Clinical & radiological features of type a aortic dissection - an indian perspective

As the literature lacks reports from Indian subcontinent, the present study was undertaken to understand Indian scenario at initial presentation of Type A Aortic Dissection (TAAD).

Materials and method: Records of 162 patients operated for TAAD from June 2014 to June 2019 were analysed about presentation patterns, clinical manifestations, and radiological features.

 Results: - The mean age was 43.3 ± 13.49 years (range 15-78), and 131 were male. 146 patients had acute, and 16 had chronic TAAD. Risk factors included hypertension (44.4%), smoking (27.8%), Marfan syndrome (27.8%), bicuspid aortic valve (8.6%), and ascending aortic/root dilatation (6.1%).   Chest pain was the commonest (88.9%) presenting symptom, followed by palpitations in 26.5 %, dyspnoea in 42 %, and syncope in 13.6 % patients. Seven patients had cerebrovascular accident.  On third of patients reported within 24 hours of the onset of pain, 45.6 % patients between 2 days to 14 days, and 11.1% patients reported after 14 days.  41.4 % patients had initial systolic blood pressures of more than 140 mmHg.  Four patients had renal malperfusion, and 23 had lower limb ischemia. Chest radiography showed mediastinal widening in 88.8 % patients. Transthoracic echocardiography identified dissection flap sin 81.4 % patients. Severe aortic regurgitation was present in 65.2% patients. The mean aorta diameter was 50.6 ± 11.9 mm (range 28-84 mm) and 54.5 ±  15.8 mm (range 26-100 mm) at the sinus level and beyond the sino-tubular junction.

Conclusion:

Indian patients were younger, predominantly male, and had lower prevalence of hypertension and higher prevalence of Marfan syndrome. Only one third patients reached to us in first 24 hours.  Aortic diameter was less than 55 mm in more than half of our patients.