• Often lethal event
• Degeneration of aortic media is hallmark of disease
• Pathogenesis controversial
• Location of intimal tear: Ascending aorta, 62%; arch, 10%; isthmus, 16%; rest in distal aorta
• Risk factors include:
• Debakey type I
• Debakey type II
• Debakey type III
• Most common cause of aortic rupture
• 2000 cases yearly
• Men affected more often than women
• Usually occurs in fifth to seventh decades of life
• Most common
-Severe, tearing chest pain often signifies intimal tear and formation of false lumen
-Ascending: Pain anterior
-Descending: Pain posterior between scapulas
• Hypotension with blood loss, leak into pericardium
• Sudden death if extends into pericardium or down a coronary artery
• If involves aortic valve or root, aortic insufficiency and acute congestive heart failure
• Obstruction of aortic branch vessels:
-Asymmetric extremity pulses
-Acute mesenteric ischemia
-Lower extremity occlusion
• Chest film
-50% have widened mediastinum
-Cardiomegaly if in failure or with pericardial effusion
-Left pleural effusion if contained rupture
• Chest CT: Diagnostic procedure of choice
• Transesophageal echocardiography (TEE)
• Magnetic resonance angiography (MRA): Useful but time-consuming
• Death occurs from cardiac tamponade, acute coronary occlusion, acute atrial regurgitation
• Replacement of ascending aorta with resection of intimal tear
• Resuspension of aortic valve commissures restores valve competence
• Majority have benign course
• Medical therapy treatment of choice
• 20% require surgery for rupture or organ ischemia
• 20% develop aneurysmal dilation of aorta requiring surgery
• Endovascular stent procedure and fenestration are new approaches being studied
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