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PubMedDate not supplied

Type B aortic dissection with early presentation mimicking acute pyelonephritis.

Aortic dissection is a life-threatening illness requiring early diagnosis and treatment. Uncommon early presentations mimicking various illnesses can delay diagnosis. This case study describes a 44-year-old woman with type B aortic dissection initially presenting as acute pyelonephritis (APN). Early clinical manifestations were sudden onset of left flank pain, fever, hematuria and pyuria, and following admission, severe abdominal pain, nausea, vomiting, reduced urine output and renal function deterioration. Abdominal computed tomography showed type B aortic dissection complicated with a small bowel infarct, ischemic ascending colon and left renal infarct. Emergency surgical interventions of small bowel resection, ileoduodenostomy and cholecystectomy were performed; a second laparotomy was subsequently performed for anastomosis leakage. The patient died due to septic shock with multiorgan failure. Aortic dissection initially mimicking APN is rare. Accurate early diagnosis of aortic dissection with indeterminate presentation is crucial. Early surgical intervention for visceral organ ischemia is important to preventing morbidity and mortality.

Adult↗

PubMed1994

Total arch graft replacement in patients with acute type A aortic dissection.

Treatment of acute type A aortic dissection with emergency total aortic arch graft replacement remains controversial. Between December 1988 and July 1993, 30 patients with this fatal disease underwent graft replacement of both the ascending aorta and total aortic arch on an emergency basis. All operations were performed with the aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis. The overall early mortality rate was 23.3% (7 patients), but that in patients with complications with shock and renal/mesenteric ischemia was 57% and 66.7%, respectively. On the other hand, the mortality rate in the 23 patients (77%) in whom neither of these two risk factors was present was low (8.7%). The overall 4-year survival rate was 66.5% +/- 8.7%, and that for patients without these two risk factors was 87.0% +/- 7.0%. The present data suggest that simultaneous total arch replacement may be justified in selected patients with acute type A aortic dissection.

Adult↗

PubMed2005

[Strategy for thrombosed type A acute aortic dissection].

The surgical treatment for thrombosed type A aortic dissection is controversial. We treated 15 cases (28.8%) with thrombosed type A acute aortic dissection among 52 cases of all type A acute aortic dissection during past 7 years and 8 months. Nine cases was treated conservatively and 6 cases received emergent operation due to cardiac tamponade, shock, and ulcer-like projection (ULP) in the ascending aorta (> 50 mm). In the group of conservative therapy, 2 cases in which the ascending aorta was enlarged (54, 60 mm), was converted to operation in the acute phase because of further enlargement of ascending aorta and increase of cardiac effusion. The other patients (aortic diameter: 40-46 mm) who received conservative therapy were well controlled by medical therapy in the early and late phase except 1 who died suddenly in the follow-up. There was no mortality and late death in the operated patients. From these results, we conclude that thrombosed type A aortic dissection in which the diameter of ascending aortic aorta is larger than 50 mm, have cardiac tamponade and ULP in the ascending aorta might needs operation.

Aged↗

PubMed1994

Surgical management of aortic dissection in patients with the Marfan syndrome.

