4. Aortic Dissection Type A Stanford — Clinical Aanalysis, Follow-up

Abstract

Background Acute aortic dissection is the most lethal event affecting the human aorta. Untreated type A dissections are associated with a very high mortality. During the first 24 to 48 hours, the mortality approximates 1–2% per hour.

Material and methods: In an effort to understand the natural history and postoperative course of type A dissections our group recently reviewed such experience with 125 patients underwent surgical treatment between 1985 and 2000.

Results: At the time of initial assessment 106 patients (84,8%) had acute and 19 patients (15,2%) had chronic aortic dissection. Hypertension was the most common predisposing factor (70,4% of patients overall). The acute onset of severe chest pain was the most common initial complaint (94,4%). Less common manifestations included congestive heart failure, pulmonary oedema, syncope, cerebrovascular accident, shock, lower extremity ischemia. In 23 patients (18,4%) the appropriate treatment was delayed by misdiagnosis. Although the clinical features of aortic dissection have gained wider appreciation, the diagnosis still remains unsuspected in a substantial number of patients. Diagnosis was confirmed by transthoracic echocardiography (TTE) or by combined echocardiographic examination (TTE and transesophageal echocardiography (TEE) in most cases. The postoperative complications seem to be a serious clinical problem. Uncomplicated postoperative course we observed only in 31% of patients. The 5-year actuarial survival rate for discharged patients was 90%.

Conclusions: The keys to a successful outcome are being aware of the symptoms of dissection, early diagnosis, and prompt application of appropriate treatment; diligent follow-up includes controlling blood pressure, decreasing the velocity of left ventricular contraction, monitoring the size of the residual aorta, and taking appropriate action if redissection or aneurysmal formation occurs.