Aortic dissection screening: Difference between revisions
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/* 2010 ACC/ AHA Guidelines - Recommendations for Screening Tests for Aortic dissection {{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, et al. |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and manag... |
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__NOTOC__ | __NOTOC__ | ||
{{Aortic dissection}} | {{Aortic dissection}} | ||
{{CMG}}; {{AE}} {{AN}}; {{RT}}; {{Laith}} | |||
==Overview== | |||
Screening guidelines state that an [[EKG]] should be obtained for all patients who present with symptoms suspicious for aortic dissection. A chest x ray should be obtained in patients determined to be at low-risk and moderate-risk. In patients in high-risk categories, [[TEE]], [[CT]] or [[MRI]] should be obtained. | |||
== | ==Screening== | ||
==2010 | ===2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>=== | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
|bgcolor="LightGreen" | '''1.''' An electrocardiogram should be obtained on all patients who present with | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with [[symptom]]s that may represent [[acute]] [[thoracic aorta|thoracic]] [[aortic dissection]]. | ||
|- | |- | ||
|bgcolor="LightGreen" |'''a.'''Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection | |bgcolor="LightGreen" |'''a.''' Given the relative infrequency of dissection-related [[coronary artery]] occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary [[cardiac]] event without delay for definitive [[aortic]] imaging unless the patient is at high risk for [[aortic dissection]].<ref name="pmid10685714">{{cite journal |author=Hagan PG, Nienaber CA, Isselbacher EM, ''et al.'' |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |year=2000 |month=February |pmid=10685714 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |author=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |year=2002 |month=May |pmid=11980527 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LightGreen" |'''2.'''The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient's pretest risk of disease as follows: | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' The role of [[chest x-ray]] in the evaluation of possible [[thoracic aorta|thoracic]] [[aortic]] disease should be directed by the patient's pretest risk of disease as follows: | ||
|- | |- | ||
|bgcolor="LightGreen" |'''a.''' Intermediate risk: Chest x-ray should be performed on all intermediate-risk patients, as it may establish a clear alternate diagnosis that will obviate the need for definitive aortic imaging ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])'' | |bgcolor="LightGreen" |'''a.''' Intermediate risk: [[Chest x-ray]] should be performed on all intermediate-risk patients, as it may establish a clear alternate [[diagnosis]] that will obviate the need for definitive [[aortic]] imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
|- | |- | ||
|bgcolor="LightGreen" |'''b.''' Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])'' | |bgcolor="LightGreen" |'''b.''' Low risk: [[Chest x-ray]] should be performed on all low-risk patients, as it may either establish an alternative [[diagnosis]] or demonstrate findings that are suggestive of [[thoracic aorta|thoracic]] [[aortic]] disease, indicating the need for urgent definitive [[aortic]] imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LightGreen" |'''3.'''Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' Urgent and definitive imaging of the [[aorta]] using [[transesophageal echocardiogram]], [[computed tomographic imaging]], or [[magnetic resonance imaging]] is recommended to identify or exclude [[thoracic aorta|thoracic]] [[aortic]] dissection in patients at high risk for the disease by initial screening.<ref name="pmid12819341">{{cite journal |author=Yoshida S, Akiba H, Tamakawa M, ''et al.'' |title=Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy--comparison of emergency helical CT and surgical findings |journal=Radiology |volume=228 |issue=2 |pages=430–5 |year=2003 |month=August |pmid=12819341 |doi=10.1148/radiol.2282012162 |url=}}</ref><ref name="pmid8668776">{{cite journal |author=Sommer T, Fehske W, Holzknecht N, ''et al.'' |title=Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging |journal=Radiology |volume=199 |issue=2 |pages=347–52 |year=1996 |month=May |pmid=8668776 |doi= |url=}}</ref><ref name="pmid7754876">{{cite journal |author=Zeman RK, Berman PM, Silverman PM, ''et al.'' |title=Diagnosis