BACKGROUND: Aortic dissection is one of the most lethal potential complications in patients with the Marfan syndrome. METHODS AND RESULTS: Among 360 patients undergoing operative treatment of aortic dissection between 1963 and 1992, 40 had the Marfan syndrome. There were 24 men and 16 women with a mean age of 35 +/- 9 years (+/- 1 SD; range, 15 to 54 years). These patients included 16 with acute type A, 2 with acute type B, 18 with chronic type A, and 4 with chronic type B aortic dissections. The aortic arch was involved in 29 cases. Preoperative complications included acute aortic valvular insufficiency in 13 patients, rupture into the pericardial space in 3, and loss of peripheral pulses in 9. The site of primary intimal tear was the ascending aorta in 25 patients, the aortic arch in 2, the descending aorta in 7, and not identified in 6. Operations included ascending aortic and aortic valvular replacement (with or without coronary artery reimplantation) in 22 patients, ascending aortic replacement alone in 5, and descending thoracic aortic replacement in 9. Four operative deaths (10 +/- 5% [+/- 70% confidence limits]) occurred in 3 acute patient-years and 1 chronic type A patient-years. Long-term follow-up (216 patient-years; range, 1 month to 22 years; mean, 5.4 years) revealed 15 late deaths, 7 from late aortic sequelae. The overall actuarial survival estimates were 71 +/- 8%, 54 +/- 10%, and 22 +/- 11% at 5, 10, and 15 years, respectively. Twenty late aortic operations were required in 14 patients. CONCLUSIONS: Despite satisfactory early results, the long-term survival of patients with the Marfan syndrome was suboptimal (albeit similar to those without the Marfan syndrome). Future progress will pivot on reducing the incidence of aortic dissection in these patients with medical therapy and/or earlier surgical intervention and enhanced postoperative serial imaging surveillance of the entire aorta.

Actuarial Analysis↗

PubMed2004

A case-control study found that low albumin and smoking were associated with aortic dissection.

OBJECTIVE: Hypertension is a risk factor for aortic dissection. Besides hypertension, associated factors for incidence of aortic dissection are not clear. The aim of this study was to examine whether other factors exist by an epidemiologic case-control approach. STUDY DESIGN AND SETTING: 240 consecutive cases suffering from acute aortic dissection were hospitalized in our university from 1989 to 2000. Blood chemistries and other information obtained immediately after admissions for the first attack were available in 226 patients. A case-control approach was performed by frequency matching age, sex, and history of hypertension in the remaining 226 cases with those of 226 healthy controls drawn from a similar geographic catchment area and all observed in 1989. RESULTS: The mean albumin (3.6 +/- 0.5 vs. 4.3 +/- 0.2 g/dL: P<.001) level of cases was significantly lower than that of controls (odds ratio: 0.004 per g/dL). The frequency with which cases of current smokers was significantly higher than that of controls (odds ratio: 3.475). The above parameters of cases compared with controls were statistically significant after adjustments for age, sex, and history of hypertension. CONCLUSION: Low albumin levels and smoking in addition to hypertension are significantly associated with aortic dissection.

Acute Disease↗

PubMed2004

A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection.

BACKGROUND: In spite of recent improvements in treatment for acute aortic dissection, mesenteric ischemia secondary to aortic dissection is still challenging. We propose a simple screening method to detect mesenteric ischemia secondary to acute aortic dissection. METHODS: From 1991 to 2002, 245 patients with acute aortic dissection were admitted to our hospital. Nine (3.7%) of those were complicated with mesenteric ischemia. The clinical records of those 9 patients were retrospectively analyzed. The ratios of the diameter of the superior mesenteric vein (SMV) to that of the superior mesenteric artery (SMA) were calculated in patients with mesenteric ischemia (group M) and in patients without mesenteric ischemia (group C). Blood test data, including results of arterial blood gas analysis, in the 2 groups were also compared. RESULTS: The SMV/SMA ratios in groups M and C were 1.16 +/- 0.33 and 1.78 +/- 0.29, respectively (P=.003). A cutoff value of the SMV/SMA ratio was 1.5 (sensitivity, 88.9%; specificity, 88.9%) with an odds ratio of 64.0. Although there were differences between the 2 groups in glutamate oxaloacetate transaminase, lactate dehydrogenase, creatine phosphate kinase, pH, and lactate values, the measurement of lactate was especially useful (P=.002). CONCLUSIONS: The combination of the SMV/SMA ratio and lactate concentration is a useful screening method to detect mesenteric ischemia secondary to acute aortic dissection.

Aged↗

PubMed1993

Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography.

