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The Impact of the Morphologic Characteristics of Type B Aortic Dissection in the Acute Phase on the Aortic Enlargement in the Late Stage

The aorta is the largest artery in the body. It begins at the top of the left ventricle, the heart’s muscular pumping chamber. An aortic dissection (AD) is a serious condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It usually occurs in a weakened area of the aortic wall and is often a life-threatening condition and represents one of the rare true emergencies in cardiac surgery.  There are two kinds of aortic dissections (Type A and Type B). The difference is where the dissection is located.

The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups (PE, PU, TE, and TU) according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Image analysis was performed on a SYNAPSE VINCENT system (Tokyo Japan, FUJIFILM Holding Corporation) with a dedicated 3D image analyzer.

A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354); TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable.

In conclusion, in patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.

Article by Ken Nakamura, et al, from Yamagata University, Yamagata, Japan.

Full access: http://t.cn/E585JMm

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