ACUTE AORTIC SYNDROME: Pathology And Therapeutic Strategyperkicabangmalang.org/assets/files/3. DR....
Transcript of ACUTE AORTIC SYNDROME: Pathology And Therapeutic Strategyperkicabangmalang.org/assets/files/3. DR....
ACUTE AORTIC SYNDROME:
Pathology And Therapeutic Strategy
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
Novi Kurnianingsih
Saiful Anwar Hospital- Brawijaya University
Malang
DEFINITION
European Heart Journal
(2014):doi:10.1093/eurheartj/ehu281
PHYSIOLOGY
CLASSIFICATION
PATHOLOGY
PROGRESSION OF ONE TYPE OF ACUTE AORTIC
SYNDROME TO ANOTHER TYPE
RISK FACTOR FOR DISSECTION
INTRAMURAL HEMATOM (IMH)
Diagnosis: circular or crescentic
thickening >5 mm of the aortic
wall in the absence of
detectable blood flow.
10-25% of AAS
•30% ascending aorta
•10% arch
•60-70% descending TA (Type B)
TYPE A
PENETRATING AORTIC ULCER
(PAU)Ulceration of an atherosclerotic plaque
penetrating through the internal elastic lamina
into the media.
● 2-7% of all AAS.
● Most commonly located in the middle andlower distal thoracic aorta (type-B PAU).
● Elderly patients, smokers, HTN, associated CAD, COPD, AAA
● Diagnosis → unenhanced/contrast enhanced CT
Main Clinical Presentations And Complications Of Patient With
Acute Aortic Dissection
Main symptoms
Present in Both
type A and B
Almost present
in Type B
Diagnostic Value Of Various Imaging Modalities Of
Acute Aortic Syndrome
CLINICAL DATA USEFUL TO ASSESS THE A PRIORI
PROBABILITY OF ACUTE AORTIC SYNDROME
Mr A
CHEST X RAY
asymptomatic PAUs with diameter>20mm or neck
>10mm represent a higher risk for disease
progression and may be candidates for early
intervention
01/10/2015
07/03/2016
Maximum Aortic Diameter 71,9 mm
Diameter IMH 36,5 mm
Predictors Of Intramural Haematoma Complications
2014 ESC Guidelines on the diagnosis and treatment of aortic diseases
TEVAR (THORACIC ENDOVASCULAR REPAIR)
Mr. BP / 48 y.o
Chief complain : chest pain
Patient suffered from chest pain like heavy sensation radiated to her back with vas score 7/10 and accompanied with coldsweeting, since 4 hour before admission (18 PM) while dinner more than > 20 minutes and didn’t relieved by rest. Then patientwent to Private hospital and was diagnosed with STEMI and given loading ASA 4 tab and CPG 8 tab and Continous infusion ISDN2 mg/h because of chest pain still persist, and planned to referred to saiful anwar hospital for revascularization with PCI. AtRSSA, chest pain was 2/10
History of DOE (-), SOB (-), PND (-), OE (-)
Risk Factor
• History of hypertension (+) since 6 month ago not routinely controlled, History of dyslipidemia (-)
• History of diabetes (-), smoking (-)
CASE 2
ECG
CHEST X-RAY
Widening of mediastinum
heart : site N, apex
rounded, cardiac waist (-),
CTR 68 %
Trop I 0.3065.3
CKMB 50 586
Laboratorium
CT AORTA
Intimal tear
Innominate disecction
Left Carotid Artery dissection
Surgery: Bentall Procedure
CONCLUSION
• Detail anamnesis,physical examination and sharp simple additional
examination can make an early recognation Of AAS and reduce
Mortality
• Technological advances in imaging techniques and better
understanding of the pathophysiology of acute aortic conditions have
lead to the discovery of variants known as AAS.
• Furthermore, various surgical and percutaneous endovascular
treatment strategies are established and ontinue to improve.
Tempels Of Palitana, Gujarat,India
STATIC DISSECTION
DYNAMIC DISSECTION
PATHOLOGY
European Heart Journal (2014):doi:10.1093/eurheartj/ehu281