BACKGROUND: Aortic dissection still has a poor prognosis despite progress in therapy. Therefore, this prospective follow-up study was designed to determine whether the degree of communication between true and false lumen in relation to the type of dissection, analyzed by transesophageal echocardiography, influences the risk after initiation of medical or surgical therapy. METHODS AND RESULTS: In eight centers, 168 patients (124 men and 44 women) of age range of 23-84 years with proven aortic dissection were examined by transesophageal echocardiography in the acute phase, after start of medical and/or surgical therapy, and during follow-up (0-65 months; mean, 10 months). Analyses were performed prospectively according to a detailed study protocol. Patients were subdivided by transesophageal echocardiography according to a modified DeBakey classification. Type I aortic dissection was found in 35%, type II aortic dissection in 17%, and type III aortic dissection in 48%. Preoperative mortality was 3%, 7%, and 2%, and survival rates were 52%, 69%, and 70%, respectively. Type III aortic dissection could be subdivided into those with communication and antegrade dissection (ca) (50%), with communication and retrograde dissection limited to the descending aorta (cr desc) (10%), with dissection extended to the aortic arch and ascending aorta (cr asc) (27%), and with noncommunicating (nc) aortic dissection (13%). An open false lumen with no thrombus formation was present in types I, II, III ca and III cr asc aortic dissection in 17%, 21%, 39%, and 27% respectively, although it was most pronounced in types III nc and III cr desc (75% and 78%). During follow-up in patients who survived, thrombus was demonstrated in the false lumen in 80% of type I aortic dissection and 81% of types III ca and III cr asc. Open false lumen was seen in type II aortic dissection in 18%. Spontaneous healing was found in 4% with type II and 4% with type III aortic dissection (mainly in patients with type III nc aortic dissection). Patients with fluid extravasation, pleural effusion, pericardial tamponade, and periaortic effusion as well as mediastinal hematoma had a mortality of 52%. Reoperations were necessary in 12-29%, with the highest rate in patients with type III ca aortic dissection. Survival for patients with types III nc and III cr desc aortic dissection was higher than those with types I, II, III ca, and III cr asc. CONCLUSIONS: Preoperative mortality appears to be reduced by transesophageal echocardiography, allowing rapid initiation of treatment. Intraoperative and postoperative mortality in aortic dissection remains high. Risk factors are fluid extravasation and an open false lumen with high communication. Thrombus formation in the false lumen can be regarded as a good prognostic sign. Surgery appears to be only a first step in the treatment of aortic dissection. Second surgery or closure of entry sites based on intraoperative echocardiography may be considered to induce thrombus formation and reduce aortic wall stress.

Adult↗

PubMed1998

Headache as the initial manifestation of acute aortic dissection type A.

The most common initial symptom of aortic dissection is chest pain. Other initial symptoms include pain in the neck, throat, abdomen and lower back, syncope, paresis, and dyspnoea. Headache as the initial symptom of aortic dissection has not been described previously. A 61-year-old woman with a history of migraine and arterial hypertension developed continuous bifrontal headache. Two hours later, right-sided thoracic pain and a diastolic murmur were suggestive of aortic dissection that was confirmed by echocardiography and subsequent surgery. The dissection commenced in the ascending aorta and involved all cervical arteries until the base of the skull. Headache as the initial manifestation of aortic dissection was assumed due to either vessel distension or pericarotid plexus ischemia. Aortic dissection has to be considered as a rare differential diagnosis of frontal headache, especially in patients who develop aortic regurgitation or chest pain for the first time.

Aneurysm↗

PubMed1988

New therapeutic approach to aortic dissection complicated by cardiac tamponade.

The management of aortic dissection with cardiac tamponade may result in increased blood pressure and thereby itself make the aortic dissection worse. Nevertheless, it is important to prevent cardiac failure caused by cardiac tamponade. We describe a case of aortic dissection with cardiac tamponade. Echocardiography and aortography showed DeBakey IIIb-type aortic dissection with retrograde dissection, complicated by cardiac tamponade and aortic insufficiency. To treat this condition, a new therapeutic approach was undertaken. A vasodilator was administered, then pericardiocentesis guided by echocardiography was performed. To prevent abrupt elevation of blood pressure in response to the relief of cardiac tamponade, the pericardial aspiration was carried out slowly--it took four hours for the complete drainage of 415 ml of blood--and a vasodilator, sodium nitroprusside, was administered. After drainage, cardiac function was reversed fully, and the systolic pressure was controlled under 140 mmHg. Then, using extra-corporeal circulation, the surgical procedure was performed successfully. We conclude that it is useful to treat cardiac tamponade by controlling blood pressure with slow drainage and use of a vasodilator in preparation for performing the surgical procedure.

