AORTIC DISSECTION

 An aortic dissection is a serious condition in which a tear occurs between the layers of the body's main artery (aorta). Blood rushes between the dissected layers causing two lumens of the aorta, one is true lumen and one is false lumen.. If the blood goes through the outside aortic wall, aortic dissection is often deadly. False lumen causes pressure on the the true lumen thus causes blood supply compromise to the organs.  Can be categorized in Type A (ascending aorta involved) and type B (ascending aorta not involved). Aortic dissection is an emergency requires immediate attention. 

• Sudden severe chest or upper back pain, often described as a tearing or ripping sensation, that spreads to the neck or down the back
• Sudden severe stomach pain
• Loss of consciousness
• Shortness of breath
• Symptoms similar to those of a stroke, including sudden vision problems, difficulty speaking, and weakness or loss of movement (paralysis) on one side of your body
• Weak pulse in one arm or thigh compared with the other
• Leg pain
• Difficulty walking

• Uncontrolled high blood pressure (hypertension)
• Hardening of the arteries (atherosclerosis)
• Weakened and bulging artery (aortic aneurysm)
• An aortic valve defect (bicuspid aortic valve)
• A narrowing of the aorta at birth (aortic coarctation)
• Turner syndrome
• Marfan syndrome
• Other connective tissue disorders
• INFECTION , syphilis , fungus infection etc.

ECHOCARDIOGRAPHY AND CT- AORTOGRAM.

Treatment of type A dissection is almost surgical repair. Surgical modality depends on whether aortic valve is involved or not. The above image is from the patient in which aortic valve and right coronary artery was involved in the dissection. Explanation of the above image is- composite replacement of aortic valve and ascending aorta using a valved conduit and a coronary artery bypass was done for right coronary artery. Stage 2 operation may be required immediately or after some time depending on the involvement of the distal aorta.

Can be treated with endovascular method or open surgical repair depending on the segments involved and feasibility for the repair. Above image is the representation of the procedure  that aortic stenting for aortic dissection type B. This image is from the patient treated for aortic aneurysm.