Sandbox vidit

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Click on boxes to expand/collapse detailed information.               xxxxxx                                                                   xxxxxx                                                         xxxxxx                                                         xxxxxx                                                         xxxxxx                                                         xxxxxx                                                         xxxxxx                                                         xxxxxx                                                                     Syncope           Non syncope loss of consciousness                                                     Known etiology Cardiovascular Orthostatic hypotension Reflex   Unknown etiology Determine if there are any high risk criteria:       Consider additional tests                                                         High risk   low risk   Consider alternative diagnoses

Characterize the symptoms

Old

❑ Imaging study confirms aortic dissection ❑ Check whether dissection occurred in ascending aorta

No

Yes

❑ Assess suitability for surgery ❑ Patient stable for pre-op testing?

No

Medical management

Yes

❑ Age>40?

No

Yes

❑ Assess need for pre-operative coronary angiography ❑ Known CAD? ❑ Significant risk factors for CAD?

No

Yes

❑ Perform angiography Is significant CAD detected on angiography?

No

Yes

❑ Plan for CABG at the time of aortic dissection repair

❑ Perform urgent operative management

❑ Perform intra-operative assessment of aortic valve by TEE for presence of one of the following: ❑ Aortic regurgitation ❑ Dissection of aortic sinuses

No

Yes

❑ Perform graft replacement of ascending aorta ± aortic arch

❑ Perform graft replacement of ascending aorta ± aortic arch ❑ Consider repair/replacement of aortic valve