Advertisement

Current Approach to the Diagnosis and Treatment of Acute Ascending Aortic Dissection

  • Robert J. Rizzo
  • Lawrence H. Cohn
Chapter

Abstract

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.

Keywords

Aortic Valve Leave Anterior Descend Aortic Dissection Pericardial Effusion Acute Aortic Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965;49:130–49.PubMedGoogle Scholar
  2. 2.
    Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Dalen JE, Alpert JS, Conn LH, Black H, Collins JJ Jr. Dissection of the thoracic aorta. Am J Cardiol 1974;34:803–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Appelbaum A, Karp RB, Kirklin JW. Ascending vs descending aortic dissections. Ann Surg 1976;183:296–300.PubMedCrossRefGoogle Scholar
  5. 5.
    DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 1982;92:1118– 34.PubMedGoogle Scholar
  6. 6.
    Wolfe WG, Oldham HN, Rankin JS, Moran JF. Surgical treatment of acute ascending aortic dissection. Ann Surg 1983;197:738–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Anagnostopoulos CE, Prabhakar MJS, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol 1972;30:263–73.PubMedCrossRefGoogle Scholar
  8. 8.
    Goldman AP, Kotler MN, Scanlon MH, Ostrum B, Parameswaran R, Parry WR. The complementary role of magnetic resonance imaging, Doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms. Am Heart J 1986; 111:970–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Erbel R, Daniel W, Visser C, Engberding R, Roelandt J, Rennollet H. Echocardiography in diagnosis of aortic dissection. Lancet 1989;1:457–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Laas J, Schuter G, Daniel W, Hendrick Ph, Haverich A. Acute type-A dissection of the aorta: which diagnostic modes remain for surgical indication? Eur J Cardiothorac Surg 1987;1:169–172.PubMedCrossRefGoogle Scholar
  11. 11.
    Adachi H, Omoto R, Hyo S, et al. Emergency surgical intervention of acute aortic dissection with the rapid diagnosis by transesophageal echocardiography. Circulation 1991;84:14–9.Google Scholar
  12. 12.
    Simon P, Owen AN, Havel M, et al. Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection. J Thorac Cardiovasc Surg 1992;103:1113–7.PubMedGoogle Scholar
  13. 13.
    Nienaber CA, Spielmann RP, von Kodolitsch Y, Siglow V, Piepho A, Jaup T. Diagnosis of thoracic aortic dissection: magnetic resonance imaging versus transesophageal echocardiography. Circulation 1992;85:434–47.PubMedCrossRefGoogle Scholar
  14. 14.
    Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328:1–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. N Engl J Med 1993;323:35–43.CrossRefGoogle Scholar
  16. 16.
    Rizzo RJ, Aranki SF, Aklog L, Couper GS, Adams DH, Collins JJ, Jr., Kinchla NM, Allred EN, Cohn LH. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection: Improved survival with less angiography. J Thorac Cardiovasc Surg 1994;108:567–75.PubMedGoogle Scholar
  17. 17.
    Cooley DA. Surgical management of aortic dissection. Tex Heart Inst J 1990;17:289–301.PubMedGoogle Scholar
  18. 18.
    Glower DD, Speier RH, White WD, Smith LR, Rankin JS, Wolfe WG. Management and long-term outcome of aortic dissection. Ann Surg 1991;214:32–41.CrossRefGoogle Scholar
  19. 19.
    Chirillo F, Marchiori MC, Andriolo L, et al. Outcome of 290 patients with aortic dissection: a 12-year multicentre experience. Eur Heart J 1990; 11:311–9.PubMedGoogle Scholar
  20. 20.
    Silvey SV, Stoughton TL, Pearl W, Collazo WA, Belbel RJ. Rupture of the outer partition of aortic dissection during transesophageal echocardiography. Am J Cardiol 1991;68:286–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984;53:849–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Creswell LL, Kouchoukos NT, Cox JL, Rosenbloom M. Coronary artery disease in patients with type A aortic dissection. Ann Thorac Surg 1995;59:585–90.PubMedCrossRefGoogle Scholar
  23. 23.
    McClurken JB, White J, Deutsch E, Jeevanandam V. Donor heart angioscopy-increasing recovery from the existing donor pool. J Heart Lung Transplant 1993;12:S95.Google Scholar
  24. 24.
    Galloway AC, Colvin SB, Grossi EA, et al. Surgical repair of type A aortic dissection by the circulatory arrest-graft inclusion technique in sixty-six patients. J Thorac Cardiovasc Surg 1993;105:781–90.PubMedGoogle Scholar
  25. 25.
    Kern MJ, Serota H, Callicoat P, et al. Use of coronary arteriography in the preoperative management of patients undergoing urgent repair of the thoracic aorta. Am Heart J 1990; 119:143–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Jex RK, Schaff HV, Piehler JM, et al. Repair of ascending aortic dissection: influence of associated aortic valve insufficiency on early and late results. J Thorac Cardiovasc Surg 1987;93:375–34.PubMedGoogle Scholar
  27. 27.
    Kouchoukos NT, Wareing TH, Murphy SF, Perrillo JB. Sixteen-year experience with aortic root replacement: results of 172 operations. Ann Surg 1991;214:308–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissection. Circulation 1984;70:153–74.CrossRefGoogle Scholar
  29. 29.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Dissection of the aorta and dissecting aortic aneurysms: improving early and long-term surgical results. Circulation 1990;82:IV 24–38.Google Scholar
  30. 30.
    Coselli JS, Buket S, Djukanovic B. Aortic arch operation: current treatment and results. Ann Thorac Surg 1995;59:19–27.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Robert J. Rizzo
    • 1
  • Lawrence H. Cohn
    • 1
  1. 1.Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations