Aortic Dissection

Part of the Contemporary Cardiology book series (CONCARD)


Dissection involving the ascending aorta has an extremely high mortality (up to 1% per minute, 60% in 60 minutes). Thus, time-consuming investigations that are not sufficiently sensitive or specific, such as computed tomography (CT), must be forsaken. Emergency surgery carries the only hope of survival for the unfortunate patient with dissection of the ascending aorta, and immediate accurate diagnosis is mandatory to guide interventional therapy. Presently, the quickest, most accurate diagnostic procedure is transesophageal echocardiography (TEE), which can be performed at the bedside, in the intensive care unit, or in the operating room.


Aortic Dissection Giant Cell Arteritis Cardiac Tamponade Marfan Syndrome 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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ballal RS, Nanda NC, Gatewood R, et al. Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation 1991;84:1903.PubMedGoogle Scholar
  2. 2.
    Bortone AS, Schena S, D’Agostino D, et al. Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming European trial. Circulation 2002;106(Suppl I):I-234–I-240.Google Scholar
  3. 3.
    Bossone E, Rampoldi V, Nienaber CA, et al. Pulse deficits: a simple clinical sign as independent predictor of in-hospital complications and mortality in patients with type A aortic dissection. Am J Cardiol 2002;89:851–855.PubMedCrossRefGoogle Scholar
  4. 4.
    Cigarro JE, Isselbacher B, DeSanctis RW, et al. Diagnostic imaging in the evaluation of suspected aortic dissection. N Engl J Med 1993;28:35.CrossRefGoogle Scholar
  5. 5.
    Collins JS, Evangelista A, Nienaber CA, et al. on behalf of the International Registry of Acute Aortic Dissection. Differences in clinical presentation, management, and outcomes of acute type A aortic dissection in patients with and without previous cardiac surgery. Circulation 2004;110:II-237–II-242.CrossRefGoogle Scholar
  6. 6.
    Dake M, Kato N, Mitchell RS. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1524–1531.CrossRefGoogle Scholar
  7. 7.
    DeBakey ME, Hendy WS, Cooley DA, et al. Surgical management of dissecting aneurysm of the aorta. J Thorac Cardiovasc Surg 1965;49:130.PubMedGoogle Scholar
  8. 8.
    Devereux RB, Roman MJ. Aortic disease in Marfan’s Syndrom. N Engl J Med 1999;340:1358–1359.PubMedCrossRefGoogle Scholar
  9. 9.
    Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection: task force report of the European Society of Cardiology. Eur Heart J 2001;22:1642–1681.PubMedCrossRefGoogle Scholar
  10. 10.
    Evangelista A, Garcia-del-Castillo H, Conzalez-Alujas T, et al. Diagnosis of ascending dissection by transesophageal echocardiography: utility of M-Mode in recognizing artifacts. J Am Coll Cardiol 1996;27:102.PubMedCrossRefGoogle Scholar
  11. 11.
    Fenoglio JJ Jr, McAllister HA Jr, DeCastro CM, et al. Congenital bicuspid aortic valve after age 20. Am J Cardiol 1977;39:164.PubMedCrossRefGoogle Scholar
  12. 12.
    Finkbohner R, Johnston D, Crawford ES, et al. Marfan syndrome: long-term survival and complications after aortic aneurysm repair. Circulation 1995;91:728–733.PubMedGoogle Scholar
  13. 13.
    Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med 1999;340:1307–1317.PubMedCrossRefGoogle Scholar
  14. 14.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA 2000;283:897–903.PubMedCrossRefGoogle Scholar
  15. 15.
    Hirata K, Triposkiadis F, Sparks E, et al. The Marfan syndrome: abnormal aortic elastic properties. J Am Coll Cardiol 1991;18:57.PubMedGoogle Scholar
  16. 16.
    Ince H, Nienaber CA. The concept of interventional therapy in acute aortic syndrome. J Card Surg 2002;17:135–142.PubMedCrossRefGoogle Scholar
