Aortic dissection natural history, complications and prognosis

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Aortic dissection carries a very poor prognosis. 90% of patients who are untreated will be dead at one year. Type A dissection is associated with a worse prognosis than type B dissection. Aortic dissection can be complicated by extension to the coronary arteries resulting in myocardial infarction, involvement of the aortic arch to cause stroke, dilation of the route to cause aortic insufficiency, extension into the pericardium to cause pericardial tamponade, and heart failure, and aortic rupture.

Natural History

• The symptoms of aortic dissection usually develop in the fifth decade of life and start with symptoms such as sudden onset chest/back pain.
• If left untreated, patients with aortic dissection may progress to develop Aortic regurgitation, myocardial ischemia, and cardiac tamponade.

Complications

The complications of aortic dissection include:

Cardiovascualr Complications

• Aortic rupture
• Pericardial tamponade
• Acute aortic regurgitation
• Myocardial ischemia
• Thoracic aortic aneurysm
• Renal ischemia
• Superior mesenteric artery dissection and resultant visceral ischemia
• Pleural effusion
• Claudication due to an extension of the dissection into the iliac arteries

Neurologic Complications

• Ischemic cerebrovascular accident (CVA) due to dissection into the head vessels
• Hemiplegia due to dissection into the spinal arteries
• Hemianesthesia due to dissection into the spinal arteries

Compression of Nearby Organs

• Superior vena cava syndrome due to swelling of the neck and face (compression of the superior vena cava or )
• Horner syndrome (compression of the superior cervical ganglia)
• Dysphagia due to (compression of the esophagus)
• Stridor and wheezing (compression of the airway)
• Hemoptysis (compression of and erosion into the bronchus)
• Vocal cord paralysis and hoarseness (compression of the recurrent laryngeal nerve)

Prognosis

• Aortic dissection carries a poor prognosis.
• Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).