Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights
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 lim...
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Veröffentlicht in: | Journal of the American College of Cardiology 2016-09, Vol.68 (10), p.1054-1065 |
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creator | Peterss, Sven Mansour, Ahmed M Ross, Julia A Vaitkeviciute, Irena Charilaou, Paris Dumfarth, Julia Fang, Hai Ziganshin, Bulat A Rizzo, John A Adeniran, Adebowale J Elefteriades, John A |
description | 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. |
doi_str_mv | 10.1016/j.jacc.2016.05.091 |
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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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2016.05.091</identifier><identifier>PMID: 27585511</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Aneurysm, Dissecting - classification ; Aneurysm, Dissecting - complications ; Aneurysm, Dissecting - etiology ; Aneurysms ; Aortic Aneurysm, Thoracic - classification ; Aortic Aneurysm, Thoracic - complications ; Aortic Aneurysm, Thoracic - etiology ; Cardiology ; Chronic Disease ; Humans ; Medical imaging ; Veins & arteries</subject><ispartof>Journal of the American College of Cardiology, 2016-09, Vol.68 (10), p.1054-1065</ispartof><rights>Copyright © 2016 American College of Cardiology Foundation. 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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.</description><subject>Aneurysm, Dissecting - classification</subject><subject>Aneurysm, Dissecting - complications</subject><subject>Aneurysm, Dissecting - etiology</subject><subject>Aneurysms</subject><subject>Aortic Aneurysm, Thoracic - classification</subject><subject>Aortic Aneurysm, Thoracic - complications</subject><subject>Aortic Aneurysm, Thoracic - etiology</subject><subject>Cardiology</subject><subject>Chronic Disease</subject><subject>Humans</subject><subject>Medical imaging</subject><subject>Veins & arteries</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0MtKAzEUBuAgitbLC7iQgBs3M-aejLsyWhUKiui6pJlMJ0M7qUlG6dv4LD6Zg9aNK1fnwPn44fwAnGKUY4TFZZu32picDHuOeI4KvANGmHOVUV7IXTBCkvIMo0IegMMYW4SQULjYBwdEcsU5xiPQlo3uFq5bwEedGr_0iw30NUyNhc-ND9o4A8c-JP35MQl-BcemTxYmD8sm-G44XrsYrUnOd1dw6pINOvXBwif75uw71F0F77voFk2Kx2Cv1stoT7bzCLxMbp7Lu2z6cHtfjqfZmkiSMlFjWhOmdaWwFEYWrJgrRpBChNSSWSIRnSPGlNZazaUqpGSmQrqoLK4FYfQIXPzkroN_7W1Ms5WLxi6XurO-jzM8dIAZE5T-hwpB-U_q-R_a-j50wyPfigrBOBrU2Vb185WtZuvgVjpsZr-F0y-klIJi</recordid><startdate>20160906</startdate><enddate>20160906</enddate><creator>Peterss, Sven</creator><creator>Mansour, Ahmed M</creator><creator>Ross, Julia A</creator><creator>Vaitkeviciute, Irena</creator><creator>Charilaou, Paris</creator><creator>Dumfarth, Julia</creator><creator>Fang, Hai</creator><creator>Ziganshin, Bulat A</creator><creator>Rizzo, John A</creator><creator>Adeniran, Adebowale J</creator><creator>Elefteriades, John A</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20160906</creationdate><title>Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights</title><author>Peterss, Sven ; 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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.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>27585511</pmid><doi>10.1016/j.jacc.2016.05.091</doi><tpages>12</tpages></addata></record> |
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subjects | Aneurysm, Dissecting - classification Aneurysm, Dissecting - complications Aneurysm, Dissecting - etiology Aneurysms Aortic Aneurysm, Thoracic - classification Aortic Aneurysm, Thoracic - complications Aortic Aneurysm, Thoracic - etiology Cardiology Chronic Disease Humans Medical imaging Veins & arteries |
title | Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights |
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