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4. Aortic Dissection Type A Stanford — Clinical Aanalysis, Follow-up
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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.
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.
Keywords
aortic dissection; hypertension
About this articleTitle
4. Aortic Dissection Type A Stanford — Clinical Aanalysis, Follow-up
Journal
Issue
Article type
Editorial
Pages
29-38
Published online
2001-01-12
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822
Article views/downloads
2043
Bibliographic record
Nadciśnienie tętnicze 2001;5(1):29-38.
Keywords
aortic dissection
hypertension
Authors
Marek Kabat
Mariola Pęczkowska
Hanna Janaszek-Sitkowska
Magdalena Makowiecka-Cieśla
Andrzej Januszewicz
Marek Sznajderman
Andrzej Biederman
Eugeniusz Szpakowski
Marian Śliwiński
Janina Stępińska
Anna Klisiewicz
Marcin Mirocha