Follow-up of acute aortic dissection

Aortic dissection is a tear in the wall of the aorta. It is a medical emergency. If left untreated the mortality rate is extremely high. Aortic dissection is divided into two types, A and B. Primary, because of low suspicion the diagnosis can delay. The natural history is poorly understood.

Our objectives were to improve diagnosis of aortic dissection. To encourage use of trans esophageal echo cardiography in emergency room. To clarify the role of prompt treatment in prognosis of aortic dissection.

This study was approved by the Committee of Ethics. All of the patients signed a informed consent. Clinical evaluation was performed by expert cardiologists, using different modalities. A complete medical history and physical examination were performed. The follow-up time of patients was 24 months.

Eleven patients were included in this study. Male/female ratio was 2.7:1. Type A was present in 7 patients, hypertension in 9. All patients were symptomatic. Three patients died, two in the emergency center, one after surgery. Surgery was performed in five patients, all with type A dissection. Four survived patients after operation and all patients with type B dissection survived follow-up time of 24 months.

Most crucial step in aortic dissection diagnosis remain clinical suspicion. It should be confirmed rapidly since it is lifesaving. We want to emphasize that the trans esophageal echo cardiography is very useful exam to make the diagnosis which is the key for correct treatment and for follow-up. It must be widely available in the emergency centre.