. Catalá-Ripoll, E.M. García-Martínez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Domingo-Chiva" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Díaz-Rangel" ] 2 => array:2 [ "nombre" => "J.Á." "apellidos" => "Monsalve-Naharro" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Cuesta-Montero" ] 4 => array:2 [ "nombre" => "J.V." "apellidos" => "Catalá-Ripoll" ] 5 => array:2 [ "nombre" => "E.M." "apellidos" => "García-Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301093" "doi" => "10.1016/j.redar.2017.03.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301093?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301506?idApp=UINPBA00004N" "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301506/v1_201711240853/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192917301567" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.006" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "826" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:577-84" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "More than 3 hours and less than 3 years old. Safety of anesthetic procedures in children under 3 years of age, subject to surgeries of more than 3 hours" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "577" "paginaFinal" => "584" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Más de 3 horas y menos de 3 años. Seguridad de procedimientos anestésicos en niños menores de 3 años, sometidos a cirugías de más de 3 horas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Álvarez Escudero, R.M. Paredes Esteban, F.J. Cambra Lasaosa, M. Vento, M. López Gil, J.C. de Agustín Asencio, M.T. Moral Pumarega" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez Escudero" ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "Paredes Esteban" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Cambra Lasaosa" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Vento" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "López Gil" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "de Agustín Asencio" ] 6 => array:2 [ "nombre" => "M.T." "apellidos" => "Moral Pumarega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301135" "doi" => "10.1016/j.redar.2017.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301135?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301567?idApp=UINPBA00004N" "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301567/v1_201711240853/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Type A chronic aortic dissection with obesity and preeclampsia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "585" "paginaFinal" => "589" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.M. Santana-Ortega, S. Urso, A. Rodríguez-Pérez, T. Sarmiento, L. Morales, G. Hernanz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Santana-Ortega" "email" => array:1 [ 0 => "luisstna@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Urso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Rodríguez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "T." "apellidos" => "Sarmiento" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "L." "apellidos" => "Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "G." "apellidos" => "Hernanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Cardíaca, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2029 "Ancho" => 2500 "Tamanyo" => 398686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The flap is observed on ultrasound. Images 1 and 2 show the true and false double aortic lumen. Images 3 and 4 show the points of connection between the double lumen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aortic dissection (AD) is rare, and has an incidence of 3 cases per 100,000 person-years. Women are affected later in life than men, although recent data report gender parity.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> When it appears before the age of 40, it is associated with risk factors such as Marfan syndrome, bicuspid aortic valve and aortic dilatation. It is characterised by the creation of a false lumen in the middle layer of the aortic wall, which is identified on ultrasound study as a flap.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The most frequent site of primary intimal tear is the ascending aorta, 1–5<span class="elsevierStyleHsp" style=""></span>cm above the Valsalva sinus. Acute presentation with early diagnosis is typical, and chest pain is usually the presenting symptom. The incidence of AD among young pregnant women is up to 100 times higher than the adult population, with no specific risk factors,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and mainly affects the ascending aorta. AD can occur at any time during pregnancy, although it is more frequent in the third trimester and postpartum. We present the case of a patient with chronic AD and atypical clinical symptoms who was diagnosed in the late postpartum period.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case study</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient is a 37-year-old, morbidly obese (BMI 46<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) woman. She had undergone a stomach reduction at age 18, which was ineffective, and had no previous history of hypertension. Ten months previously, during her first pregnancy, she underwent urgent caesarean section under epidural anaesthesia due to severe preeclampsia with no proteinuria. The procedure was uneventful, and the foetus was full-term (37 weeks), with a normal Apgar 1-5-10<span class="elsevierStyleHsp" style=""></span>min score. After delivery, she was transferred to the 24-h ICU.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After the caesarean section, she noticed the onset of mild, intermittent, non-irradiated epigastric pain, with no other symptoms. She dismissed the symptoms, and at 72<span class="elsevierStyleHsp" style=""></span>h was discharged home. Ten months later, she consulted her doctor due to no improvement in the epigastric pain. A scheduled computerised axial tomography performed in a private centre showed evidence of AD. In view of these findings, she was transferred to the reference centre to undergo a transthoracic ultrasound, which showed adequate biventricular function (left ejection fraction of 59% according to the Teicholz formula), a tricuspid aortic valve with significant aortic insufficiency (pressure half-time of 430<span class="elsevierStyleHsp" style=""></span>mmsg), secondary to a central jet. An ascending aortic aneurysm, with a maximum diameter of 55<span class="elsevierStyleHsp" style=""></span>mm, was documented above the aortic annulus, with dilatation of the sinotubular junction. No intimal flap was observed. Urgent computed tomography (CT) of the chest and abdomen showed the presence of an intimal flap at the level of the aortic root, immediately distal to the origin of the coronary arteries (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The dissection reached the proximal third of both common iliac arteries. The arterial trunks originated in true lumen. These findings corresponded to a type A AD, according to the Stanford classification.