RESUMEN
Acute aortic dissection is the most common catastrophe of the aorta and is associated with high morbidity and mortality. The 2-week mortality rate approaches 75% in patients with undiagnosed ascending aortic dissection. Despite advances in diagnostics and medical and surgical techniques, as well as the emergence of an endovascular management approach, the overall mortality associated with aortic dissection is 27%. An aortic dissection lesion begins with a tear that is typically transverse and does not involve the entire circumference of the vessel. The tear in the aortic intima and media allows for the blood to surge into the aortic wall. A 56-year-old Egyptian male patient known ischemic heart disease, heavy smoker presents to the Emergency Department with a history of sudden onset of constricting epigastric pain and right loin pain with radiation to the back and parasternal area, with normal blood pressure ,equal pulse. ECG showed incomplete RBBB, T wave inversion from V2 to V6. Bedside echocardiography showed good LVEF, good kinesis of LV wall, widened Aortic root [43mm]. TEE has proven extensive partially thrombosed aortic dissection starting 1 cm above the root of the aortic valve and Involving all the visible thoracic aorta communication between real lumen and false lumen was seen at the level of 25 cm of descending aorta. Spiral CT for chest and abdomen showed extensive Aortic dissection involving anterolateral aspect of ascending, descending thoracic aorta and posterolateral aspect of abdominal aorta. Right renal artery was involved as well, with multiple right renal infarctions, angiography was done and revealed occluded right renal artery and dilated ascending aorta, LAD had a 70% lesion near the apex, LCX had a 30% osteal lesion. Aortic angiogram showed grossly dilated ascending and arch of aorta. Aortic branches are not compromised. Patient was treated with nitroglycerin infusion, sodium nitroprusside infusion, labetalol and sedation. Was stabilized, then surgical repair of ascending Aorta with reposition of the Aortic valve was done. Eariy diagnosis of aortic dissection can speed up the process of management medically or surgically, and can increase the survival rate for such patients. Once you suspect aortic dissection you should proceed to more investigations with out excluding the clinical presentation from the picture