of aortic dissection: value of helical CT with multiplanar reformation and three-dimensional rendering |journal=AJR Am J Roentgenol |volume=164 |issue=6 |pages=1375–80 |year=1995 |month=June |pmid=7754876 |doi= |url=}}</ref><ref name="pmid16831999">{{cite journal |author=Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y |title=Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis |journal=Arch. Intern. Med. |volume=166 |issue=13 |pages=1350–6 |year=2006 |month=July |pmid=16831999 |doi=10.1001/archinte.166.13.1350 |url=}}</ref><ref name="pmid8416265">{{cite journal |author=Nienaber CA, von Kodolitsch Y, Nicolas V, ''et al.'' |title=The diagnosis of thoracic aortic dissection by noninvasive imaging procedures |journal=N. Engl. J. Med. |volume=328 |issue=1 |pages=1–9 |year=1993 |month=January |pmid=8416265 |doi=10.1056/NEJM199301073280101 |url=}}</ref><ref name="pmid2563839">{{cite journal |author=Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H |title=Echocardiography in diagnosis of aortic dissection |journal=Lancet |volume=1 |issue=8636 |pages=457–61 |year=1989 |month=March |pmid=2563839 |doi= |url=}}</ref><ref name="pmid6496346">{{cite journal |author=Börner N, Erbel R, Braun B, Henkel B, Meyer J, Rumpelt J |title=Diagnosis of aortic dissection by transesophageal echocardiography |journal=Am. J. Cardiol. |volume=54 |issue=8 |pages=1157–8 |year=1984 |month=November |pmid=6496346 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
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|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | ||
|- | |- | ||
|bgcolor="LightCoral"|'''1.''' A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' A negative [[chest x-ray]] should not delay definitive [[aortic]] imaging in patients determined to be high risk for [[aortic]] dissection by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|} | |} | ||
== | ===Genetic Syndromes of Familial Thoracic Aortic Aneurysms and Dissections (DO NOT EDIT) <ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780 }} </ref>=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| Line 36: | Line 38: | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Sequencing of the [[ACTA2]] gene is reasonable in patients with a family history of thoracic aortic | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Sequencing of the [[ACTA2]] gene is reasonable in patients with a family history of [[thoracic aorta|thoracic]] [[aortic aneurysm]]s and/or dissections to determine if [[ACTA2]] [[mutation]]s are responsible for the inherited predisposition.<ref name="pmid16027248">{{cite journal| author=Pannu H, Fadulu VT, Chang J, Lafont A, Hasham SN, Sparks E et al.| title=Mutations in transforming growth factor-beta receptor type II cause familial thoracic aortic aneurysms and dissections. | journal=Circulation | year= 2005 | volume= 112 | issue= 4 | pages= 513-20 | pmid=16027248 | doi=10.1161/CIRCULATIONAHA.105.537340 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027248 }} </ref><ref name="pmid17994018">{{cite journal| author=Guo DC, Pannu H, Tran-Fadulu V, Papke CL, Yu RK, Avidan N et al.| title=Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. | journal=Nat Genet | year= 2007 | volume= 39 | issue= 12 | pages= 1488-93 | pmid=17994018 | doi=10.1038/ng.2007.6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17994018 }} </ref><ref name="pmid16444274">{{cite journal| author=Zhu L, Vranckx R, Khau Van Kien P, Lalande A, Boisset N, Mathieu F et al.| title=Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus. | journal=Nat Genet | year= 2006 | volume= 38 | issue= 3 | pages= 343-9 | pmid=16444274 | doi=10.1038/ng1721 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16444274 }} </ref><ref name="pmid16928994">{{cite journal| author=Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H et al.| title=Aneurysm syndromes caused by mutations in the TGF-beta receptor. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 8 | pages= 788-98 | pmid=16928994 | doi=10.1056/NEJMoa055695 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928994 }} </ref><ref name="pmid18781618">{{cite journal| author=Stheneur C, Collod-Béroud G, Faivre L, Gouya L, Sultan G, Le Parc JM et al.| title=Identification of 23 TGFBR2 and 6 TGFBR1 gene mutations and genotype-phenotype investigations in 457 patients with Marfan syndrome type I and II, Loeys-Dietz syndrome and related disorders. | journal=Hum Mutat | year= 2008 | volume= 29 | issue= 11 | pages= E284-95 | pmid=18781618 | doi=10.1002/humu.20871 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18781618 }} </ref><ref name="pmid19409525">{{cite journal| author=Guo DC, Papke CL, Tran-Fadulu V, Regalado ES, Avidan N, Johnson RJ et al.| title=Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease. | journal=Am J Hum Genet | year= 2009 | volume= 84 | issue= 5 | pages= 617-27 | pmid=19409525 | doi=10.1016/j.ajhg.2009.04.007 | pmc=PMC2680995 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19409525 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