Aortic Dissection↗

PubMed1990

[Treatment of type A aortic dissection by exclusive glueing].

From 1984 to 1990, 24 patients suffering from type A aortic dissection were treated by directly suturing the entry orifice of the dissection and glueing (gelatin-resorcin-formaldehyde glue) the dissected aortic tunicae, without any prosthetic replacement. Associated aortic insufficiency in 21 patients was treated by valve replacement (8 patients) or plasty (8 patients). Deep hypothermia with circulatory arrest was required in 13 patients, whose aortic arch was involved by the dissection. All patients survived the operation. All these patients were followed up from 6 to 60 months. All were controlled with Doppler echography. In addition, 21 of them were examined with angiography, 17 with CT and 5 with MRI. 21 patients had an ascending aorta and an apparently normal aortic arch. Limited dissection of the descending aorta, requiring no second surgery, was noted in 2 patients. Persisting dissection of the descending aorta was present in 13 patients. Valve replacement was necessary 18 months later in 1 patient. Heart transplantation was necessary 14 months later in a patient suffering from associated cardiomyopathy. These results demonstrate that aortic glueing is effective and safe in the middle term for the treatment of aortic dissection.

Adult↗

PubMed1990

[Treatment of type A aortic dissection by exclusive gluing. Long-term results apropos of 15 patients].

Between 1984 and 1988, 15 patients with a type A aortic dissection were treated with direct suturing of the entry opening of the dissection and gluing of the dissected aortic layers using the GRF glue (gelatine-resorcine-formaldehyde), without prosthetic replacement. An associated aortic insufficiency, in 10 patients, was treated with valve replacement (5 patients) or plasty (5 patients). Deep hypothermia with circulatory arrest were necessary in 10 patients whose dissection reached the ascending aorta. All patients survived the procedure. These patients are followed from 6 to 44 months. They are all controlled by echo-Doppler. In addition, ten had an angiography, 6 a control scan and 5 a NMR. In twelve patients, the ascending aorta as well as the aortic junction are normal. A limited aortic dissection which did not require a secondary procedure, is found in 3 patients. A dissection of the descending aorta is present in 10 patients. Two patients had to be re-operated: one, for a valve replacement, 18 months later; the other, for a myocardiopathy at the terminal stage, 14 months later, requiring an orthotopic transplantation. These results show that gluing of the aorta is an easy and effective treatment in type A aortic dissections.

Adult↗

PubMed1994

Aorta and aortic valve morphologies predisposing to aortic dissection. An in vivo assessment with transoesophageal echocardiography.

Predisposing factors for aortic dissection are well known from necropsy series. To evaluate the frequency of aortic and aortic valve disease in aortic dissection in vivo, 139 patients with acute aortic dissection (96 men, 43 women, mean age 60.5 +/- 15.7 years) were studied by transoesophageal echocardiography (TEE) using 3.5 and 5.0 MHz transducers. Left ventricular hypertrophy by TEE, defined as an end-diastolic wall thickness of the left ventricular septal wall over 1.5 cm, was found in 42 (67.7%) of 62 patients with type I, in 10 (58.8%) of 17 patients with type II and in 46 (76.7%) of 60 patients with type III dissection. The mean value for the aortic root diameter was 3.2 +/- 1.3 cm.m-2 in type I dissection and 2.8 +/- 0.9 cm.m-2(ns) in type II dissection. In the patient group with type III dissection this diameter was significantly smaller (1.8 +/- 0.9 cm.m-2; P < 0.001). Thickening of aortic valve leaflets was demonstrated in six (9.7%) of 62 patients with aortic dissection type I (two of them with mild aortic stenosis), in two (11.8%) of 17 patients with aortic dissection type II and in 15 (25.0%) of 60 patients with aortic dissection type III. A bicuspid aortic valve was diagnosed in five (6.3%) of 79 patients with aortic dissection types I and II and in one (1.7%) of 60 patients with type III dissection. By colour coded Doppler echocardiography, aortic regurgitation was found in 46 (74.2%) of 62 patients with type I, 13 (76.5%) of 17 patients with type II and 23 (38.3%) of 60 patients with type III dissection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

