The five years registry of acute aortic dissection in Prapokklao Hospital.

Abstract

Objective : To assess the presentation, investigation, management, and outcomes of acute Aortic dissection

Material and Method : Case series review with patients from January 2003 to December 2007.Data were collected at presentation, and by physician review of hospital records.

Result : There were 42 cases of acute aortic dissection, 18 cases (42.8 percent) were type A dissection and 24 cases were type B dissection. The ratio of male : female was 1.8:1 and the mean age was 59.6 year old. The most presenting symptom was acute chest pain (83.3 percent), and initial chest radiography with widened mediastinum was found more often in type A than type B dissection (88.9 percent vs. 58.3 percent, P<0.05). Computed tomography was the initial imaging modality used in 85.7 percent. Of 42 patients with acute aortic dissection, 66.67 percent were managed in Prapokklao Hospital and 33.33 percent were referred to the higher tertiary care hospitals in Bangkok. Overall in-hospital mortality was 53.6 percent.

Conclusion : Acute aortic dissection is not uncommon but complications develop rapidly and outcome is often fatal. The typical presentation is acute chest pain with widened mediasternum by chest radiography. The physical examinations are diverse. The imaging modalities are essential and a high clinical index of suspicion is necessary. Despite significant advance in diagnosis and therapeutic techniques,mortality and morbidity rates remain high.

Key words : Acute Aortic Dissection, Cardiovascular system.