title: Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.
abstract: Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention.
authors.affiliation: Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.
authors.forename: C S
authors.initials: CS
authors.lastname: Roberts
authors.forename: W C
authors.initials: WC
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000473:pathology*; D001013:Aorta, Thoracic / Q000473:pathology; D001019:Aortic Rupture / Q000473:pathology*; D001344:Autopsy; D016122:Brachiocephalic Trunk / Q000473:pathology; D002339:Carotid Arteries / Q000473:pathology; D005260:Female; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000473:pathology; D011651:Pulmonary Artery / Q000473:pathology