title: Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection.
abstract: OBJECTIVE
  We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change.
  
  
  BACKGROUND
  Aneurysmal dilation of the aorta is a critical late complication in AD patients.
  
  
  METHODS
  Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending aorta surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 +/- 26 months, and CT was repeated for 31 +/- 27 months.
  
  
  RESULTS
  Aneurysm (diameter > or =60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic aorta (UT), mid descending thoracic aorta (MT), lower descending thoracic aorta (LT) and abdominal aorta (AA), respectively. Of 53 patients in whom CT was repeated for > or =2 years, the rates of aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 +/- 3.66 mm/year, 3.21 +/- 2.70 mm/year, 2.62 +/- 2.19 mm/year, and 1.93 +/- 3.13 mm/year, respectively (p < 0.01), and aneurysm developed in 15 (28%). The initial false lumen diameter at the UT, the aorta diameter at the MT, and Marfan syndrome were independent predictors of late aneurysm. A > or =22-mm initial false lumen diameter at the UT predicted late aneurysm with a sensitivity of 100% and a specificity of 76%. The patients with initial UT false lumen diameter > or =22-mm (n = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001).
  
  
  CONCLUSIONS
  The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jmsong@amc.seoul.kr
authors: Jong-Min
authors: JM
authors: Song
authors: Sung-Doo
authors: SD
authors: Kim
authors: Jeong-Hoon
authors: JH
authors: Kim
authors: Mi-Jeong
authors: MJ
authors: Kim
authors: Duk-Hyun
authors: DH
authors: Kang
authors: Joon Beom
authors: JB
authors: Seo
authors: Tae-Hwan
authors: TH
authors: Lim
authors: Jae Won
authors: JW
authors: Lee
authors: Meong-Gun
authors: MG
authors: Song
authors: Jae-Kwan
authors: JK
authors: Song
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome