Clinical Findings of Aortic Dissection

Lee, Ju Young; Yoo, Byung Su; Ahan, Seung Chan; Hwang, Sung Oh; Yoon, Jung Han; Park, Keum Soo; Choe, Kyung Hoon

Abstract

BACKGROUND
The purpose of this study is to evalute the clinical findings, DeBakey classification, major associated complication, and mortality of aortic dissection. METHOD: A retrospective clinical study was done on 43 cases of aortic dissection who had been admitted to Wonju College of Medicine Hospital from January, 1988 to September, 1994. We classified to DeBakey type, and dissection was considered to be acute if elapsed time from clinical onsets to admission was less than 2 weeks.
RESULTS
1) Aortic dissection was seen a little more frequently in women than men with M : F ratio of approximately 1 : 1.3. The peak incidence was in the fifth, with the range being 30 to 70 years of age. 2) The frequent symptoms were pain in 67.4%, dyspnea in 9.3%, mental deterioration in 9.3%, syncope in 4.7%, and others in 9.3%. Anterior chest pain was most seen in type I, II of DeBakey classification. But, abdominal pain or back pain were mainly seen in type III dissection. 3) Hypertension was the most frequent physical finding in 72.1% and shock in 16.2%, pulse deficit in 23.6%, neurologic manifestation in 14%. 4) The diagnosing of aortic dissection was made by transthoracic echocardiography in 44.2%, transesophageal echocardiography in 23.3%, computed tomography in 65.1%, magnetic resonance imaging in 23.3%, and aortogram in 20.9%. 5) According to the DeBakey classification, type I was found in 23.3%, type II in 16.3%, and type III in 60.5%. 6) According to the age of dissection, acute dissection was found in 72.1%, chronic dissection in 27.9%. 7) Aortic regurgitation was complicated in 16.3%, pericardial effusion in 9.3%, hemothorax in 25.6%, and renal involvement in 14%. Aortic regurgitation, pericardial effusion, and hemothorax were mainly complicated in type I or type II aortic dissection, and renal vascular involvement was complicated in type I or type II dissection. 8) The hospital death rate was 27.9%. Mortality was high in acute dissaction, typeI or type II dissection and complicated dissection.
CONCLUSIONS
The incidence of aortic dissection was more predominant in female patients. Most commom intial chief complaints was pain. Hypertension was combined in 72% of the patients. According to the DeBakey type, most common type was type III(60%). Complication of aortic dissection was aortic regurgitation(16%), pericardial effusion(9%), hemothorax(25%), renal arterial involvement(14%). In hospital mortality was 28% and more increased in patients with proximal dissection and combined complication.