ACUTE TYPE AAORTIC DISSECTION: A PATHOLOGY UNDER DIAGNOSED

Objective: To compare the frequency of acute type A aortic dissection with chronic dissections, at two large cardiac surgery centers of the country. A cute type a aortic dissection: a pathology under diagnosed Material and Methods: This study was conducted at Rehman Medical Institute, Peshawar and National Institute of Cardiovascular diseases, Karachi, between January 2001 and January 2007. All patients with type A aortic dissection are studied retrospectively. Patients with aortic aneurysm, under going aortic root surgery, were not included in the study. Results: Out of 13 patients who underwent aortic root surgery for various pathologies of the aorta, 9 cases had type A aortic dissection. Eight patients were diagnosed by trans-thoracic and trans-esophageal echocardiography and one patient was diagnosed on contrast enhanced computerized tomography (CT) scan. None of the patients had cardiac catheterization or MRI. Six of the nine dissections were chronic. One patient had Marfan Syndrome. Eight patients were hypertensive. One patient had aortic valve repair with supra coronary tube graft interposition for ascending aortic dissection; while eight patients had aortic root replacement with prosthetic composite grafts. There was one in-hospital death. Post operative echocardiogram of the patient with aortic valve repair, revealed mild aortic regurgitation. Seven of the eight surviving patients are in NYHA class I while one patient is in NYHA class II. Conclusion: Aortic root surgery can be safely performed with results comparable to the published data. Hypertension needs to be controlled to avoid its potentially lethal complications, like aortic dissection.