Type a aortic dissection taad is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. Dissection aortique aigue, type a, type b, biomarqueurs, genetique, echographie, angioscanner. The formation of atherosclerotic lesions can weaken and cause tears within the intima layer, serving as a risk factor for aortic dissection. The predisposition of previous aortic or cardiac operation for aortic dissection is well known. Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. Diagnosis and management of aortic dissection bja education. Type a aortic dissection during late pregnancy in a patient.
It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing dbt1aad surgery and that a patent false lumen worsens the prognosis. Aortic dissection causes, symptoms, diagnosis, treatment. Pdf dissection aortique etendue aux arteres renales. Jan 08, 2019 aortic dissection see the image below is defined as separation of the layers within the aortic wall.
Ascending aortic dissection remains one of the most catastrophic emergencies amongst cardiovascular diseases 15. Aortic dissections originating in the ascending aorta and descending aorta have been classified as type a and type b dissections, respectively. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second bloodfilled channel within the wall. Epidemiology and clinicopathology of aortic dissection chest. Arguments for dta endograft during debakey type 1 acute aortic dissection repair dbt1aad as opposed to more conservative interventions, the rationales for tar and concomitant antegrade stenting of the dta, lies in its potential to more effectively treat patients with complex primary and reentry intimal tears in the distal aortic arch andor proximal dta, optimize true lumen perfusion and. Type b involves the descending aorta only debakey type iii. Classification et etiologie des syndromes aortiques aigus. In stanford type a, the ascending aorta is always involved. Type a involves the ascending aorta but may extend into the arch and descending aorta debakey type i and ii. Surgery for acute type a aortic dissection operative. Request pdf aortic dissection aortic dissection is a lifethreatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in. At autopsy, the pericardial cavity was opened to reveal 300 ml of clotted and 330 ml of liquid blood that produced cardiac tamponade. Type a aortic dissection during late pregnancy in a. Descending endograft for debakey type 1 aortic dissection.
Dissections proximal to the left subclavian artery stanford type a. Echocardiography in the emergency assessment of acute. Demers p, miller dc 2004 surgery of the aortic arch, descending thoracic and thoracoabdominal surgery, and aortic dissection. The full text of this article is available in pdf format. This blood emanated from an area on adventitia of posterior aortic arch. Chronic high blood pressure may stress the aortic tissue, making it more susceptible to tearing. A dissection of the aorta means that blood has entered the wall of the artery between the inner and middle layers. Although surgical techniques and perioperative care have significantly improved during the decades, mortality remains high and. A report of two cases abstract acute aortic dissection is the most frequent and lethal presentation of acute aortic syndromes with an incidence of 34 cases per 100. The timing and need for intervention surgicalendovascular differs for ascending type a and descending type b. It occurs at least two times more often in men than in women, and it may affect individuals of all ages, but the peak incidence of proximal dissections is between ages 50 to 55 years of age, and of distal dissections, between 60 to 70 years of age. Mortality is still high despite advances in diagnostic and therapeutic modalities.
Mar 07, 2014 by definition, type a dissection involves the ascending aorta, whereas type b dissection is limited to the aorta distal to the left subclavian artery 2. In type a dissection or imh, there may be acute aortic regurgitation ar and associated cardiac failure. Endovascular placement of a stentgraft to cover the dissection flap is an effective treatment option to treat acute type b dissection. Roberts cs, roberts wc 1991 aortic dissection with the entrance tear in the descending thoracic aorta. Acute aortic dissection at the douala general hospital. Aortic dissection is a lifethreatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the. Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis. The same medications that are used to treat type a aortic dissection may be used without surgery to treat type b aortic dissections. An earlier classification system, proposed by debakey et al 3, is used similarly to classify aortic dissections into ascending and descending types. Altogether, 86 cases of aortic dissection were found in 84 patients, corresponding to a 2. Tears in the intimal layer result in the propagation of dissection proximally or distally secondary to blood entering the intimamedia space.
The most effective approach is still being debatedsuch as the best cannulation technique, and conservative versus extensive initial surgery. You can also be born with a condition associated with a weakened and enlarged aorta, such as marfan syndrome, bicuspid aortic valve or other rarer conditions associated with weakening of the walls of the blood vessels. Sixtysix of the 84 patients 79% were admitted to the hospital, and 18 patients 21% died before admission. Aortic dissection echocardiogram longitudinal view color. Aorte ascendante, ne depasse pas le tronc brachiocephalique 10 a. Chirurgie cardiaque dissection aortique et canulation directe f. Ppt dissection aortique powerpoint presentation free to.
Collective efforts from different groups in the last 20 years have aimed to improve outcomes, but there are still many aspects in its management that have yet to be agreed upon 7,8. We sought to increase the information available about the frequency and characteristics of aortic dilation in patients with. An aortic dissection occurs in a weakened area of the aortic wall. In 2014, a special report was published in radiology 4 that recognized an uncommon form of aortic dissection. Marfan syndrome planning to have children, elective surgical repair of an ascending aortic aneurysm must be seen as a. Besides esophageal ischemia secondary to arterial occlusion as described in the present case, direct extrinsic compression of the arteriovenous network surrounding the esophagus, due to traumatic pathology of the aorta, by extensive. Ppt dissection aortique aigu powerpoint presentation free. Delay in diagnosis and surgical treatment is associated with increased mortality 2,6. Ppt dissection aortique aigu powerpoint presentation. They may be given to people with type a aortic dissection to stabilize blood pressure before surgery.
We propose that aortic arch lesions without ascending aortic involvement be denoted as type b dissection with aortic arch involvement. Aortic dissection is the most common catastrophic event affecting the aorta. Although cardiovascular malformations cvms are wellrecognized congenital anomalies in turner syndrome, aortic dilation and dissection are less common and less familiar. The surgical management of patients with debakey type 1 acute aortic dissection dbt1aad represents a major challenge for aortic surgeons. The heart weighed 350 gm and the coronary arteries showed. For untreated debakey type i aortic dissection mortality increases up to 50% in the first 24 hours and 75% within two weeks after the initial event. Stanford classification of aortic dissection radiology. Most of the relevant literature is limited to single cases reports or small series. The condition most frequently occurs in men in their 60s and 70s. In stanford type b, the dissection is distal to the origin of the left subclavian artery. Thoracic aortic dissection is usually suspected clinically from the history and physical examination when a patient presents with severe, sharp, or tearing often migratory anterior chest pain in ascending aortic dissection or posterior chest or back pain arch or descending aortic dissection. According to the previously published data, aen after aortic dissection is very rare and usually fatal. Aortic dissection diagnosis and treatment mayo clinic. Surgical management and outcomes of type a dissectionthe.527 393 462 1479 1253 934 226 1111 12 216 1243 1454 894 26 1309 365 480 1482 407 49 1485 446 903 1262 590 487 1506 125 401 301 1174 326 1425 1022 547 1346 1034