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European Heart Journal 1991 12(9):1247-1256;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Predictability of aortic dissection as a function of aortic diameter

G. SÜTSCH*, R. JENNI*, L. VON SEGESSER{dagger} and M. TURINA{dagger}

*From the Departments of Internal Medicine, University Hospital Zürich, Switzerland
{dagger}Cardiovascular Surgery, University Hospital Zürich, Switzerland

Received 16 July 1990; revised 16 November 1990; .

Correspondence: Dr G. Sütsch, MD, Department of Internal Medicine, Cardiology, University Hospital, Rämistrasse 100, CH-809l Zürich, Switzerland

Abstract

The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the lime of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6·0±1·3 cm in group 1 and 6·4±1·4 cm in group 2; mean±SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3·2±0·8 cm . m–12 and 3·4±0·7cm m–2 respectively; ns). However, the individual diameters showed a pronounced scatter in both groups (range from 3·6±11·0 cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19 without dissection) and seven patients were treated medically. Emergency surgery was performed in 45/66 patients (all with acute type A dissection) andelective repair in 21/66 (19 without and two with chronic type A dissection). In-hospital mortality was 18% in the emergency group, 5% in the elective group and 57% in the medical group.

It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable; acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair andhave to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm.

Key Words: Dissection of ascending aorta • echocardiography and aortic dissection • aortic diameter and dissection


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