Asymptomatic, Chronic Type-A Dissection of a Large Ascending Thoracic Aortic Aneurysm in a Young Patient

Abstract

INTRODUCTION Incidence of thoracic aortic dissection (TAD) in the general population is very low, ranging from 2.6-3.5 cases per 100,000 persons per year, but it is associated with a high rate of mortality and morbidity. 1-3 Based on the nature of its onset and anatomical location, TAD is classified as either acute or chronic Stanford type-A dissection involving the ascending aorta and type-B distal to the left subclavian artery. 4,5 Acute type-A dissection is highly lethal with a 30-day mortality of 50% compared to 10% of type B. 2 Most acute TAD patients presented with a sudden onset of severe chest, abdominal, or back pain, but 6.4% of them may have painless dissection. 6 The majority of patients with TAD were older with a mean age of 63 years while only 7% of them were less than 40 years of age. 7 Common predisposing factors for TAD are hypertension, atherosclerosis, and a history of cardiac surgery 2 , while in young patients they are more likely Marfan's syndrome, bicuspid aortic valve, and prior aortic surgery. 7 We report a case of a healthy, young male veteran who presented with asymptomatic, chronic type-A dissection of a large aortic aneurysm, complicated by severe aortic regurgitation (AR). Several physical signs characteristic of chronic, severe AR were found in this patient.