THORACICANEURYSMSpontaneous rupture without warning is less commonSaccular are more common than fusiformSymptoms: tracheal deviation, wheezing cough, dyspnea, stridor,hemoptysis, recurrent pneumonitis,hoarseness, dysphagiasuperiorvena caval syndromeSteady & boring, sometimes pulsating,pain due to compression& erosion of adjacent musculoskeletal structuresRupture is heralded bythe dramatic onset ofexcruciating painSurgical excision is theprocedure of choice for=or>7 cmindiameter in the ascending or the descending aorta
THORACIC ANEURYSM • Spontaneous rupture without warning is less common • Saccular are more common than fusiform • Symptoms: tracheal deviation, wheezing cough, dyspnea, stridor, hemoptysis, recurrent pneumonitis, hoarseness, dysphagia, superior vena caval syndrome • Steady & boring, sometimes pulsating, pain due to compression & erosion of adjacent musculoskeletal structures • Rupture is heralded by the dramatic onset of excruciating pain • Surgical excision is the procedure of choice for = or > 7 cm in diameter in the ascending or the descending aorta
THE LATEST CONCEPTOFAORTICDISSECTION
THE LATEST CONCEPT OF AORTIC DISSECTION
INTRODUCTIONPrevalence:Maletofemale=2:1Peak incidence:6th & 7th decadesMortality rate: (Untreated)>25% withinthefirst 24 h>50%withinthefirst week>75% within one month>90% 1within one year
INTRODUCTION • Prevalence: – Male to female = 2:1 • Peak incidence: – 6th & 7th decades • Mortality rate: (Untreated) – >25% within the first 24 h – >50% within the first week – >75% within one month – >90% within one year
PATHOGENESISTwo possible mechanisms:Rupture of the intima with secondary dissection intothe mediaHemorrhage within a diseased media followed bydisruption of the subjacent intima & subsequentpropagation of the dissection through the intimaltear
PATHOGENESIS Two possible mechanisms: – Rupture of the intima with secondary dissection into the media – Hemorrhage within a diseased media followed by disruption of the subjacent intima & subsequent propagation of the dissection through the intimal tear
CLINICALPICTUREThe most common symptom is pain (>90%)Contrast to AMl, most painful at onset, not crescendo"TearingMigratingProximal dissection: anterior chestDistal dissection:backPulse deficits,“pseudohypotension"Syncope, CVACardiac tamponadeAortic regurgitationAMI (l - 2%), Mesenteric infarction, Renalinfarction
CLINICAL PICTURE • The most common symptom is pain (>90%) – Contrast to AMI, most painful at onset, not crescendo – “Tearing” – Migrating – Proximal dissection: anterior chest – Distal dissection: back • Pulse deficits, “pseudohypotension” • Syncope, CVA • Cardiac tamponade • Aortic regurgitation • AMI (1 - 2%), Mesenteric infarction, Renal infarction