| Line 43: | Line 45: | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Sequencing of other | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Sequencing of other [[gene]]s known to cause [[familial]] [[thoracic aorta|thoracic]] [[aortic aneurysm]]s and/or dissection ([[TGFBR1]], [[TGFBR2]], [[MYH11]]) may be considered in patients with a family history and clinical features associated with [[mutation]]s in these [[gene]]s.<ref name="pmid16027248">{{cite journal| author=Pannu H, Fadulu VT, Chang J, Lafont A, Hasham SN, Sparks E et al.| title=Mutations in transforming growth factor-beta receptor type II cause familial thoracic aortic aneurysms and dissections. | journal=Circulation | year= 2005 | volume= 112 | issue= 4 | pages= 513-20 | pmid=16027248 | doi=10.1161/CIRCULATIONAHA.105.537340 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027248 }} </ref><ref name="pmid17994018">{{cite journal| author=Guo DC, Pannu H, Tran-Fadulu V, Papke CL, Yu RK, Avidan N et al.| title=Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. | journal=Nat Genet | year= 2007 | volume= 39 | issue= 12 | pages= 1488-93 | pmid=17994018 | doi=10.1038/ng.2007.6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17994018 }} </ref><ref name="pmid16444274">{{cite journal| author=Zhu L, Vranckx R, Khau Van Kien P, Lalande A, Boisset N, Mathieu F et al.| title=Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus. | journal=Nat Genet | year= 2006 | volume= 38 | issue= 3 | pages= 343-9 | pmid=16444274 | doi=10.1038/ng1721 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16444274 }} </ref><ref name="pmid16928994">{{cite journal| author=Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H et al.| title=Aneurysm syndromes caused by mutations in the TGF-beta receptor. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 8 | pages= 788-98 | pmid=16928994 | doi=10.1056/NEJMoa055695 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928994 }} </ref><ref name="pmid18781618">{{cite journal| author=Stheneur C, Collod-Béroud G, Faivre L, Gouya L, Sultan G, Le Parc JM et al.| title=Identification of 23 TGFBR2 and 6 TGFBR1 gene mutations and genotype-phenotype investigations in 457 patients with Marfan syndrome type I and II, Loeys-Dietz syndrome and related disorders. | journal=Hum Mutat | year= 2008 | volume= 29 | issue= 11 | pages= E284-95 | pmid=18781618 | doi=10.1002/humu.20871 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18781618 }} </ref><ref name="pmid19409525">{{cite journal| author=Guo DC, Papke CL, Tran-Fadulu V, Regalado ES, Avidan N, Johnson RJ et al.| title=Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease. | journal=Am J Hum Genet | year= 2009 | volume= 84 | issue= 5 | pages= 617-27 | pmid=19409525 | doi=10.1016/j.ajhg.2009.04.007 | pmc=PMC2680995 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19409525 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' If one or more first-degree relatives of a patient with known thoracic aortic aneurysm and/or dissection are found to have thoracic aortic dilatation, [[aortic aneurysm|aneurysm]], or [[aortic dissection|dissection]], then referral to a geneticist may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' If one or more first-degree relatives of a patient with known [[thoracic aortic aneurysm]] and/or dissection are found to have [[thoracic aorta|thoracic aortic]] [[dilatation]], [[aortic aneurysm|aneurysm]], or [[aortic dissection|dissection]], then referral to a [[geneticist]] may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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Latest revision as of 02:54, 4 December 2022
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]; Laith Adnan Allaham, M.D.[4]
Overview
Screening guidelines state that an EKG should be obtained for all patients who present with symptoms suspicious for aortic dissection. A chest x ray should be obtained in patients determined to be at low-risk and moderate-risk. In patients in high-risk categories, TEE, CT or MRI should be obtained.
