acute aortic syndrome: pathology and therapeutic strategyperkicabangmalang.org/assets/files/3. dr....
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ACUTE AORTIC SYNDROME:
Pathology And Therapeutic Strategy
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
Novi Kurnianingsih
Saiful Anwar Hospital- Brawijaya University
Malang
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DEFINITION
European Heart Journal
(2014):doi:10.1093/eurheartj/ehu281
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PHYSIOLOGY
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CLASSIFICATION
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PATHOLOGY
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PROGRESSION OF ONE TYPE OF ACUTE AORTIC
SYNDROME TO ANOTHER TYPE
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RISK FACTOR FOR DISSECTION
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INTRAMURAL HEMATOM (IMH)
Diagnosis: circular or crescentic
thickening >5 mm of the aortic
wall in the absence of
detectable blood flow.
10-25% of AAS
•30% ascending aorta
•10% arch
•60-70% descending TA (Type B)
TYPE A
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PENETRATING AORTIC ULCER
(PAU)Ulceration of an atherosclerotic plaque
penetrating through the internal elastic lamina
into the media.
● 2-7% of all AAS.
● Most commonly located in the middle andlower distal thoracic aorta (type-B PAU).
● Elderly patients, smokers, HTN, associated CAD, COPD, AAA
● Diagnosis → unenhanced/contrast enhanced CT
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Main Clinical Presentations And Complications Of Patient With
Acute Aortic Dissection
Main symptoms
Present in Both
type A and B
Almost present
in Type B
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Diagnostic Value Of Various Imaging Modalities Of
Acute Aortic Syndrome
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CLINICAL DATA USEFUL TO ASSESS THE A PRIORI
PROBABILITY OF ACUTE AORTIC SYNDROME
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Mr A
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CHEST X RAY
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asymptomatic PAUs with diameter>20mm or neck
>10mm represent a higher risk for disease
progression and may be candidates for early
intervention
01/10/2015
07/03/2016
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Maximum Aortic Diameter 71,9 mm
Diameter IMH 36,5 mm
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Predictors Of Intramural Haematoma Complications
2014 ESC Guidelines on the diagnosis and treatment of aortic diseases
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TEVAR (THORACIC ENDOVASCULAR REPAIR)
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Mr. BP / 48 y.o
Chief complain : chest pain
Patient suffered from chest pain like heavy sensation radiated to her back with vas score 7/10 and accompanied with coldsweeting, since 4 hour before admission (18 PM) while dinner more than > 20 minutes and didn’t relieved by rest. Then patientwent to Private hospital and was diagnosed with STEMI and given loading ASA 4 tab and CPG 8 tab and Continous infusion ISDN2 mg/h because of chest pain still persist, and planned to referred to saiful anwar hospital for revascularization with PCI. AtRSSA, chest pain was 2/10
History of DOE (-), SOB (-), PND (-), OE (-)
Risk Factor
• History of hypertension (+) since 6 month ago not routinely controlled, History of dyslipidemia (-)
• History of diabetes (-), smoking (-)
CASE 2
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ECG
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CHEST X-RAY
Widening of mediastinum
heart : site N, apex
rounded, cardiac waist (-),
CTR 68 %
Trop I 0.3065.3
CKMB 50 586
Laboratorium
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CT AORTA
Intimal tear
Innominate disecction
Left Carotid Artery dissection
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Surgery: Bentall Procedure
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CONCLUSION
• Detail anamnesis,physical examination and sharp simple additional
examination can make an early recognation Of AAS and reduce
Mortality
• Technological advances in imaging techniques and better
understanding of the pathophysiology of acute aortic conditions have
lead to the discovery of variants known as AAS.
• Furthermore, various surgical and percutaneous endovascular
treatment strategies are established and ontinue to improve.
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Tempels Of Palitana, Gujarat,India
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STATIC DISSECTION
DYNAMIC DISSECTION
PATHOLOGY
European Heart Journal (2014):doi:10.1093/eurheartj/ehu281
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