Early Complications and Management After Bypass Circulation

  • J. O. C. AulerJr
  • M. J. C. Carmona
Conference paper


Aortic dissection could be defined as a splitting of the aortic tunica media with extraluminal blood in the aortic wall. This blood penetrates the diseased medial layer and cleaves the laminar plane of the media in two, thus dissecting the aortic wall. The association of some medial degeneration, recurring flexion of the aorta and tensions applied to the aortic intima by hydrodynamic forces operating within the aorta may lead to an intimal tear and installation of a dissection. The majority of tears occur at the ascending aorta (60–65%). Subsequent propagation of the dissecting haematoma is related to hydrodynamic forces in the aorta, the pulse wave in the aorta being most important. Acute aortic regurgitation, cardiac tamponade, myocardial ischemia and heart block are the principal causes of death following aortic dissection. The peak incidence of aortic dissection is in the sixth and seventh decades of life, being twice more common in men [1]. In nontraumatic aortic dissection the pathogenesis is a degeneration of the medial collagen and elastin of the medial layer of the aortic wall [2, 3]. Although the mechanisms of such medial deterioration remain to be totally elucidated, aging process and coexisting history of hypertension are present in the majority of the cases of aortic dissection [1]. Due to its catastrophic evolution, acute aortic dissection requires prompt clinical diagnosis and treatment. Acute or chronic dissection is based on the time of onset of the dissection. Arbitrarily, acute dissection is defined when the onset is less than 2 weeks in duration. This classification is based on clinical data that reported 70% of untreated patients dying within 1 week and 90% dying within 3 months.


Cardiopulmonary Bypass Aortic Dissection Circulatory Arrest Acute Aortic Dissection Hypothermic Circulatory Arrest 
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Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • J. O. C. AulerJr
    • 1
  • M. J. C. Carmona
    • 1
  1. 1.Dept. of Anaesthesiology, Institute of CardiologySão Paulo University School of MedicineSão PauloBrazil

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