title: Can we predict the site of entry tear by computed tomography in patients with acute type a aortic dissection?
abstract: BACKGROUND
  In patients with acute type A aortic dissection (AAD), localization of the primary entry tear to be excluded is of major importance for intervention.
  
  
  OBJECTIVE
  There are reliable indirect computed tomography (CT) findings to predict the entry site.
  
  
  METHODS
  In 83 patients with type A AAD whose primary entry tears were identified surgically between 2003 and 2009, we retrospectively examined the diagnostic CT scans regarding pericardial effusion, the largest short-axial diameter of the aorta, widths of true and false lumens, and false lumen thrombosis at 6 levels of thoracic aorta from the aortic root to the descending aorta.
  
  
  RESULTS
  The primary entry sites identified intraoperatively were proximal ascending in 21 patients, middle ascending in 21, distal ascending in 21, arch in 17, and descending or unknown in 16. The multivariate logistic analysis revealed that pericardial effusion (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.2-3.4, P < 0.001) and dilated ascending aorta (OR: 1.6, 95% CI: 1.1-2.4, P = 0.012) were the significant CT findings to predict the entry tear in the ascending aorta. It also revealed that the significant CT finding to predict the entry tear distal to the aortic arch was nonthrombosed false lumen in the descending aorta (OR: 1.2, 95% CI: 1.1-2.1, P = 0.048).
  
  
  CONCLUSIONS
  We can predict the primary entry site by the preoperative CT findings in patients with type A AAD, considering pericardial effusion, aortic diameter, widths of true and false lumens, and false lumen thrombosis at different anatomic levels.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. takami@nagoya2.jrc.or.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takami
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Wataru
authors.initials: W
authors.lastname: Kato
authors.forename: Kei
authors.initials: K
authors.lastname: Fujii
authors.forename: Makoto
authors.initials: M
authors.lastname: Hibino
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Munakata
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uchida
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D001013:Aorta, Thoracic / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014056:Tomography, X-Ray