Large Area of the False Lumen Favors Secondary Dilatation of the Aorta After Acute Type A Aortic Dissection

Abstract

Background— Since 1994 patients with acute aortic dissection type A (AADA) are followed-up in our outpatient clinic. Early diagnosis of secondary dilatation of the diseased aorta is crucial to reduce late mortality in these patients. Aim of the present study is to asses the impact of a large volume in the false lumen of the diseased downstream aorta on secondary dilatation. Methods and Results— 134 patients of 264 patients who underwent surgery for AADA (between January 1994 and June 2003) are followed-up at our outpatient clinic since 1994. 84 patients (62.7%) fulfilled the inclusion criteria. Areas of the true and the false lumens of the aorta were analyzed and a logistic regression was calculated at 5 levels of the aorta for each patient. Patients were divided in 3 groups: group 1 included 34 patients (40.5%) without progression, group 2 had 34 patients (40.5%) with slight progression, and group 3 had 16 patients (19.0%) with important progression, requiring surgery in all patients. In 87.5% of the patients the area of the original lumen was <0% in group 3, compared with 11.8% in group 2 and 8.8% in group 1 in relation to the total area of the aorta 6 months after surgery ( P <0.001). Conclusion— A large false lumen, with an area of the true lumen <30% 6 months after surgery, is the strongest predictor for secondary dilatation of the diseased downstream aorta.

Echocardiography in aortic diseases: EAE recommendations for clinical practice

“…Other variables have been considered to have poor prognosis, such as compression of the true lumen 61 or partial false lumen thrombosis. 62 In contrast, a completely thrombosed false lumen showed a protective role.…”

“…63 In addition to maximal aortic diameter, some TOE information such as echolucent areas has been related to dissection and enlargement evolution. 61 The natural history of PAU is unknown. Like intramural haematomas, several evolutive possibilities have been proposed.…”

Ratio of the false lumen to the true lumen is associated with long-term prognosis after surgical repair of acute type A aortic dissection

“…Immer and colleagues 16 reported that a large false lumen with an area of the true lumen < 30% 6 months after surgery is the strongest predictor for secondary dilatation of the diseased downstream aorta. This finding is consistent with the results of the current study.…”

A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy

“…Importantly, a FL diameter larger than 22 mm is predictive of an aneurysm with a sensitivity of 100% and specificity of 76%. Even though the true lumen diameter can change with blood pressure and cardiac cycle, it is still an important predictor of blood support to vital organs and tissues ( 36 , 37 ). Moreover, complete FLT is the ultimate goal of treatment since it indicates a good prognosis ( 11 ).…”