In recent years, there have been significant improvements in the management of acute aortic dissection, including screening, diagnosis, and surgical options. However, acute aortic dissection represents a serious cardiovascular disease associated with a high risk of early mortality and significant morbidity in those who emerge from the emergency phase. Considerable progress has been made in the last decade in improving our understanding of the pathophysiology of this disorder. The current classifications of acute aortic dissection have faced challenges. There is a growing scientific consensus in favor of a classification that integrates existing features based on both morphological and functional criteria. The location and size of the initial tear in the innermost layer of the aorta determine the main cause of the aortic dissection. This tear causes the middle layer of the aortic wall to rupture and affects the size of the effected area. It is crucial to determine the necessary course of action for the patient, which may involve emergency surgery, endovascular intervention, or the most appropriate conservative care. The management and monitoring of acute aortic dissection is a constantly evolving field of research. This review provides an overview of preventing, recognizing, and treating life-threatening acute aortic dissections.

In recent years, there have been significant improvements in the management of acute aortic dissection, including screening, diagnosis, and surgical options. However, acute aortic dissection represents a serious cardiovascular disease associated with a high risk of early mortality and significant morbidity in those who emerge from the emergency phase. Considerable progress has been made in the last decade in improving our understanding of the pathophysiology of this disorder. The current classifications of acute aortic dissection have faced challenges. There is a growing scientific consensus in favor of a classification that integrates existing features based on both morphological and functional criteria. The location and size of the initial tear in the innermost layer of the aorta determine the main cause of the aortic dissection. This tear causes the middle layer of the aortic wall to rupture and affects the size of the effected area. It is crucial to determine the necessary course of action for the patient, which may involve emergency surgery, endovascular intervention, or the most appropriate conservative care. The management and monitoring of acute aortic dissection is a constantly evolving field of research. This review provides an overview of preventing, recognizing, and treating life-threatening acute aortic dissections.

OBJECTIVE: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians. METHODS: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis. RESULTS: 326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%. CONCLUSIONS Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine.
Adult ; Anxiety ; Aripiprazole* ; Clozapine ; Diagnosis ; Drug Monitoring ; Early Diagnosis ; Female ; Humans ; Indomethacin ; Myocarditis ; Panic ; Pericarditis* ; Polypharmacy ; Psychotic Disorders ; Valproic Acid*