Acute Aortic Syndromes
Cystic medial degeneration in the aortic wall is an intrinsic feature of several connective tissue disorders which are associated with dissection such as Marfan’s syndrome, Ehlers–Danlos syndrome and, occasionally, giant cell aortitis. All patients in whom a thoracic aortic dissection is suspected should be monitored and treated in a high-dependency environment for haemodynamic and cardiac rhythm monitoring and for central venous access. The attrition rate in patients with proximal dissection treated surgically occurs through complications having already occurred or through the friability of the aortic wall at surgery. Preservation of the native aortic valve, which avoids the complications associated with a prosthetic valve, usually requires approximation of the two layers of dissected aortic wall and resuspension of the commissures with pledgeted sutures. Fenestration may be performed alongside ascending aortic surgery and additional abdominal aortic grafting. Degeneration of the collagen and elastin matrix within the aortic medial layer is the chief predisposition in most cases of aortic dissection.