  17. 17.
    Isselbacher EM, Cigarroa JE, Eagle KA. Cardiac tamponade complicating proximal aortic dissection: is pericardiocentesis harmful? Circulation 1994;90:2375–2379.PubMedGoogle Scholar
  18. 18.
    Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 2004;43:665–669.PubMedCrossRefGoogle Scholar
  19. 19.
    Kazui T, Washiyama N, Muhammad BA, et al. Extended total arch replacement for acute type A aortic dissection: experience with seventy patients. J Thorac Cadiovasc Surg 2000;119:558–565.CrossRefGoogle Scholar
  20. 20.
    Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000;160:2977–2982.CrossRefGoogle Scholar
  21. 21.
    Lai DT, Robbins RC, Mitchell SC, et al. Does profound hypothermic circulatory arrest improve survival in patients with acute type A aortic dissection? Circulation 2002;106(Suppl I):I-218–I-228.Google Scholar
  22. 22.
    Mehta RH, O’Gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002;40:685–692.PubMedCrossRefGoogle Scholar
  23. 23.
    Nienaber, CA, Eagle KA. Aortic Dissection: New Frontiers in Diagnosis and Management Part I: From Etiology to Diagnostic Strategies. Circulation 2003;108:628–635.PubMedCrossRefGoogle Scholar
  24. 24.
    Nienaber CA, Eagle KA. Aortic Dissection: New Frontiers in Diagnosis and Management Part II: Therapeutic Management and Follow-Up. Circulation 2003;108:772.PubMedCrossRefGoogle Scholar
  25. 25.
    Nienaber CA, Ince H, Petzsch M, et al. Endovascular treatment of thoracic aortic dissection and its variants. Acta Chir Belg 2002;102:292–298.PubMedGoogle Scholar
  26. 26.
    Nienaber CA, Spielmann RP, von Kodolitsch Y, et al. Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation 1992;85:434.PubMedGoogle Scholar
  27. 27.
    Nienaber CA, von Kodolitsch Y. Therapeutic management of patients with Marfan syndrome: focus on cardiovascular involvement. Cardiol Rev 1999;7:332–341.PubMedCrossRefGoogle Scholar
  28. 28.
    Nienaber CA, von Kodolitsch Y, Nicholas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328:1.PubMedCrossRefGoogle Scholar
  29. 29.
    Nguyen B, Muller M, Kipfer B, et al. Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation. Eur J Cardiothorac Surg 1999;15:496–500.PubMedCrossRefGoogle Scholar
  30. 30.
    O’Gara PT, DeSanctis RW. Acute aortic dissection and its variants. Towards a common diagnostic and therapeutic approach. Circulation 1995;92:1376.PubMedGoogle Scholar
  31. 31.
    Palma JH, Marcondes de Souza JA, Alves CMR, et al. Self expandable aortic stent-graft for treatment of descending aortic dissections. Ann Thorac Surg 2002;73:1138–1142.PubMedCrossRefGoogle Scholar
  32. 32.
    Reed D, Reed C, Stemmerman G, et al. Are aortic aneurysms caused by atherosclerosis? Circulation 1992;85:205.PubMedGoogle Scholar
  33. 33.
    Roberts CS, Roberts WC. Aortic dissection with the entrance tear in abdominal aorta. Am Heart J 1991;121:1834.PubMedCrossRefGoogle Scholar
  34. 34.
    Roberts CS, Roberts WC. Dissection of the aorta associated with congenital malformation of the aortic valve. J Am Coll Cardiol 1991;17:712.PubMedCrossRefGoogle Scholar
  35. 35.
    Salim MA, Alpert BS, Ward JC. Effect of beta-adrenergic blockade on aortic root rate of dilation in the Marfan syndrome. Am J Cardiol 1994;74:629.PubMedCrossRefGoogle Scholar
  36. 36.
    Schor JS, Yerlioglu ME, Galla JD, et al. Selective management of acute type B aortic dissection: long-term follow-up. Ann Thorac Surg 1996;61:1339–1341.PubMedCrossRefGoogle Scholar
  37. 37.
    Yacoub MH, Gehle P, Candrasekaran V, et al. Late results of a valve preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998;115:1080–1090.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Personalised recommendations