Complications
Risk dependent on method used to reattach the coronary artery button.
May present with: severe, stabbing, sudden-onset chest pain; absent pulses; confusion; tachycardia; loss of consciousness; signs of abdominal ischemia; differing BP in different arms, wide pulse pressure due to aortic regurgitation, or distant heart sounds secondary to tamponade.
Left shoulder, back, or abdominal pain is not infrequent.
Requires immediate surgery, once confirmed by echo and CT scan/MRI of the thorax. Exceptions are previous cardiac surgery, dissection more than a few days old, history of CAD, and anticoagulation therapy. Uncomplicated acute dissection of the descending aorta (type B) may initially be managed medically.[19]
Cardiac catheterization is recommended in patients with previous cardiac surgery and those with possible CAD.
Acute dissection beyond the left subclavian artery is initially treated medically, unless there is evidence of distal ischemia.
Following surgery for aortic dissection, lifelong therapy with beta-blockers (or an angiotensin-II receptor antagonist if beta-blockers are contraindicated/not tolerated) is indicated.
Usually seen after previous cardiac surgery.
Patients require extensive workup for surgery. Most require initial aortic arch replacement beyond a previous ascending aortic graft insertion using the so-called elephant trunk procedure.[87]
A second-stage elephant trunk procedure is required 2 to 4 months postoperatively.
In many patients, the entire aorta is replaced because of the dissected weakened aorta becoming aneurysmal.
Following surgery for aortic dissection, lifelong therapy with beta-blockers (or an angiotensin-II receptor antagonist if beta-blockers are contraindicated/not tolerated) is indicated.
The weakened aortic wall is still too stressed by pulsatile flow.
If dilation is beyond 2 mm every 6 months or aortic root area/body height ratio of 10 despite drug treatment, surgical referral is recommended.
Occurs with aortic root dilation.
May be recurrent so use of mesh strongly recommended during first repair.[91]
Mitral valve prolapse often progresses to severe mitral valve regurgitation, especially in females.
Surgery is indicated when regurgitation either becomes severe (grade 4+) or symptomatic or there is evidence of hemodynamic compromise.[88]
Low risk in David reimplantation; high risk in composite valve graft procedure.
Heart valve disease or intrinsic cardiomyopathy may occur and require referral to a cardiologist.
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