Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes.
OBJECTIVE
To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition.


METHODS
We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years.


RESULTS
There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes.


CONCLUSIONS
Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.
Zalzstein
Eli
E
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. eliz@bgumail.bgu.ac.il
Hamilton
Robert
R
Zucker
Nili
N
Diamant
Samuel
S
Webb
Gary
G
D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D008382:Marfan Syndrome / Q000453:epidemiology*; D012307:Risk Factors; D016896:Treatment Outcome