title: Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights.
abstract: We review current knowledge regarding the natural transition of aortic dissection from acute to chronic stages. As this is not well understood, we also bring to bear new data from our institution. Type A dissection rarely transitions naturally into the chronic state; consequently, information is limited. Type B dissections are routinely treated medically and indeed undergo substantial changes during their temporal course. General patterns include: 1) the aorta dilates and, absent surgical intervention, aortic enlargement may cause mortality; 2) continued false lumen patency, particularly with an only partially thrombosed false lumen, increases aortic growth, whereas calcium-channel blockers affect aortic dilation favorably; 3) aortic dilation manifests a temporal dynamic, with early rapid growth and deceleration during transition; 4) the intimal flap dynamically changes over time via thickening, straightening, and loss of mobility; and 5) temporal remodeling, on the cellular level, initially shows a high grade of wall destruction; subsequently, significant fibrosis ensues.
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.
authors: Sven
authors: S
authors: Peterss
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
authors: Ahmed M
authors: AM
authors: Mansour
authors: Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
authors: Julia A
authors: JA
authors: Ross
authors: Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
authors: Irena
authors: I
authors: Vaitkeviciute
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
authors: Paris
authors: P
authors: Charilaou
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
authors: Julia
authors: J
authors: Dumfarth
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; China Center for Health Development Studies, Peking University, Beijing, China.
authors: Hai
authors: H
authors: Fang
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Disease #2, Kazan State Medical University, Kazan, Russia.
authors: Bulat A
authors: BA
authors: Ziganshin
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, New York.
authors: John A
authors: JA
authors: Rizzo
authors: Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
authors: Adebowale J
authors: AJ
authors: Adeniran
authors: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. Electronic address: john.elefteriades@yale.edu.
authors: John A
authors: JA
authors: Elefteriades
mesh_terms: D000784:Aortic Dissection / Q000145:classification / Q000150:complications* / Q000209:etiology; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000150:complications* / Q000209:etiology; D002908:Chronic Disease; D006801:Humans
keywords: acute/chronic aortic dissection; aortic dissection histopathology; aortic wall; growth/dilation rate; natural history