Aortic dissection natural history, complications and prognosis
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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] Sahar Memar Montazerin, M.D.[3]
Overview
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. The complications of aortic dissection include but not limited to aortic rupture, pericardial tamponade, myocardial ischemia, compression of nearby organs and etc. 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%).
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.[1]
- 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:[2][3][4][5][6][7]
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 compression of the superior vena cava
- 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.[8]
- Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).
References
- ↑ Juang, Derek; Braverman, Alan C.; Eagle, Kim (2008). "Aortic Dissection". Circulation. 118 (14). doi:10.1161/CIRCULATIONAHA.108.799908. ISSN 0009-7322.
- ↑ Cambria, Richard P.; Brewster, David C.; Gertler, Jonathan; Moncure, Ashby C.; Gusberg, Richard; Tilson, M.David; Darling, R.Clement; Hammond, Grahme; Megerman, Joseph; Abbott, William M. (1988). "Vascular complications associated with spontaneous aortic dissection". Journal of Vascular Surgery. 7 (2): 199–209. doi:10.1016/0741-5214(88)90137-1. ISSN 0741-5214.
- ↑ Fadahunsi, Opeyemi; Romeo, Michael (2014). "Cardiac tamponade – presentation of type A aortic dissection". Journal of Community Hospital Internal Medicine Perspectives. 4 (5): 25449. doi:10.3402/jchimp.v4.25449. ISSN 2000-9666.
- ↑ Cai, Jingjing; Cao, Yu; Yuan, Hong; Yang, Kan; Zhu, Yuan-Shan (2012). "Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve". Journal of Cardiovascular Disease Research. 3 (2): 138–142. doi:10.4103/0975-3583.95370. ISSN 0975-3583.
- ↑ Siegelman, Stanley S.; Sprayregen, Seymour; Strasberg, Zeno; Attai, Lari A.; Robinson, George (1970). "Aortic Dissection and the Left Renal Artery". Radiology. 95 (1): 73–78. doi:10.1148/95.1.73. ISSN 0033-8419.
- ↑ Blanco, M.; Díez-Tejedor, E.; Larrea, J. L.; Ramírez, U. (1999). "Neurologic complications of type I aortic dissection". Acta Neurologica Scandinavica. 99 (4): 232–235. doi:10.1111/j.1600-0404.1999.tb07352.x. ISSN 0001-6314.
- ↑ Arata, Kenichi; Imagama, Itsumi; Shigehisa, Yoshiya; Mukaihara, Kousuke; Toyokawa, Kenji; Matsuba, Tomoyuki; Imoto, Yutaka (2015). "Aortic Fenestration for Type B Chronic Aortic Dissection Complicated with Lower Limb Malperfusion Induced by Walking Exercise". Annals of Vascular Diseases. 8 (1): 29–32. doi:10.3400/avd.cr.14-00101. ISSN 1881-641X.
- ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.