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Diagnosis and management of patients with aortic dissection
  1. Hüseyin Ince,
  2. Christoph A Nienaber
  1. Department of Internal Medicine, Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany
  1. Correspondence to:
    Professor Christoph A Nienaber
    Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; christoph.nienaber{at}med.uni-rostock.de

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Cardiovascular disease is the leading cause of death in Western society and is on the rise in developing countries. Aortic diseases constitute an emerging share of the burden. New diagnostic imaging modalities, increasing life expectancy, longer exposure to elevated blood pressure, and the proliferation of modern non-invasive imaging modalities have all contributed to the growing awareness of acute and chronic aortic syndromes and pathologies.1–5

Acute aortic syndrome includes aortic dissection, intramural haematoma (IMH), and symptomatic aortic ulcer. Propagation of the dissection can proceed in anterograde or retrograde fashion from the initial tear involving side branches and causing complications such as malperfusion syndromes, tamponade, or aortic valve insufficiency.6 Common predisposing factors in the International Registry of Aortic Dissection (IRAD) were hypertension in 72% of cases, followed by atherosclerosis in 31% and previous cardiac surgery in 18% (table 1). Analysis of the young patients with dissection (<40 years of age) revealed that younger patients were less likely to have a history of hypertension (34%) or atherosclerosis (1%), but were more likely to have Marfan syndrome, bicuspid aortic valve, and/or prior aortic surgery.7

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Table 1

 Demographics and history of patients (n = 464) with acute aortic dissection

DIAGNOSTIC WORK-UP

Diagnostic imaging studies in the setting of suspected aortic dissection is aimed to rapidly confirm or exclude the diagnosis, classify the extent of the dissection, and assess the emergent nature of the problem, with correct classification in distal or proximal dissection being of paramount importance (fig 1).

Figure 1

 Classification of distal or proximal aortic dissection. De Bakey: type I, originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distally; type II, originates in and is confined to the ascending aorta; type III, originates in the descending aorta and extends distally down to the aorta or, rarely, retrograde into the …

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