Diagnosis and clinical management of aortic dissection

Abstract

Aortic dissection is a potentially lethal clinical entity that requires rapid diagnosis, appropriate medical management, and potential surgical intervention. Nomenclature and treatments for aortic dissection are based on the location and extent of the dissection. Aortic dissections result from an intimal tear and may occur in the ascending aorta, aortic arch, or descending aorta. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Optimal medical therapy, often using a combination of medications to achieve systolic blood pressure control is essential in management of dissection. Surgical intervention is indicated for aortic dissection of the ascending aorta and aortic arch, and in selective dissections of the descending aorta. Regardless of operative technique, the goal of surgery is to prevent progression of the dissection, restore end organ perfusion whenever possible, and prevent rapid cardiovascular collapse and death.

The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

“…The physiological responses of BB decrease left ventricular contractions by affecting the level of ions 16 – 19 . This mechanism leads to the reduction of aortic BP and heart rate to lower than 120 mmHg and 60 BPM, respectively 15 – 17 ; for additional BP reduction and in the presence of life-threatening conditions like malperfusion in branch vessels or vessel wall’s rupture, surgical operation or thoracic endovascular aortic repair (TEVAR) is essentially needed 8 , 20 – 22 . However, the rate of reoperation for patients treating with surgery is about 10% higher than medical intervention after about 12 years 10 , 12 .…”