Yonsei Med J.  2009 Apr;50(2):239-244.

The Characteristics of Acute Aortic Dissection among Young Chinese Patients: A Comparison between Marfan Syndrome and Non-Marfan Syndrome Patients

• Tsai SH
• Lin YY
• Hsu CW
• Chen YL
• Liao MT
• Chu SJ

Abstract

PURPOSE
Aortic dissection (AoD) is one of the most common catastrophes involving the aorta. Nevertheless, early diagnosis remains to be a challenge in the Emergency Department (ED), particularly in young individuals. In this study, we attempted to identify the characteristics of acute AoD among young individuals, particular in patients with Marfan syndrome. MATERIALS AND METHODS: This was an retrospective chart-review study conducted in a tertiary referring hospital. The hospital database was queried for the combination of AoD and patients under age of 40 years. The medical charts were reviewed to obtain demographic data, clinical data and laboratory characteristics by using a standardized data collection sheet. A comparison between Marfan syndrome and non-Marfan syndrome patients was performed. RESULTS: During the 10-years period, 18 of 344 patients with acute AoD were younger than 40 years-old. Patients with Marfan syndrome developed acute AoD at a younger age than patients without Marfan syndrome. The mean diastolic blood pressure was significantly lower in patients with Marfan syndrome upon presenting to the ED than those without. Patients with Marfan syndrome had trends toward higher risk of development of type A AoD, increased recurrence rate and higher mortality rate than those without. However, statistical significance was not present. CONCLUSION: ED physicians should have high alert to acute AoD in young patients presenting with severe unexplained chest and back pain, particularly in those patients with a history of heart diseases, hypertension, and Marfan syndrome or featuring Marfanoid habitus. Acute coronary syndrome, unexplained abdominal symptoms, and sudden cardiac arrest could be the initial manifestation of AoD in young patients. A low threshold to perform enhanced computed tomography may facilitate early diagnosis and timely treatment in this patient population.

Keyword

Aortic dissection; young age; Marfan syndrome; hypertension; congenital heart disease

MeSH Terms

Adult
Aneurysm, Dissecting/*complications/epidemiology/*pathology
Aortic Aneurysm/complications/epidemiology/*pathology
Asian Continental Ancestry Group
Female
Heart Defects, Congenital/complications/physiopathology
Humans
Hypertension/complications/physiopathology
Male
Marfan Syndrome/*complications/*physiopathology
Middle Aged
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Twelve-lead electrocardiography of patient No. 12 obtained in the emergency department. Note ST elevation in Lead II, III, aVF, reciprocal changes in I and aVL, and ST elevation in the rV4 (arrow) as well as high degree of AV block, findings consistent with acute inferio-posterior wall myocardial infarction.

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