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An aortic dissection is a life-threatening condition resulting from a tear in the aorta, the main blood vessel that carries blood away from the heart. In most cases, the innermost lining of the aorta becomes torn, and blood from within the aorta flows into the middle layer, forcing this layer apart from the inner layer. This can lead to a loss of blood flow to major organs, heart failure or an aortic rupture.
An aortic dissection, or tear, may occur in the chest (thoracic) area of the artery, but can also occur in the abdominal aorta. This results in either one of two channels, where blood continues to flow or stays still. If the blood does not travel, it can pool and push blood on other branches causing them to narrow and further reduce blood flow. It can also result in a ballooning or widening of the aorta, causing an aneurysm.
Risk of aortic dissection may be elevated due to a number of conditions:
- History of high blood pressure
- Previous thoracic aortic aneurysm
- Inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome
- Congenital heart defects, such as coarctation of the aorta (narrowing of the aorta)
- Blood vessels swelling due to auto-immune conditions, such as arteritis (inflammation of artery walls) and syphilis
Less commonly, aortic dissection may be caused by trauma or injury to the aorta.
Symptoms of Aortic Dissection
Almost all patients with an acute aortic dissection experience pain in the chest, neck, back, abdomen or legs. The area where the pain subsides depends on the location of the dissection. The pain often comes on suddenly and is at its most severe at the start. Patients often describe it as a sharp, stabbing pain or tearing. The pain can also travel, moving to the arms or legs as the condition worsens.
Additional symptoms may include the following:
- Difficulty swallowing
- Dizziness or fainting
- Nausea and vomiting
- Pain in the abdomen
- Pale skin
- Rapid, weak pulse
- Shortness of breath or trouble breathing when lying flat
- Stroke-like symptoms
The sooner an aortic dissection is diagnosed and treated, the more likely a patient is to survive.
Treatment of Aortic Dissection
Houston Methodist physicians will conduct a physical examination and review the patient’s medical history. Blood work will be taken to rule out a heart attack. A series of tests may be required, including a cardiac MRI, chest X-ray, computed tomography (CT) scan with contrast dye, an echocardiogram or transesophageal echocardiogram (TEE).
Some cases of aortic dissection can be treated with medication. This usually involves taking drugs to decrease blood pressure and manage pain. Beta blockers may also be prescribed to alleviate hypertension.
Endovascular repair, which involves a smaller incision than open surgery, is another option to treat aortic dissection. This involves placing a stent graft to close the defect within the lining of the aorta. For cases where medication or endovascular repair are not possible, open surgery is often necessary. In open surgery, the segment of torn aorta is removed and replaced with a synthetic graft.
The Aortic Program, part of the Houston Methodist DeBakey Heart & Vascular Center, serves the specific needs of patients living with complex aortic conditions. When aortic problems arise, patients know they can rely on Aortic Program doctors and staff for prompt, patient-focused care. Each member of our multidisciplinary team of cardiologists, surgeons, nurse practitioners and other professionals has years of experience in treating conditions specific to the aorta. Our unique combination of unparalleled expertise and advanced technology enables us to offer each patient a treatment program tailored to his or her needs.