open access

Vol 5, No 1 (2001)
Artykuły redakcyjne
Published online: 2001-01-12
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4. Aortic Dissection Type A Stanford — Clinical Aanalysis, Follow-up

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
Nadciśnienie tętnicze 2001;5(1):29-38.

open access

Vol 5, No 1 (2001)
Artykuły redakcyjne
Published online: 2001-01-12

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.

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Keywords

aortic dissection; hypertension

About this article
Title

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

Journal

Arterial Hypertension

Issue

Vol 5, No 1 (2001)

Pages

29-38

Published online

2001-01-12

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

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