1. Síndrome Aórtico Agudo
C. Benítez P
CCVT HLV UG

2. Risk Conditions for Aortic Dissection
• Connective tissue disorders
• Hereditary fibrillinopathies
• Marfan’s syndrome
• Ehlers-Danlos syndrome
• Hereditary vascular diseases
• Bicuspid aortic valve
• Coarctation
• Chronic hypertension and atherosclerosis
• Smoking, dyslipidemia, cocaine/crack
• Vascular inflammation
• Giant cell arteritis
• Takayasu arteritis
• Behcet’s disease
• Syphilis
• Ormond’s disease
• Deceleration trauma and iatrogenic origin
• Deceleration trauma (car accident, fall from height)
• Iatrogenic factors
• Catheter/instrument intervention
• Valvular/aortic surgery
• Side or cross clamping/aortotomy
• Graft anastomosis
• Patch aortoplasty
• Cannulation site

4. • El punto del desgarro
intimal da la
deficinicón del tipo .
…………………….
………….. Y su pronóstico y
tratamiento

5. • Symptom Comment
• Experience of pain Almost ubiquitous—96% of patients report pain
• Location of pain Anterior characterizes ascending dissection;
• posterior characterizes descending dissection
• Severity of pain “10 out of 10”
• Onset of pain Abrupt (distinguishes from MI)
• Quality of pain “Tearing” quality
• Variability of pain Classical patterns common, but not invariable;
• 4% of patients experience no pain
• Waxing and waning Variability in severity of pain reflects physiological
• of pain (decrease in aortic wall tension with rx of BP) and
• anatomic events (spontaneous re-entry).
• Pleuritic component Reflects pericardial and pleural inflammation
• Cardiac ischemia True anginal/infarction symptoms may occur from
• involvement of RCA
• Abdominal pain Vigilant search for intestinal ischemia essential
• (lethal phenomenon)
• Renal ischemia Usually asymptomatic, except in case of infarction
• Leg pain From involvement of iliac artery by dissection
• process
• Paralysis of legs From spinal cord ischemia or peripheral nerve ischemia
• (paraplegia)
• Syncope From either:
• Involvement of head vessels
• Tamponade
• Acute aortic insufficiency
• Vaso-vagal response to pain
• Dyspnea Acute aortic insufficiency poorly tolerated

6. Signs of Aortic Dissection
Sign Comment
• Hypertension (or hypotension) Hypertension more common in descending
dissection
• Hypotension may signify tamponade
• Aortic insufficiency AI murmur may hide
• Pulse deficits Most common in an arm: “pseudo-hypotension”
• Fever Intense inflammatory response to dissection
• Local signs in mediastinum Hoarseness (stretch of recurrent laryngeal nerve)
• Tracheal obstruction (by aorta)
• Hemoptysis (pulmonary rupture)
• Hematemesis (esophageal rupture)
• Continuous murmur (rupture into RA, RV, LA)

7. AngioTAC

9. AngioTAC 3d

10. MRI

11. MRI
• Desventajas :
Mayor tiempo
Metales
Pcte inestable

12. Eco TE
Objetiva
• Flap de Disección
• Flujo o trombosis en
falso lumen

14. Recordar

16. Todo es igual ????

19. Asociados a Válvula Bicúspide
• Recuerde
2% de la población
Válvula bicúspide

20. • Recuerde :
• Gradiente medio > 30
= INTERVENCION

21. Que es mejor ???

22. Zonas de Landing

23. Clasificación de Crawford
Tipo I Desde el tercio superior de la aorta torácica hasta la
parte superior de la abdominal. Incluye arterias
viscerales.
Tipo II Desde el tercio proximal de la aorta descendente a la
aorta infrarrenal.
Tipo III Empieza en los dos tercios distales de la aorta torácica y
se extiende por gran parte de la aorta abdominal
Tipo IV Confinado a la aorta abdominal, incluyendo vasos
viscerales

24. Identificação do real diametro do vaso
Lei de Laplace
Davies JE and Sundt TM (2007) Surgery Insight: the dilated ascending aorta—indications
for surgical

25. Crecimiento Aneurisma
Coady M. A. et al.; J Thorac Cardiovasc Surg 1997;113:476-491

26. Manejo en Urgencia
• Dx Diferencial:
TEP masivo
SCA
Neumotórax a tensión

27. Manejo en Urgencia
• Analgesia
• Stress de la Pared
Vasodilatadores
directos
Betabloqueo
Descartar compromiso
visceral precoz.

28. No lo Olvide
• “There is no disease more conducive to
clinical humility than aneurysms of the
aorta”
Sir William Osler
1900