The aorta is the largest artery that supplies oxygenated blood from the heart to the circulatory system. An aortic dissection is a condition in which inner layer of the aorta tears and extends to the wall leading to dissection. Due to dissection, aortic rupture occurs, and blood flows between the layers of blood vessel wall decreasing blood flow to the organs.
This condition is a serious health concern, as it can lead to death if not treated promptly. However, early diagnosis and treatment can improve the chances of survival. The condition is not relatively common but mostly seen in men with age more than 60.
The aortic stenosis symptoms are similar to those of heart diseases such as heart attack. Signs and symptoms of aortic dissection include:
Aortic dissection can be classified into acute, sub-acute, and chronic based on the onset. The condition is said to be acute if the onset is less than 14 days, sub-acute for 15 to 90 days, and chronic for more than 90 days or 3 months.
Aortic dissection occurs in the area where the wall is weak. Persistent high blood pressure causes the walls of the aorta to strain, making the wall more susceptible to tearing.
Marfan syndrome, weakened or enlarged aorta or accidental injuries to the chest can also cause aortic dissection.
The risk of aortic dissection increases if you have hypertension, thoracic aortic aneurysm, aortic valve defect, Marfan syndrome (a connective tissue disease that affects blood vessel integrity), Turner’s syndrome (a chromosomal disorder of a female which results in high blood pressure and heart problems) or inflammation of the arteries.
Men, people above age 60, people who use cocaine, and perform high-intensity heavy lifting are at more risk for aortic dissection.
The complications of aortic dissection are:
Your doctor performs a physical examination to measure blood pressure and observe any abnormal noises of the aorta. An x-ray is suggested to detect aortic dissection. But more sophisticated tests are essential to confirm the diagnosis.
Computerized tomography (CT) scan: This scan helps to give a three-dimensional view of the aorta and requires injection of a contrast dye. But the tears in the intimal layer are difficult to detect with this scan.
Magnetic resonance imaging (MRI): This scan provides a three-dimensional view, and the intimal tears can also be detected using this procedure.
Transesophageal echocardiogram (TEE): It is a non-invasive test and requires you to swallow an echocardiography probe. The test helps to identify dissections in the ascending aorta and involvement of carotid artery.
Aortic dissections are divided into two groups, based on the area of the aorta dissected.
Type A is more severe condition than type B, but both the types of tears may extend into the abdomen.
Aortic dissection treatment includes medications and surgery. Often, type B is treated with medication and type A is treated with surgery.
Beta blockers and nitroprusside are given to reduce heart rate and blood pressure. In patients with type A aortic dissection, these medications are given to stabilize blood pressure before surgery.
In the aortic dissection surgery, the dissected aorta is removed as much as possible and block the entry of blood into the aortic wall. Then your surgeon reconstructs the aorta with a graft. If the aortic valve is damaged, then it is replaced with a new synthetic valve. This valve is placed in the graft while reconstructing the aorta. For complicated type B aortic dissections, stents are placed to repair the aorta.
After surgery, you need to follow-up regularly to monitor the condition. Your doctor recommends the use of blood pressure lowering medications for the lifetime to prevent complications.