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Michael

Tanaka

Department of Cardiology and Vascular Medicine
Universitas Pelita Harapan Siloam Hospitals Lippo Village
AorBc DissecBon
Epidemiology
Anatomy and Patophysiology
Clinical PresentaBon
Diagnosis
Management
Case IllustraBon
Epidemiology
Swedish NaBonal Cause of Death Registry 1987-20021
16.3/100.000 men and
9.1/100.000 women
Global Burden Disease 2010 (between 1990 and 2010)2
Death 2.49/100.000 2.78/100.000
UnderesBmate & misdiagnosis
Acute aorBc dissecBon 30/ 1 millions
Acute Myocardial InfarcBon 140-fold more common
InternaBonal Registry of AorBc DissecBon (IRAD)3
mean age 63 years
63% male
1. Thoracic aor+c aneurysm and dissec+on. Circula+on.2006
2. Global and regional burden of aor+c dissec+on and aneurysms. Global Heart.2014
3. The Interna+onal Registry of Acute Aor+c Dissec+on. JAMA.2000
Diameter:
- 40 mm
- Taper gradually downstream

Rate of expansion:
- Men: 0,9 mm/ decade
- Women: 0,7 mm/ decade

ESC Guideline on the diagnosis and treatment of aor+c diseases. 2014


AorBc Layers
AorBc Diseases
Acute AorBc Syndrome
Emergency condiBon
Similar clinical characterisBcs
Tear or ulcer blood from aorBc lumen to
media
Rupture vasa vasorum that bleed to media
AorBc dilaBon and rupture
AorBc DissecBon
Intramural Hematoma
PenetraBng aorBc ulcer
TraumaBc aorBc Injury
AorBc DissecBon
InBmal tear
DirupBon of medial layer by intramural bleeding
SeparaBon of aorBc wall layers
True lumen and false lumen with or without
communicaBon
AdvenBBal disrupBon aorBc rupture
Re-entering into aorBc lumen through second
inBmal tear
ClassicaBon of AD
Clinical PresentaBon
Chest pain
Abrupt onset
Severe chest/back pain
Sharp, ripping, tearing, knife-like
LocaBon
Chest (80%) type A
Back or abdominal (40 or 25%) type B
AorBc regurgitaBon congesBve heart failure
Myocardial ischemia
DiagnosBc ModaliBes
Chest X-Ray
TTE, TEE
CT-scan
MRI
Lab : D-Dimer

Probability of AAS
High risk condiBon High-risk pain High-risk clinical exam

Marfan syndrome (or Chest, back, or Evidence of perfusion


other connecBve abdominal pain decit:
Bssue diseases) described as any of pulse decit
Family history of the following: systolic blood
aorBc disease abrupt onset pressure dierence
Known aorBc valve severe intensity focal neurological
disease ripping or tearing decit (in conjuncBon
Known thoracic aorBc with pain)
aneurysm AorBc diastolic
Previous aorBc murmur (new and
manipulaBon with pain)
(including cardiac Hypotension or shock
surgery)
Management