by Laura Cuppini
It occurs when the internal layer of the aorta tears, causing blood to enter the wall and causing the formation of a false “lumen”, the rupture of which leads to an often fatal hemorrhage.
Vittorio Emanuele Parsi, full professor of International Relations at the Catholic University of Milan, underwent emergency surgery for dissection of the aorta, as he said in an interview with Corriere. On December 27, while speaking in public in Cortina, he had a strong pain in his chest. A few hours later he was in the operating room.
The true light and the false light
Aortic dissection (or dissection) is a very serious pathology characterized by the passage of blood between two layers of the aorta wall, which are separated with the formation of two “lumen” (internal cavities of the artery): the true lumen of the aorta and the “false lumen”. The outer wall of the false lumen is very weak and its rupture leads to fatal aortic hemorrhage. Aortic dissection carries high mortality rates within the first 48 hours of symptom onset.
The causes and role of hypertension
Aortic dissection can be caused by Marfan syndrome (systemic connective tissue disease) or by atherosclerosis (pathology characterized by alterations of the artery wall, which lose its elasticity). However, arterial hypertension, which can damage the aortic wall, plays an important role. The dissection can be of three types: the first begins at the level of the ascending aorta and extends along the entire length of the artery; the second begins in the same point but ends earlier, sparing the supra-aortic trunks; the third begins at the level of the descending thoracic aorta and continues to the diaphragm or even beyond.
The possible consequences
When the dissection extends towards the heart it can cause detachment of the aortic valve leaflets, thus causing severe insufficiency. Furthermore, the dissection can compress the arteries branching from the aorta from the outside, causing acute ischemia. If the dissection is “proximal” (i.e. extended towards the heart) obstruction of the coronary arteries may occur resulting in acute myocardial infarction. If, however, it occurs distally (i.e. in the opposite direction to the heart), there may be compression of the supra-aortic trunks, with cerebral ischemia, or of other arteries. The most serious complication of an aortic dissection (potentially fatal) is hemorrhage that occurs when the damaged wall tears due to internal pressure.
Symptoms: acute chest pain
The main symptom of aortic dissection is acute pain in the chest, similar to that of a heart attack, which however also extends posteriorly between the shoulder blades and towards the lumbar region. The pain appears suddenly and is accompanied by the signs of hemorrhagic shock: hypotension, sweating, shortness of breath and, sometimes, loss of consciousness. If the dissection causes acute aortic insufficiency, there is severe respiratory difficulty, up to pulmonary edema. Other symptoms linked to the compression of the arteries originating from the aorta may then appear, such as hemiparesis (partial loss of motor function of one half of the body), aphasia (speech disorder) due to cerebral ischemia or abdominal pain due to intestinal ischemia. Ischemia is defined as the decrease or interruption of the blood supply in a specific area of the body. If the dissection also affects the renal arteries it can lead to death within a few hours.
Diagnosis and therapies
The diagnosis is made with an echocardiogram, which allows us to highlight the dissection, the “false lumen”, and the patency (condition of normal opening of a conduit) of the main arteries starting from the aorta. The therapy is based on intensive treatment of the state of shock and on the use of anti-hypertensive drugs. In the case of dissection of the descending thoracic aorta or abdominal aorta, spontaneous healing may sometimes occur due to coagulation of the blood contained in the false lumen. In all other cases it is necessary to subject the patient to emergency surgery.
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February 16, 2024 (modified February 16, 2024 | 11:52)
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