3. Learning Objectives
At the end of this lecture you should understand:
1. Anatomy of different segments of the Aorta
2. Different pathologies affecting the Aorta
3. Strategy in management of different pathologies
4. Surgical procedures for Aorta
6. Aortic dissection
• Def.: blood leaves aortic lumen via an “intimal tear” ,separating the inner
from the outer layers of the media creating a “false lumen”
8. Classification
• Time of presentation:
• Acute: within 14 days
• Chronic: after 2 months
• Subacute: between 14 days and 2 months
• Site:
• Stanford classification
• Debakey classification
10. • Pathogenesis is not well understood, several theories might explain it
• Cystic medial degeneration :oldest theory, only in minority of patients (lost ground)
• Penetration of atherosclerotic ulcer (uncommon)
• Intramural hematoma :from bleeding vasa vasorum into the media
• Risk factors include,
• Age
• Hypertension
• CT disorders
• Iatrogenic and trauma
• High cardiac output status
11. • Clinical presentation may be in the form of severe “tearing pain” from chest
through to the back, sudden death, asymptomatic or as a complicated
dissection.
• Complications :
• Arch vessel occlusion
• Myocardial ischemia
• Hemopericardium,hemothorax
• Severe aortic valve incompetence
• Upper,lower limb,mesenteric or renal ischemmia
• CVS or paraplegia
12. Diagnosis of type A dissection
• History,clinical picture,ECG,CXR,ECHO ,etc……
• Imaging
• The primary role is to differentiate between type A dissection (emergency)and type
B
• As a rule centers planning to refer suspected acute type A dissection should use
the imaging modality in which they have most expertise with minimum delay.
• Aortography used to be the gold standard till recently
• CT angiography 90% sensitivity and specificity
17. Management
• Medical treatment has no rule in acute type A dissection
• In the acute setting it is usually safest to focus on treating the
immediately life-threatening complication
• The main variable to think about are
1. Extent of the resection (root or arch replacement needed ??)
2. Cannulation strategy
3. Need for circulatory arrest
4. Can aorta be clamped ?
5. Myocardial protection ,cerebral and spinal protection ,use of DHCA
6. Venting