Téma: Overview works

Aortic dissection: necroptic and clinico-morphological analysis of 10 cases

Vladimír Bartoš, Jaroslav Ivan, Lívia Jančiová, Martin Péč

Introduction: Aortic dissection (AD) belongs to the life-threatening condition that is characterized by an intimal tear and a further longitudinal splitting of the wall of vessel. Etiology, morphological picture, and clinical manifestations are variable. Aim: The aim of the article was the evaluation of necroptical and clinico-morphological findings of all cases suffered from AD, that were dissected from January 2008 – to May 2009 in the Department of Forensic Medicine and Pathological Anatomy in Zilina. Material and methods: Observed group consisted of 10 patients (9 males, 1 female), mean age 59.2 years (age from 36 to 86 years). The elementary anamnesis data were obtained from clinical documentation or dead body inspection report. Complete necroptic examinations were made according to standard criteria. Results: Three cases consisted of hospitalized patients, 2 cases included a sudden collapse and exitus before arrival of the emergency medical service, 5 cases were death without witnesses. Clinically, the most frequent symptoms were an intense thoracic pain or back pain spreading to the lower extremity, in one case an acute ischemia of the lower extremity was reported. The hypertension was documented in 6 patients. Based on De Bakey classification we recognized 4 cases of dissection the type 1, and 6 cases of the type 2. According to Standford classification all cases were the type A. The external rupture of aortic root with a cardiac tamponade was present in 8 cases. We diagnosed 2 cases of a rupture of the ascendant aorta in higher position accompanied by a massive hemorrhage into the thoracic cavity. Histomorphologically, the atherosclerotic changes of variable degree (I – III degree) were predominating in 9 cases. Histological finding was consistent with idiopathic cystic medionecrosis of the aorta in 1 case. Conclusion: In our study the main disorder of AD was atherosclerotic aortosclerosis and the most common vascular risk factor was arterial hypertension. Despite of diagnostic and therapeutic advantages mortality remains still high. There is necessary to make clearer those etiologic factors and mechanisms that are associated with higher risk of its onset and to improve detection of disease even before the onset of the fatal complications.

Ročník 2009  Témy časopisu Internal medicine 6 / 2009

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