Aortic dissection natural history, complications and prognosis: Difference between revisions
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The complications of aortic dissection include: | The complications of aortic dissection include: | ||
* The aorta may rupture, leading to [[massive blood loss]] resulting in death. Indeed, aortic dissection accounts for 3-4% of [[sudden deaths]]. | * The aorta may rupture, leading to [[massive blood loss]] resulting in death. Indeed, aortic dissection accounts for 3-4% of [[sudden deaths]]. | ||
*[[Hypotension]] and [[shock]] | *[[Hypotension]] and [[shock]] due to [[aortic rupture]] | ||
*[[Pericardial tamponade]] | *[[Pericardial tamponade]] | ||
*[[Acute aortic regurgitation]]due to the aortic dissection generating into [[Valsalva]] with an aortic valve insufficiency | *[[Acute aortic regurgitation]]due to the aortic dissection generating into [[Valsalva]] with an aortic valve insufficiency | ||
Revision as of 01:49, 20 August 2012
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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-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Natural History
If the patient remains untreated, the mortality is:
- 1% per hour during the first day
- 75% at 2 weeks
- 90% at 1 year
Complications
The complications of aortic dissection include:
- The aorta may rupture, leading to massive blood loss resulting in death. Indeed, aortic dissection accounts for 3-4% of sudden deaths.
- Hypotension and shock due to aortic rupture
- Pericardial tamponade
- Acute aortic regurgitationdue to the aortic dissection generating into Valsalva with an aortic valve insufficiency
- Pulmonary edema
- Myocardial ischemia due to involvement from the right or left coronary ostium (but most commonly the right coronary artery is involved
- Mesenteric and renal ischemia- can lead to hematuria, renal infarction, acute renal failure, or visceral ischemia
- Claudication due to an extension of the dissection into the iliac arteries
- Redissection and aortic diameter enlargement
- Aneurysmal dilatation and saccular aneurysm
Neurologic findings include:
- Ischemic cerebrovascular accident (CVA)
- Hemiplegia
- Hemianesthesia
Compressive symptoms include:
- Superior vena cava syndrome
- Horner syndrome (involves superior cervical ganglia)
- Dysphagia (involves the esophagus)
- Airway compromise
- Hemoptysis (involves the compression of the bronchus)
- Vocal cord paralysis and hoarseness
Prognosis
- 30% hospital-based mortality rates
- 60% 10-year survival rate when treated
The mortality rate is conditional and based upon the patient's clinical condition.
Type A aortic dissection
- surgical treatment-30% mortality rate
- medial treatment-60% mortality rate
Type B aortic dissection
- surgical treatment-10% mortality rate
- medical treatment- 30% mortality rate