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Common Congenital Heart Lesions - page 106 / 126

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Pathophysiology: In aortic dissection, a blood filled channel divides the medial layers of the aorta, (bluntly) dissecting the intima from the adventitia along various lengths of the vessel. ADis is definitely a life-threatening condition.

Diagnostic tests/Imaging: Diagnosis of ADis must not be delayed! Death may ensue. Transesophageal Echocardiography: one of the most useful tests; often the initial diagnostic test because of its universality (most hospitals can do this), great sensitivity and specificity, and reasonable cost. MRI and contrast angiography: also useful for detecting ADis

Treatment: Treatment of ADis must have aim to stop the dissection that’s taking place. If acute ADis, must reduce systolic BP and decrease LV contraction force to minimize aortic wall shear stress.

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    Drugs to use: Beta-blockers (to reduce force of LV contraction and to lower BP), vasodilators (to rapidly reduce

BP).

Surgical therapy: repairing intimal tear, suturing edges of false channel, sometimes inserting a synthetic aortic graft Type A dissections: early surgical correction shown to improve outcome compared with drugs alone.

Type B dissections: if uncomplicated and subacute, managed with aggressive drugs alone – early surgical intervention does not improve patient outcome.

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    If develop evidence of propagation of ADis, compromise of major branches of aorta, impending rupture, or

continuing pain, then do surgery.

Catheter based repair with endovascular stent-grafts is being explored as an alternative to surgical intervention.

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