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[Quantitative detection of changes in the thoracic aorta in patients with chronic aortic dissection using
S Mohr-Kahaly1, R Erbel, A Stühn
1II. Med. Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz.
Insights
Chronic aortic dissection (AD) patients with non-communicating dissections show less aortic enlargement and more false lumen thrombosis over 3 years compared to communicating dissections, indicating a more favorable prognosis.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Thoracic Surgery
Background:
- Chronic aortic dissection (AD) is a serious cardiovascular condition requiring long-term monitoring.
- Understanding the morphologic changes in the descending thoracic aorta is crucial for managing AD patients.
- Distinguishing between communicating and non-communicating AD types is important for prognosis.
Purpose of the Study:
- To quantitatively assess morphologic changes in the descending thoracic aorta of stable chronic aortic dissection patients over a 3-year period.
- To compare the outcomes of communicating (ca) versus non-communicating (nc) aortic dissections.
- To evaluate the progression of false lumen (FL) thrombosis in different types of AD.
Main Methods:
- Serial 3-year follow-up study involving 42 clinically stable patients with chronic aortic dissection.
- Quantitative assessment of descending thoracic aorta morphology using transesophageal echocardiography (TEE).
- Classification of AD types based on De Bakey criteria, distinguishing between communicating and non-communicating dissections.
Main Results:
- Diametral enlargement of the descending thoracic aorta was observed, with greater enlargement in communicating type I and type III AD compared to type III nc AD at 3 years.
- The true lumen to false lumen (FL) ratio significantly changed in communicating AD, worsening over time, while remaining stable in non-communicating AD.
- Progressive FL thrombosis occurred in 76% of patients, with complete thrombosis being significantly more frequent in type III nc AD (84%) compared to communicating types (6-18%).
Conclusions:
- Non-communicating aortic dissections appear to have a more favorable outcome with less aneurysmal dilatation compared to communicating aortic dissections.
- The findings support the hypothesis that non-communicating AD has a better prognosis due to increased false lumen thrombosis and stable lumen ratio.
- TEE is a valuable tool for quantitatively monitoring aortic morphologic changes and assessing outcomes in chronic aortic dissection.
Abstract:
The aim of this serial 3 year follow-up study in 42 clinically stable patients with chronic aortic dissection was to assess quantitatively morphologic changes of the descending thoracic aorta (AD) using transesophageal echocardiography (TEE). Communicating dissections (ca) were present in 16/19 patients with operated type I and in 11/23 patients with type III AD whereas 12/23 type III AD according to De Bakey were non-communicating (nc). Diametral enlargement of the disc. thoracic aorta was 4 mm (mean value) at 1 year in all patients, 5.9 mm in type I ca, 7.2 mm in type III ca but only 3.1 mm in type III nc at 3 years. The ratio between true lumen and false lumen (FL) changed in ca AD from 1:2 to 1:3 over the period of 3 years but remained constant at 1:1 in ncAD. Progressive thrombosis of the false lumen (FL) occurred in 76% of patients but complete thrombosis of the FL occurred in only 6% of type I ca, 18% type III ca but in 84% of type III nc patients. Our results confirm observations that non-communicating dissections seem to have a more favorable outcome and less aneurysmal dilatation compared to ca dissection.