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent scheduled transoesophageal echocardiography-guided replacement of the ascending aorta with a 30<span class="elsevierStyleHsp" style=""></span>mm Dacron® tube (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>) and the aortic valve with a 24<span class="elsevierStyleHsp" style=""></span>mm ATS<span class="elsevierStyleSup">®</span> mechanical heart valve (Medical Inc. USA) while connected to a cardiopulmonary bypass (CPB) machine with arterial and venous cannulation in the right femoral artery and right atrium, respectively. Monitoring with INVOS<span class="elsevierStyleSup">®</span> cerebral oximetry (Somanetics, USA) was uneventful. After hypothermic circulatory arrest, CPB was restarted with cannulation of the brachiocephalic artery (duration of CPB, aortic clamping and cardiac standstill was 327, 121 and 52<span class="elsevierStyleHsp" style=""></span>min, respectively). The intervention was uneventful. The patient was transferred, intubated, to the ICU in sinus rhythm, with normal cardiac function and no vasoactive agents. Her lower limbs, although swollen, were warm and well perfused.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">She was extubated 6<span class="elsevierStyleHsp" style=""></span>h after surgery. At 24<span class="elsevierStyleHsp" style=""></span>h, rhabdomyolysis (CK 40,000<span class="elsevierStyleHsp" style=""></span>IU/L) associated with continuous pain in the right popliteal region was observed. Examination showed oedema with local induration, distal paraesthesia and immobility of the right ankle, leading to a diagnosis of compartment syndrome. Urgent fasciotomy of the superficial and deep anterior, medial and postlateral compartment was performed. Five days later, before definitive closure of the fasciotomy, she required reintervention due to muscular necrosis. Ten days of aortic surgery, the patient was transferred to the hospital ward. The follow-up transthoracic echocardiography scan showed good left ventricular systolic function, with normal function of the valvular prosthesis, no significant gradients and no sign of aortic insufficiency or pericardial effusion. The patient was discharged home 21 days after the intervention. At 3 months, she showed complete recovery, with NYHA functional class I.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Type A AD is a rare, potentially lethal condition that typically presents with sharp chest or interscapular pain. It requires urgent surgery, since risk of mortality increases by 1% each hour after onset during the first 24–48<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In pregnancy, AD has a mortality rate of 30% for the mother and 50% for the foetus.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The causes of death are aortic rupture, cardiac tamponade, aortic insufficiency and myocardial ischaemia, central nervous system malperfusion, and visceral and renal ischaemia.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> AD is considered chronic when it is observed 2 weeks or more after onset of symptoms. In patients with no symptoms or with atypical presentation, early diagnosis is impossible in the acute phase, and the exact moment in which the dissection occurred is impossible to determine. In our case, the process probably started in the days following delivery, when preeclampsia was documented. Diagnosis of AD was a fortuitous radiological finding, and the flap was only observed on CT. The highest diagnostic yield is obtained with CT, followed by transoesophageal echocardiography, transthoracic echocardiography with intravenous contrast (peripheral administration of 1<span class="elsevierStyleHsp" style=""></span>mL perflutren protein type A microsphere or sulphur hexafluoride) and finally, transthoracic echocardiography without contrast.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Given the high mortality rate, risk factors for suspected AD are of vital importance. In pregnant women, it has been associated with connective tissue disease that predisposes to vascular lesions and an increase in pregnancy-related haemodynamic stress. The diameter of the aortic annulus is often increased in pregnancy, and can remain 1<span class="elsevierStyleHsp" style=""></span>mm larger postpartum.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In our case, connective tissue disease was ruled out. The search for new risk factors is hampered by the low incidence of AD in young people, and obesity has been suggested as a new risk factor. The obesity epidemic has led to a greater prevalence of pregnant women with BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>30, as in our case. Adipose tissue is known to cause endocrine activation and release of cytokines and vasoactive substances that may have an adverse effect on tissue and aortic biomechanics. These substances include angiotensin II, angiotensin-converting enzyme, and beta-growth factor. In animal studies, these have been shown to increase the likelihood of both aortic aneurysm formation and impaired vasodilation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The postoperative period in our patient was also complicated by reperfusion in the right lower limb. During CPB, the right femoral artery was cannulated for arterial perfusion (20 Fr femoral cannula) until the onset of hypothermic circulatory arrest, and then CPB was resumed through the brachiocephalic trunk (anterograde reperfusion). The cannula remained in place, and might have reduce circulation to the right femoral artery, thus preventing distal perfusion of the leg during the warm-up phase, which lasted 150<span class="elsevierStyleHsp" style=""></span>min due to the patient's high BMI. After disconnection from the CPB machine, the femoral cannula was removed, and this could have induced ischaemia-reperfusion syndrome. The rapid diagnosis of this complication allowed us to resolve it satisfactorily.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">AD should be considered in pregnant women with additional risk factors, such as arterial hypertension and preeclampsia. The absence of typical symptoms cannot rule out diagnosis or chronification of the disease. Further epidemiological studies are needed to discover new risk factors, such as obesity, that are currently on the rise in the developed world.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal rights</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of all patients and/or subjects included in this manuscript. The informed consent forms can be obtained from the author for correspondence.