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Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection.

Abstract

OBJECTIVES
We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change.
BACKGROUND
Aneurysmal dilation of the aorta is a critical late complication in AD patients.
METHODS
Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending aorta surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 +/- 26 months, and CT was repeated for 31 +/- 27 months.
RESULTS
Aneurysm (diameter > or =60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic aorta (UT), mid descending thoracic aorta (MT), lower descending thoracic aorta (LT) and abdominal aorta (AA), respectively. Of 53 patients in whom CT was repeated for > or =2 years, the rates of aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 +/- 3.66 mm/year, 3.21 +/- 2.70 mm/year, 2.62 +/- 2.19 mm/year, and 1.93 +/- 3.13 mm/year, respectively (p < 0.01), and aneurysm developed in 15 (28%). The initial false lumen diameter at the UT, the aorta diameter at the MT, and Marfan syndrome were independent predictors of late aneurysm. A > or =22-mm initial false lumen diameter at the UT predicted late aneurysm with a sensitivity of 100% and a specificity of 76%. The patients with initial UT false lumen diameter > or =22-mm (n = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001).
CONCLUSIONS
The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.

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  • Publisher Full Text

    • Authors

    Song JM, Kim SD, Kim JH, Kim MJ, Kang DH, Seo JB, Lim TH, Lee JW, Song MG, Song JK

    Institution

    Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jmsong@amc.seoul.kr

    Source

    Journal of the American College of Cardiology 50:8 2007 Aug 21 pg 799-804

    MeSH

    Adult
    Aged
    Aneurysm, Dissecting
    Aorta, Thoracic
    Aortic Aneurysm
    Female
    Follow-Up Studies
    Humans
    Longitudinal Studies
    Male
    Middle Aged
    Postoperative Complications
    Prognosis
    Tomography, X-Ray Computed
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17707186