The results of total arch graft implantation with open stent-graft placement for type A aortic dissection.

BACKGROUND: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement. METHODS: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta. RESULTS: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 +/- 1.6 years. CONCLUSION: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.

Adult↗

PubMed2005

[Aortic dissection in elderly patients].

We performed 12 operations for aortic dissection in octogenarians from 1997 to 2004. Male : female = 1 : 11. Mean duration of follow-up is 33 +/- 19 months. As regards the etiology, acute type A aortic dissection was 8, chronic type A aortic dissection was 3 and chronic type B aortic dissection with distal arch aneurysm was 1. Total arch replacement was performed in 2 patients and hemiarch replacement in 10. In all patients with acute type A aortic dissection, hemiarch replacement was performed with the aid of selective cerebral perfusion or deep hypothermic circulatory arrest with retrograde cerebral perfusion. Postoperative respiratory failure was found in 1 patient, re-exploration for bleeding in 1, mediastinitis in 1 and temporary neurological dysfunction in 1. There was no hospital mortality. Two patients were died of respiratory failure 4 and 27 months after surgery. The results were acceptable. We recommend that age should not be the only determinant in deciding whether emergency operation should be performed in octogenarians.

Age Factors↗

PubMed2004

Correlation of hemostatic molecular markers and morphology of the residual false lumen in chronic aortic dissection.

We evaluated our hypothesis that morphological change of the aortic dissection can be predicted by serial measurements of hemostatic molecular markers. Between February 1999 and February 2003, 50 patients with chronic aortic dissection of the descending thoracic aorta were studied at random intervals of 1 to 59 months (mean, 15.4+/-14.3) after onset. Morphologies of the false lumen of the aortic dissection determined by computed tomographic (CT) images were divided into four groups. Twenty-two images had aortic dissection associated with intramural hematoma or a completely thrombosed false lumen without ulcer-like projections (group 1), 14 had a thrombosed false lumen with ulcer-like projections (group 2), 18 had patent, but a partially thrombosed false lumen (group 3), and 15 had a completely patent false lumen (group 4). Blood samples for detection of hemostatic molecular markers were collected on the same day or within 1 month of the CT scan being performed. Thrombin-antithrombin complex (TAT) and D-dimer proved to be significantly higher in group 3 than in group 1. There was no significant correlation between the external diameter and hemostatic molecular markers except for prothrombin fragments 1+2 (PTF1+2). Simultaneous determinations of these hemostatic markers and multiple CT scans were performed more than twice in 19 of the patients. These cases were divided into three groups according to the morphological changes of the false lumen in the interval; morphologically progressive, regressive and no change cases. Five cases showed reduction or disappearance of the false lumen (the regressive cases). Only one case showed that the false lumen progressively enlarged and was partially patent thereafter (the progressive case). Mean plasma levels of TAT and D-dimer were changed correlated with the morphological progressive or regressive changes. The morphology of aortic dissection was correlated with hemostatic molecular markers such as TAT or D-dimer. We concluded that the serial measurement of D-dimer and TAT is useful for predicting morphological changes in chronic aortic dissection, and it can be an alternative way to follow up for patients of aortic dissection.

Adult↗

PubMed2004

[Soluble elastin fragments in serum are elevated in aortic dissection].

