New trends in managemen Of Acute Aortic Dissection

Abstract

As the most frequently diagnosed lethal condition of the aorta and also one of the least diagnosed conditions (only 15% had a right diagnosis in a post mortem series )aortic dissection has been paid a great attention that changed it's natural history from an only post mortem diagnosis to a treatable emergency medical condition .Debakey et Coolly(1954) forever changed the historical course of the disease by successfully performing a primary surgical repair of aortic dissection.

The condition also develops from whatever causes a tear in the intima of the aorta so it let blood makes a new way in the media called the false lumen this new route may progress retro or antegrade. .(HTN .Inherited connective tisuue disorders.trauma.pregnancy) all are risk factors

The Most common classification systems used to classify aortic dissection are Debakey's and Stanford's they classify it according to site and extent of the disease which affect the clinical decision either medical or surgical.

The symptoms of aortic dissection may be highly variable and may mimic much more common conditions. Thus, a high index of suspicion must be maintained Sharp sudden tearing pain that occur in the anterior and posterior surfaces of the trunk is the most common presenting symptom.

Signs of AD depend on the site, and extent, and aortic branches involved in the dissection( Neurological complications of dissection are more common in type A dissections and include stroke, spinal cord ischemia, ischemic neuropathy, and hypoxic encephalopathy. Dyspnea may be caused by congestive heart failure or tracheal or bronchial compression.. Recurrent abdominal pain suggests involvement of either the celiac trunk (8%) or the mesenteric artery (8–13%). Flank pain., oliguria, or anuria suggests involvement of renal arteries. Paraplegia may occur when too many pairs of intercostal arteries are separated from the lumen of the aorta).

Rapid increase in mortality of the undiagnosed cases underscores the importance of rapid diagnosis (Once suspected routine and specific ways of diagnosis must be used)

An ECG should be performed in all patients. This test helps differentiate pain from acute myocardial infarction Chest x-ray is also used as a routine even with Avery limited value in confirming the diagnosis.

A reliable method for serum diagnosis of acute aortic dissection is extremely attractive and many are in the way to play a role ( Smooth-muscle myosin heavy-chain. Soluble elastin fragments. D-dimer .c-reactive protein). Many imaging modalities like (TTE\TEE,.CT,.MRI.,Aortography,.IVUS)are being used to reach a final diagnosis The evaluation of suspected acute aortic dissection begins with a determination of the clinical likelihood that the diagnosis is correct and an evaluation of the hemodynamic stability of the patient; Unstable patient should undergo ECG to rule out acute coronary syndrome.. A transesophageal echocardiogram is then performed. If TEE fails to reveal acute aortic dissection, , CT arteriogram or aortography (potentially with IVUS) is the next study of choice.