Circulation. 2005;112:3802-3813
doi: 10.1161/CIRCULATIONAHA.105.534198
doi: 10.1161/CIRCULATIONAHA.105.534198
(Circulation. 2005;112:3802-3813.)
© 2005 American Heart Association, Inc.
Contemporary Reviews in Cardiovascular Medicine |
Acute Aortic Syndromes
From the Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor (T.T.T., K.A.E.), and Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Rostock, Germany (C.A.N.).
Reprint requests to Kim A. Eagle, MD, Albion Walter Hewlett Professor of Internal Medicine, Clinical Director, Cardiovascular Center, University of Michigan, 300 N Ingalls, 8B02 Ann Arbor, MI 48109-0477. E-mail keagle@umich.edu
Key Words: aorta • blood pressure • diagnosis • echocardiography • imaging
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
 |
Introduction |
|---|
In 1760, Dr Nicholls, physician to King George II, first described on necropsy an acute aortic dissection. Over the course of more than 200 years, we have developed a growing awareness and understanding of acute and chronic aortic syndromes. Recent advances in imaging and therapeutic techniques have further emphasized the importance of early diagnosis of acute aortic syndromes, which continues to be crucial to survival. However, we continue to be uncomfortable in the diagnosis and management of this highly lethal disorder. In the present report, we review the etiology, pathophysiology, clinical presentation, outcomes, and therapeutic approaches to acute aortic syndromes. In each section, we summarize the most clinically relevant issues as "take home points" (THPs) to affirm their importance in the diagnosis and management of this disorder.
|
Pathophysiology |
|---|
Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma (IMH), and symptomatic aortic ulcer. In the classic sense, acute aortic dissection requires a tear in the aortic intima that commonly is preceded by medial wall degeneration or cystic media necrosis.1 Blood passes through the tear separating the intima from the media or adventitia, creating a false lumen. Propagation of the dissection can proceed in anterograde or retrograde fashion from the initial tear involving side branches and causing complications such as malperfusion syndromes, tamponade, or aortic valve insufficiency.2–5
Both acquired and genetic conditions share a common pathway leading to the breakdown in the integrity of the intima. All mechanisms that weaken the media layers of the aorta will eventually lead
This article has been cited by other articles:
 |
|
 |
|
  C. A. Nienaber, S. Kische, V. Skriabina, and H. Ince Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease Circ Cardiovasc Imaging, November 1, 2009; 2(6): 499 - 506. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Attia, C. Young, H. B. Fallouh, and M. Scarci In patients with acute aortic intramural haematoma is open surgical repair superior to conservative management? Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 868 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Suzuki, A. Distante, A. Zizza, S. Trimarchi, M. Villani, J. A. Salerno Uriarte, L. De Luca Tupputi Schinosa, A. Renzulli, F. Sabino, R. Nowak, et al. Diagnosis of Acute Aortic Dissection by D-Dimer: The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) Experience Circulation, May 26, 2009; 119(20): 2702 - 2707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Hebballi and J. Swanevelder Diagnosis and management of aortic dissection CEACCP, February 1, 2009; 9(1): 14 - 18. [Full Text] [PDF]
|
|
|
|
 |
|
 E. L. Meredith and N. D. Masani Echocardiography in the emergency assessment of acute aortic syndromes Eur J Echocardiogr, January 1, 2009; 10(1): i31 - i39. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kodama, K. Nishigami, T. Sakamoto, T. Sawamura, T. Hirayama, H. Misumi, and K. Nakao Tight Heart Rate Control Reduces Secondary Adverse Events in Patients With Type B Acute Aortic Dissection Circulation, September 30, 2008; 118(14_suppl_1): S167 - S170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Farber Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357:349-359 Perspectives in Vascular Surgery and Endovascular Therapy, September 1, 2008; 20(3): 316 - 318. [PDF]
|
|
|
|
 |
|
 M. Grimm, C. Loewe, R. Gottardi, M. Funovics, D. Zimpfer, S. Rodler, M. Dorfmeister, M. Schoder, J. Lammer, S. Aharinejad, et al. Novel Insights Into the Mechanisms and Treatment of Intramural Hematoma Affecting the Entire Thoracic Aorta Ann. Thorac. Surg., August 1, 2008; 86(2): 453 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Suzuki, A. Distante, A. Zizza, S. Trimarchi, M. Villani, J. A. Salerno Uriarte, L. de Luca Tupputi Schinosa, A. Renzulli, F. Sabino, R. Nowak, et al. Preliminary experience with the smooth muscle troponin-like protein, calponin, as a novel biomarker for diagnosing acute aortic dissection Eur. Heart J., June 1, 2008; 29(11): 1439 - 1445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Swee and M. D. Dake Endovascular Management of Thoracic Dissections Circulation, March 18, 2008; 117(11): 1460 - 1473. [Full Text] [PDF]
|
|
|
|
|
|
S. L. Kahn and M. D. Dake Stent Graft Management of Stable, Uncomplicated Type B Aortic Dissection Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 162 - 169. [Abstract] [PDF]
|
|
|
|
|
|
C. A. Nienaber and H. Ince Commentary on "Stent Graft Management of Stable, Uncomplicated Type B Aortic Dissection" Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 170 - 173. [PDF]
|
|