OBJECTIVES: We aimed to establish an enzyme-linked immunosorbent assay (ELISA) for measuring soluble elastin fragments (sELAF) in serum and to reveal its usefulness in diagnosing acute aortic dissection. BACKGROUND: Acute aortic dissection is a life-threatening disease of the aorta. However, the diagnosis is still frequently missed, especially at onset. The establishment and clinical availability of simplified laboratory test(s) to help diagnose and screen acute aortic dissection patients is therefore urgently needed. METHODS AND RESULTS: An ELISA to measure sELAF in serum was developed using the newly created double monoclonal antibodies which recognize the different epitopes of human aortic elastin. Twenty-five acute aortic dissection patients, 50 patients with acute myocardial infarction, and 474 healthy individuals were enrolled in the study. The sELAF levels from healthy subjects gradually increased with aging. When the cutoff point for positivity was set at the mean + 3SD above the mean of those in healthy subjects at each age, 16 acute aortic dissection patients (64.0%) were found to be positive, while only one acute myocardial infarction patient was positive (2.0%). Acute aortic dissection patients with either an open or a partially open pseudolumen were found to be 88.9% positive for sELAF, while those with its early closure was 0% positive. The difference in the sELAF levels between acute aortic dissection patients with and without a thrombotic closure of false lumen was significant (60.3 +/- 15.6 vs 135.4 +/- 53.2 ng/ml, p < 0.005). CONCLUSIONS: The sELAF level in serum may be a useful marker for helping both diagnose and screen acute aortic dissection, while also helping distinguish acute aortic dissection from acute myocardial infarction.

Acute Disease↗

PubMed2005

Outcome of medical and surgical treatment in patients with acute type B aortic dissection.

BACKGROUND: Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. METHODS: In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. RESULTS: Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 +/- 1.9%, 95.2% +/- 2.1%, and 95.2% +/- 2.1%. CONCLUSIONS: Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.

Acute Disease↗

PubMed1986

[Role of echocardiography in the diagnosis of aortic dissection].

We evaluated sensitivity, specificity and predictive values of echocardiography in detecting aortic dissection. We studied in the same period of time two groups of consecutive patients with good quality echocardiographic examination. Group I, with high prevalence of the disease (76%), was composed of 25 patients; 19 patients with aortic dissection (11 of the type A and 8 of the type B) and 6 patients with clinical and echocardiographic suggestion of aortic dissection which was not confirmed by angiography. Group II, with lower prevalence of the disease (4%), was composed of 382 adult patients who underwent aortic angiography for different reasons. In this second group there were 16 out of the 19 patients of the first group, with aortic dissection, who underwent aortic angiography and the 6 patients with suspicion of aortic dissection which was not confirmed by angiography. Type A dissection: The finding of intimal flap on echocardiography was highly specific (98%) but relatively insensitive (45%); its positive predictive value was low (50% in the first and 34% in the second group). The specificity of increased thickness of aortic wall was lower (89%) and the sensitivity higher (81%); its positive predictive value was satisfactory in the first group (81%) and very low in the second (13%). Aortic root dilatation was fairly specific (76%); the sensitivity of this finding was high (87%) but its positive predictive value was still low (66% in the first and 7% in the second group). To conclude: the positive predictive value of the 3 echocardiographic signs of aortic dissection varied, in relation to the different prevalence of the disease, from 50, 81 and 66% in the first group to 34, 13 and 7% in the second group; the diagnostic utility of the echocardiographic examination appeared limited, in these patients, by the low values of sensitivity and positive predictive values; aortography is still the most valuable technique in the diagnosis of aortic dissection; echocardiography was useful in the early evaluation of some emergency cases (chest pain, shock, collapse...) suggesting sometimes the correct diagnostic hypothesis of aortic dissection; in the presence of a typical clinical picture, the contemporary presence of the 3 echocardiographic signs, though having the lowest sensitivity (36%), was highly predictive of the type A dissection. Type B dissection: In these patients the clinical picture, in contrast with type A dissection, Type A, was not indicating careful and complete echocardiographic aortic scan. Then the echocardiographic examination was even more disappointing: sensitivity 25%.

Adult↗