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres945439" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec918125" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres945438" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec918124" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case study" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal rights" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-06" "fechaAceptado" => "2017-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec918125" "palabras" => array:3 [ 0 => "Aortic dissection" 1 => "Aorta" 2 => "Preeclampsia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec918124" "palabras" => array:3 [ 0 => "Disección aórtica" 1 => "Aorta" 2 => "Preeclampsia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La disección aórtica es una dolencia potencialmente letal, con una incidencia en la gestante hasta 100 veces superior comparada con la de la población adulta. Suele presentarse con un cortejo típico caracterizado por dolor torácico. Presentamos el caso de una mujer de 37 años con antecedente gestacional y obesidad mórbida, diagnosticada de disección aórtica crónica tipo A por un hallazgo radiológico documentado a los 10 meses posparto.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santana-Ortega LM, Urso S, Rodríguez-Pérez A, Sarmiento T, Morales L, Hernanz G. Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia. Rev Esp Anestesiol Reanim. 2017;64:585–589.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2554 "Ancho" => 2500 "Tamanyo" => 402289 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Images 1 and 2 show the flap in the ascending aorta, with the dissection progressing towards the aortic arch in image 3, and the descending aorta in image 4.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2029 "Ancho" => 2500 "Tamanyo" => 398686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The flap is observed on ultrasound. Images 1 and 2 show the true and false double aortic lumen. Images 3 and 4 show the points of connection between the double lumen.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1007 "Ancho" => 2499 "Tamanyo" => 200697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intraoperative transoesophageal echocardiography. Image 1 shows the significant jet from the dysfunctional aorta, and image 2 shows the central characteristic of the regurgitant jet.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of acute aortic dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Nienaber" 1 => "R.E. Clough" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)61005-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2015" "volumen" => "385" "paginaInicial" => "800" "paginaFinal" => "811" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25662791" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Januzzi" 1 => "E.M. Isselbacher" 2 => "R. Fattori" 3 => "J.V. Cooper" 4 => "D.E. Smith" 5 => "J. Fang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2003.08.054" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "665" "paginaFinal" => "669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14975480" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender-related differences in acute aortic dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Nienaber" 1 => "R. Fattori" 2 => "R.H. Mehta" 3 => "B.M. Richartz" 4 => "A. Evangelista" 5 => "M. Petzch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000130644.78677.2C" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "109" "paginaInicial" => "3014" "paginaFinal" => "3021" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15197151" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from International Registry of Acute Aortic Dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. Pape" 1 => "M. Awais" 2 => "E.M. Woznicki" 3 => "T. Suzuki" 4 => "S. Trimarchi" 5 => "A. Evangelista" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2015.05.029" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2015" "volumen" => "66" "paginaInicial" => "350" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26205591" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular problems in pregnant women with Marfan syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Goland" 1 => "U. Elkayam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.493569" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2009" "volumen" => "119" "paginaInicial" => "619" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19188522" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.S. Bonser" 1 => "A.M. Ranasinghe" 2 => "M. Loubani" 3 => "J.D. Evans" 4 => "N.M. Thalji" 5 => "J.E. Bachet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2011.06.067" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2011" "volumen" => "58" "paginaInicial" => "2455" "paginaFinal" => "2474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22133845" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of contrast-enhanced echocardiography on the diagnostic algorithm of acute aortic dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Evangelista" 1 => "G. Avegliano" 2 => "R. Aguilar" 3 => "H. Cuellar" 4 => "A. Igual" 5 => "T. González-Alujas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehp505" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "472" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20037148" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pregnancy and thoracic aortic disease: managing the risks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Wanga" 1 => "C. Silversides" 2 => "A. Dore" 3 => "V. de Waard" 4 => "B. Mulder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2015.09.003" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2016" "volumen" => "32" "paginaInicial" => "78" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26604124" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence and clinical impact of obesity in adults with Marfan syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.T. Yetman" 1 => "B.W. McCrindle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "137" "paginaFinal" => "139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20386774" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "e5–6" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemia-reperfusion injury in an aortic dissection patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Yin" 1 => "J.R. Yang" 2 => "Y.S. Wei" 3 => "B.L. Liang" 4 => "Y.B. Wei" 5 => "K.Q. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2014.12.037" "Revista" => array:5 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "987" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25669873" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301518/v1_201711240853/en/main.assets" "Apartado" => array:4 [ "identificador" => "71024" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006400000010/v1_201711240853/S2341192917301518/v1_201711240853/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301518?idApp=UINPBA00004N" ]
