Current Approach to the Diagnosis and Treatment of Acute Ascending Aortic Dissection
Acute dissection of the ascending aorta creates a sudden, extremely tenuous condition of rapidly fatal consequence, unless treated by prompt surgical repair.1–6 In a collective review of 963 patients with aortic dissection who did not receive surgical treatment, the mortality rate at one day was 37% and at one week was 70%; 86% of deaths were due to aortic rupture.7 Aortic dissection occurs when a tear within the intimal lining allows circulating blood to be pumped directly into the aortic wall, rapidly separating the outer media and adventitia from the inner media and intima. A false channel is thereby created within the aortic wall, extending for various distances proximal and distal to the original intimal tear, which may lead to aortic rupture, major branch vessel obstruction with ischemia, or aortic valve regurgitation. Surgical intervention can prevent aortic rupture and reverse organ or extremity ischemia and aortic valve insufficiency, but must be performed promptly before these complications occur or their effects become irreversible. Thus, in addition to prompt surgical therapy, rapid efficient diagnosis of acute aortic dissection is also of critical importance.
KeywordsAortic Valve Leave Anterior Descend Aortic Dissection Pericardial Effusion Acute Aortic Dissection
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