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DISSECTION OF AORTA


Dissection of the aorta represents a serious health condition, in which the inner layer of the aorta wall breaks. Then, the blood runs through the tear, leading to the deformation of the inner and middle layer of the aortic wall. In the event that the blood goes through the outer layer of the wall, the dissection of the aorta is often fatal. The most common and most dangerous type of dissection of the aorta is the one when theere is a tear of the wall of its  initial, upward part, immediately after leaving the heart, with or without catching of the downward (further) part of the aorta. Another, less dangerous type of dissection is the one that involves only the downward part of the aorta. This condition is relatively rare.

Symptoms:

  • Sudden severe pain in the chest or in the upper part of the spine, often described as a feeling of splitting or tearing, with a spread in the neck or down the spine;
  • Lack of breath;
  • Sudden difficulties with speech and vision, weakness or paralysis of one side of the body
  • Losing consciousness;
  • Weak pulse in one hand, compared to the other.

Causes:

Chronic high blood pressure damages the aortic tissue, making it more susceptible to cracks.

Inborn conditions that are associated with a weakened and enlarged aorta, such as Marfan syndrome, bicuspid (two-leaflet) aortic valve, or others.

Rarely, dissection can be caused by trauma (injuries) to the chest, most often during car accidents.

Risk factors

  • Uncontrolled high blood pressure (hypertension)
  • Aortic aneurysm;
  • Atherosclerosis;
  • Bicuspid aortic valve
  • Congenital narrowing of the aortic segment (coarctation of the aorta).
  • Certain genetic diseases (Turner syndrome, Marfan syndrome, connective tissue disorders)
  • Inflammatory or infectious conditions (giant cell arteritis, arterial inflammation, and syphilis, a sexually transmitted infection)
  • Gender (Men have twice the incidence of aortic dissection)
  • Age (The incidence of aortic dissection has a peak of occurrence in the 7th and 8th decade of life)
  • Pregnancy (Aortic dissection rarely occurs in otherwise healthy pregnant women)
  • Weight lifting. Dealing with this sport increases the risk of developing aortic dissection, increasing blood pressure during training.

Complications

Aortic dissection can lead to:

  • Death due to internal bleeding;
  • Damage to organs, such as kidney failure or deadly damage to the gut;
  • Aortic valve damage (aortic regurgitation) or heart failure (cardiac tamponade).

Diagnostics:

  • Transseophageal echocardiography (TEE).
  • Computerized tomography (CT). (Golden Standard in Diagnosis of Aortic Dissection)
  • Magnetic resonance angiogram (MRA)

Treatment:

Surgical treatment is necessary, and it is the removal of as much as possible a segment of the damaged part of the aorta (in particular the place of tear) and the reconstruction of that part using a synthetic tubular graft. If the aortic valve is damaged, its reconstruction or replacement by artificial one is also done. If the dissection is by the type of catching of the lower part of the aorta, the treatment can be done by placing a stent (wire network structure) in the damaged part of the aorta.

Medical treatment is reduced to reducing blood pressure and reducing pain. This therapy is not definitive, and is used to stabilize the condition of the patient prior to surgery, or to prevent the spread of dissection in the previously undamaged segment of the aorta. The role of medicines is also significant after surgical treatment, in order to limit the blood pressure level for a lifetime.

Prevention

  • Blood pressure control.
  • Cessation of smoking
  • Aspiring towards normal body weight, nutrition with as little salt, plenty of fruits, vegetables and integral cereals, moderate physical activity.

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