acute aortic syndrome: pathology and therapeutic strategyperkicabangmalang.org/assets/files/3. dr....

ACUTE AORTIC SYNDROME:

Pathology And Therapeutic Strategy

JOHN DOE, MD

SUBTITLE 32 PT ARIAL BOLD ITALICS

Novi Kurnianingsih

Saiful Anwar Hospital- Brawijaya University

Malang

DEFINITION

European Heart Journal

(2014):doi:10.1093/eurheartj/ehu281

PHYSIOLOGY

CLASSIFICATION

PATHOLOGY

PROGRESSION OF ONE TYPE OF ACUTE AORTIC

SYNDROME TO ANOTHER TYPE

RISK FACTOR FOR DISSECTION

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

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

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

Diagnostic Value Of Various Imaging Modalities Of

Acute Aortic Syndrome

CLINICAL DATA USEFUL TO ASSESS THE A PRIORI

PROBABILITY OF ACUTE AORTIC SYNDROME

Mr A

CHEST X RAY

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

Maximum Aortic Diameter 71,9 mm

Diameter IMH 36,5 mm

Predictors Of Intramural Haematoma Complications

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

TEVAR (THORACIC ENDOVASCULAR REPAIR)

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

ECG

CHEST X-RAY

Widening of mediastinum

heart : site N, apex

rounded, cardiac waist (-),

CTR 68 %

Trop I 0.3065.3

CKMB 50 586

Laboratorium

CT AORTA

Intimal tear

Innominate disecction

Left Carotid Artery dissection

Surgery: Bentall Procedure

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.

Tempels Of Palitana, Gujarat,India

STATIC DISSECTION

DYNAMIC DISSECTION

PATHOLOGY

European Heart Journal (2014):doi:10.1093/eurheartj/ehu281