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Age-dependent aortic elongation: a new predictor for type A aortic dissection?
  1. Ibrahim Akin1,2,
  2. Christoph A Nienaber3
  1. 2DZHK, DZHK (Deutsches Zentrum für Herz-Kreislaufforschung), Mannheim, Germany
  2. 1Cardiology, Universitätsmedizin Mannheim, Mannheim, Germany
  3. 3Cardiology and Aortic Centre, Royal Brompton Hospital and Harefield Trust, London, UK
  1. Correspondence to Professor Ibrahim Akin; Ibrahim.Akin{at}umm.de

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Aortic dissection is a relatively rare condition with catastrophic outcomes if left untreated. The classification of this pathology is essentially based on its anatomical location or acuity. Data from the International Registry for Acute Aortic Dissection (IRAD) revealed that in the absence of immediate surgical repair, acute type A aortic dissection (ATAAD) is associated with a 24% mortality in the first 24 hours, 29% at 48 hours, 44% at day 7 and 50% after 2 weeks. Despite major advances in diagnostic yield, the early clinical diagnosis of aortic dissection remains elusive in up to 38% of patients. Furthermore, in 28% of cases the correct diagnosis was ascertained only after postmortem examination.1

The most common risk factor associated with aortic dissection is systemic hypertension, with up to 72%. Particularly in the elderly, other major risk factors include atherosclerosis, prior cardiac surgery and known aortic aneurysms. With younger age (<40 years), hereditary conditions of aortopathology (eg, Marfan syndrome and other genetic factors) constitute a significant fraction of cases of aortic dissection.1

Despite recent advances in identifying structural and biomechanical properties of the aorta in vivo, a variety of determinants for the evolution to an aortic dissection are still unclear. The common denominator is a weakening of the aortic tunica media, which predisposes to dissection by splitting the cohesive layers of the aortic wall. This weakening of the tunica media could be …

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