Aortic dissection is caused by longitudinal dissection of weakened aortic media by blood stream and associated with hypertension, Marfan's syndrome, congenital vascular anomaly such as bicuspid aortic valve or coarctation of aorta and pregnancy. Aortic dissection has a very high mortality of over 90% without treatment. In Korea, it is easily anticipated that the frequency of aortic dissection maybe increased probably due to the westernization of life style and increasing tendency of hypertension and lift expectancy. But there are lack of detailed reports about aortic dissection in Korea till now. The author reviewed 28 cases of aortic dissection for 15years and compared them with other countries in aspects of etiological diseases, clinical presentations, complications, laboratory data, diagnostic modalities, treatments and hospital courses. The results were as folowings: 1) The most frequent age group was seventh decade and there was slightly higher incidence in female. 2) According to the DeBakey classification, type I was found in 25%, type II in 43%, and type III in 32%. 3) Hypertension was the most frequent cause, comprising 71% (20 cases) and Marfan's syndrome was found in 3 cases and cardiovsascular syphilis, chest trauma and unknown in each 2 cases respectively. 4) The frequent symptoms were pain in 79%, dyspnea in 46%, headache in 32%, and nausea & vomiting in 21%. Diastolic murmur was heard in 21%. 5) Aortic rupture was complicated in 32%, vascular obstruction in 32%, shock in 25%, aortic regurgitation in 21% and congestive heart failure in 18%. 6) According to the age of dissection, acute dissection was found in 61% and chronic dissection in 39%. Aortic rupture, heart failure and vascular obstruction were more common in acute dissection. The patients who died in hospital were exclusively in acute dissction. In marfan's syndrome aortic dissection occurred suddenly during hospitalization. 7) Chest x-ray film showed cardiomegaly in 46%, dilatation of aortic arch in 39% and diffuse mediastinal widening in 31%. 8) Laboratory data showed leukocytosis in 36%, anemia in 25%, increased total bilirubin in 18%, increased SGOT or SGPT in 32%, increased BUN or creatinine in 18%, hematuria in 39% and proteinuria in 46%. 9) ECG showed left ventricular hypertrophy in 42%, old myocardial infarction or myocardial ischemia in 25%, ventricular arrhythmia in 18%, atrial arrhythmia in 11% and heart block in 11%. 10) The first recognition of aortic dissection was made by aortography in 32%, echocardiography in 32%, C.T. in 29% and abdominal sonography in 7%. 11) The hospital death rate was 21% and the causes of death were aortic rupture in 4 cases and congestive heart failure and D.I.C. in each one. The higher mortality was observed in acute dissection, combined hypertension, intially hypotensive patient, old age, congestive heart faiulre, aortic rupture and myocardial ischemia or infarction. The authors have found that, comparing with those of other countries, aortic dissection was more common in female, proximal type were more frquent, dyspnea and aortic rupture were more common and aortic regurgitation was less common. And renal and hepatic dysfunction were more common.
Alanine Transaminase ; Anemia ; Aorta, Thoracic ; Aortic Coarctation ; Aortic Rupture ; Aortic Valve ; Aortic Valve Insufficiency ; Aortography ; Arrhythmias, Cardiac ; Aspartate Aminotransferases ; Bicuspid ; Bilirubin ; Cardiomegaly ; Cause of Death ; Classification ; Creatinine ; Dilatation ; Dyspnea ; Echocardiography ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Headache ; Heart ; Heart Block ; Heart Failure ; Heart Murmurs ; Hematuria ; Hospitalization ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Incidence ; Infarction ; Korea* ; Leukocytosis ; Life Style ; Marfan Syndrome ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Nausea ; Pregnancy ; Proteinuria ; Rivers ; Shock ; Syphilis ; Thorax ; Vomiting ; X-Ray Film