Cardiologist Questions Cardiologist

Aorta questions?

Looking for a school project, can't find anything definitive online. Why would an ascending aortic dissection generally require surgery, when a descending would not? Does it have to do with pressures or wall thickness?


2 Answers

CardiologistCardiologist
Ascending aortic dissection would require surgery usually in an emergent fashion due to the very close proximity of the dissection to the very important blood vessels such as arteries to heart itself (coronary arteries) and arteries going into the brain (carotid and vertebral arteries). Dissection causing blockage of these arteries would lead to massive heart attack or stroke, also ascending aortic aneurysms are more prone to rupturing into the sac outside the heart called pericardium which can lead to compression of heart and death, these circumstances warrant that ascending aortic aneurysm to be fixed emergently. Sometimes descending aortic dissection could affect arteries in the gut or kidneys or legs, in these circumstances it needs to be addressed immediately, however vast majority of descending aortic dissections do not affect those arteries, so they can be managed with good control of blood pressure that would allow for healing of the dissection or prevent getting worse. Good luck with your school project!
This is quite a project. The reason that aortic aneurysms are separated for treatment is this: If the dissection, which typically begins at the ductus arteriosis, goes downward to the distal aorta, the only indication for surgery is poor blood flow to the gut or extremities. The reason that a dissection that goes retrograde to the ascending aorta is repaired, is that the risk of blood dissecting into the pericardium, which is generally deadly.