Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection.
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.
Song
Jong-Min
JM
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jmsong@amc.seoul.kr
Kim
Sung-Doo
SD
Kim
Jeong-Hoon
JH
Kim
Mi-Jeong
MJ
Kang
Duk-Hyun
DH
Seo
Joon Beom
JB
Lim
Tae-Hwan
TH
Lee
Jae Won
JW
Song
Meong-Gun
MG
Song
Jae-Kwan
JK
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