Analysis of ascending aortic diameter and long‐term prognosis in patients with ascending aortic dissection

Abstract Background The incidence of aortic dissection has been reported to be lower in women; however, women have a poor prognosis. Also, the incidence of false lumen thrombosis has been reported to be different between Europe, the United States, and Japan. We aimed to determine gender differences in long-term prognosis of acute type B aortic dissection. Methods We retrospectively reviewed 220 consecutive patients hospitalized for acute type B aortic dissection between January 2012 to December 2017. After exclusion criteria of unknown onset time, >14 days after the onset, in-hospital death, and aortic events requiring additional treatment during hospitalization were applied, 186 patients were analyzed by gender: 133 men and 53 women. The patient background, treatment method, prognosis, and outcome were compared and examined. Results Both the proportions of smoking history and patients receiving oxygen therapy during hospitalization were significantly higher in men (59% vs. 22%, p<0.01; 91% vs. 72%, p<0.01, respectively), whereas that of classical aortic dissection was similar between men and women (41% vs. 32%, p=0.36). The avoidance rate of a composite of all deaths and aortic events 2 years after discharge was similar (hazard ratio, 0.99; 95% confidence interval, 0.52 to 1.59; p=0.966).(Picture1) Picture 1 Conclusion The long-term prognosis of acute type B aortic dissection treated by medical therapy during hospitalization was equivalent in men and women despite gender differences in several background factors.

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Long-Term Prognosis of Acute Aortic Dissection With Medical Treatment

Japanese Circulation Journal ◽

10.1253/jcj.65.359 ◽

2001 ◽

Vol 65 (5) ◽

pp. 359-359 ◽

Cited By ~ 30

Author(s):

Yumiko Kozai ◽

Shigeru Watanabe ◽

Masayori Yonezawa ◽

Yasutaka Itani ◽

Toshihisa Inoue ◽

...

Keyword(s):

Aortic Dissection ◽

Medical Treatment ◽

Acute Aortic Dissection ◽

Long Term Prognosis

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Long-Term Prognosis of Type A Aortic Dissection in Non-Marfan Patients With Histologic Pattern of Cystic Medial Necrosis

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2007.10.051 ◽

2008 ◽

Vol 85 (3) ◽

pp. 972-977 ◽

Cited By ~ 11

Author(s):

Evaldas Girdauskas ◽

Thomas Kuntze ◽

Michael A. Borger ◽

Torsten Doenst ◽

Michael Mochalski ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Cystic Medial Necrosis ◽

Type A Aortic Dissection ◽

Histologic Pattern ◽

Medial Necrosis ◽

Long Term Prognosis

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Type A Iatrogenic Aortic Dissection Following Catheterization Without Coronary Involvement: Long-term Prognosis

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2014.09.016 ◽

2015 ◽

Vol 68 (3) ◽

pp. 254-255 ◽

Cited By ~ 1

Author(s):

Iván J. Núñez-Gil ◽

Daniel Bautista ◽

María José Pérez-Vizcaíno ◽

Enrico Cerrato ◽

Pablo Salinas ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Iatrogenic Aortic Dissection ◽

Long Term Prognosis

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Pregnancy in women with bicuspid aortic valve

European Heart Journal ◽

10.1093/eurheartj/ehab724.2894 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Belkadi ◽

O Milleron ◽

L Eliahou ◽

F Arnoult ◽

G Delorme ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Aortic Diameter ◽

Z Score ◽

Aortic Dilation ◽

Genetic Syndrome ◽

Pregnancy And Postpartum ◽

Ascending Aortic Diameter

Abstract Background Aortic dissection during pregnancy is uncommon, however, the risk of aortic dissection is increased if there is underlying aortopathy. Bicuspid aortic valve (BAV) is common in the general population and is associated with the presence of an aortic aneurysm, but this condition is mostly asymptomatic and ignored in women of childbearing age. Data on pregnancy in patients with BAV are scarce, and guidelines on this topic are based on the consensus opinion of experts. The risk of occurrence of aortic dissection as a function of aortic diameter during pregnancy remains poorly known in women with BAV. Purpose To investigate demographic and echocardiographic characteristics and aortic events associated with pregnancy in women with BAV and to estimate ascending aortic diameter at the time of pregnancy. Methods We performed a retrospective study using data from our tertiary centre. All women seen at our centre between 1996 and 2020 with BAV, at least 1 pregnancy, and no genetic syndrome were included. We have collected data from echocardiograms performed in and out of our centre and aortic events. Assuming from the literature an annual aortic dilation rate of 0.2 mm at the sinus of Valsalva and 0.4 mm at the tubular ascending aorta, we estimated ascending aortic size and Z-score at the time of pregnancy. Results We identified 47 women with BAV with occurrence of 103 pregnancies. The median age of BAV diagnosis was 43 years. The aorta was measured at a median of 13.3 years since the last delivery. At BAV diagnosis, the median largest ascending aortic diameter was 44mm, and the median Z-score was +4.3. Ascending aortic diameter was ≥40mm in 37/47 (79%) and Z-score ≥2 in 44/47 (94%). No aortic dissection was observed during pregnancy and postpartum in all 103 pregnancies. At the time of pregnancy, the estimated median diameter of the ascending aorta was 37mm and the estimated median Z-score was +3.3. The largest aortic diameter during pregnancy was estimated to be ≥40mm in 36/103 pregnancies, ≥45mm in 13/103, and ≥50mm in 1/103; Z-score was estimated to be ≥2 in 81/103 and ≥4 in 40/103. Type A aortic dissection occurred in 1 woman, 13 years after pregnancy, and type B aortic dissection in 1 woman, 14 years after pregnancy. Planned surgery was performed in 8 women at a median of 17.5 years after the last pregnancy: 1 isolated aortic valve replacement and 7 prophylactic aortic surgeries associated with aortic valve surgery. Conclusions In our population of women with BAV, pregnancy is not associated with the occurrence of aortic dissection even though, when estimating aortic diameter at the time of pregnancy, the rate of aortic dilation was high (Z-score ≥2 in 81/103 pregnancies). Prospective studies of a large population of women with BAV are needed to assess the risk of aortic complication during pregnancy according to aortic diameter. FUNDunding Acknowledgement Type of funding sources: None.

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Current evidence for thoracic aorta type B dissection management

Vascular ◽

10.1177/1708538113504400 ◽

2013 ◽

Vol 22 (6) ◽

pp. 439-447 ◽

Cited By ~ 7

Author(s):

Laura Capoccia ◽

Vicente Riambau

Keyword(s):

Aortic Dissection ◽

Current Evidence ◽

Acute Type ◽

Type B ◽

Chronic Complications ◽

The Poor ◽

Time Period ◽

Type B Dissection ◽

Long Term Prognosis

Aortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention.

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