Screening
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[1]
| Class I |
| "1. An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection. |
| a. Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection.[2][3] (Level of Evidence: B)" |
| "2. The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient's pretest risk of disease as follows: |
| a. Intermediate risk: Chest x-ray should be performed on all intermediate-risk patients, as it may establish a clear alternate diagnosis that will obviate the need for definitive aortic imaging. (Level of Evidence: C) |
| b. Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. (Level of Evidence: C)" |
| "3. Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening.[4][5][6][7][8][9][10] (Level of Evidence: B)" |
| Class III (No Benefit) |
| "1. A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. (Level of Evidence: C)" |
Genetic Syndromes of Familial Thoracic Aortic Aneurysms and Dissections (DO NOT EDIT) [1]
| Class IIa |
| "1. Sequencing of the ACTA2 gene is reasonable in patients with a family history of thoracic aortic aneurysms and/or dissections to determine if ACTA2 mutations are responsible for the inherited predisposition.[11][12][13][14][15][16] (Level of Evidence: B)" |
| Class IIb |
| "1. Sequencing of other genes known to cause familial thoracic aortic aneurysms and/or dissection (TGFBR1, TGFBR2, MYH11) may be considered in patients with a family history and clinical features associated with mutations in these genes.[11][12][13][14][15][16] (Level of Evidence: B)" |
| "2. If one or more first-degree relatives of a patient with known thoracic aortic aneurysm and/or dissection are found to have thoracic aortic dilatation, aneurysm, or dissection, then referral to a geneticist may be considered. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter
|month=ignored (help) - ↑ Hagan PG, Nienaber CA, Isselbacher EM; et al. (2000). "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease". JAMA. 283 (7): 897–903. PMID 10685714. Unknown parameter
|month=ignored (help) - ↑ Klompas M (2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. PMID 11980527. Unknown parameter
|month=ignored (help) - ↑ Yoshida S, Akiba H, Tamakawa M; et al. (2003). "Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy--comparison of emergency helical CT and surgical findings". Radiology. 228 (2): 430–5. doi:10.1148/radiol.2282012162. PMID 12819341. Unknown parameter
|month=ignored (help) - ↑ Sommer T, Fehske W, Holzknecht N; et al. (1996). "Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging". Radiology. 199 (2): 347–52. PMID 8668776. Unknown parameter
|month=ignored (help) - ↑ Zeman RK, Berman PM, Silverman PM; et al. (1995). "Diagnosis of aortic dissection: value of helical CT with multiplanar reformation and three-dimensional rendering". AJR Am J Roentgenol. 164 (6): 1375–80. PMID 7754876. Unknown parameter
|month=ignored (help) - ↑ Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y (2006). "Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis". Arch. Intern. Med. 166 (13): 1350–6. doi:10.1001/archinte.166.13.1350. PMID 16831999. Unknown parameter
|month=ignored (help) - ↑ Nienaber CA, von Kodolitsch Y, Nicolas V; et al. (1993). "The diagnosis of thoracic aortic dissection by noninvasive imaging procedures". N. Engl. J. Med. 328 (1): 1–9. doi:10.1056/NEJM199301073280101. PMID 8416265. Unknown parameter
|month=ignored (help) - ↑ Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H (1989). "Echocardiography in diagnosis of aortic dissection". Lancet. 1 (8636): 457–61. PMID 2563839. Unknown parameter
|month=ignored (help) - ↑ Börner N, Erbel R, Braun B, Henkel B, Meyer J, Rumpelt J (1984). "Diagnosis of aortic dissection by transesophageal echocardiography". Am. J. Cardiol. 54 (8): 1157–8. PMID 6496346. Unknown parameter
|month=ignored (help) - ↑ 11.0 11.1 Pannu H, Fadulu VT, Chang J, Lafont A, Hasham SN, Sparks E; et al. (2005). "Mutations in transforming growth factor-beta receptor type II cause familial thoracic aortic aneurysms and dissections". Circulation. 112 (4): 513–20. doi:10.1161/CIRCULATIONAHA.105.537340. PMID 16027248.
- ↑ 12.0 12.1 Guo DC, Pannu H, Tran-Fadulu V, Papke CL, Yu RK, Avidan N; et al. (2007). "Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections". Nat Genet. 39 (12): 1488–93. doi:10.1038/ng.2007.6. PMID 17994018.
- ↑ 13.0 13.1 Zhu L, Vranckx R, Khau Van Kien P, Lalande A, Boisset N, Mathieu F; et al. (2006). "Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus". Nat Genet. 38 (3): 343–9. doi:10.1038/ng1721. PMID 16444274.
- ↑ 14.0 14.1 Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H; et al. (2006). "Aneurysm syndromes caused by mutations in the TGF-beta receptor". N Engl J Med. 355 (8): 788–98. doi:10.1056/NEJMoa055695. PMID 16928994.
- ↑ 15.0 15.1 Stheneur C, Collod-Béroud G, Faivre L, Gouya L, Sultan G, Le Parc JM; et al. (2008). "Identification of 23 TGFBR2 and 6 TGFBR1 gene mutations and genotype-phenotype investigations in 457 patients with Marfan syndrome type I and II, Loeys-Dietz syndrome and related disorders". Hum Mutat. 29 (11): E284–95. doi:10.1002/humu.20871. PMID 18781618.
- ↑ 16.0 16.1 Guo DC, Papke CL, Tran-Fadulu V, Regalado ES, Avidan N, Johnson RJ; et al. (2009). "Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease". Am J Hum Genet. 84 (5): 617–27. doi:10.1016/j.ajhg.2009.04.007. PMC 2680995. PMID 19409525.