European heart journal
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European heart journal · Dec 1991
Comparative StudyPredictability of aortic dissection as a function of aortic diameter.
The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the time of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6.0 +/- 1.3 cm in group 1 and 6.4 +/- 1.4 cm in group 2; mean +/- SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3.2 +/- 0.8 cm.m-2 and 3.4 +/- 0.7 cm.m-2, respectively; ns). ⋯ It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable: acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair and have to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm.