Aortic Dissection

Interview with Dr. Dhiren Shah, Cardiac Surgeon

Interviewer (Patient): Good morning, Dr. Shah. Thank you for taking the time to speak with me today. I have some concerns about a condition called aortic dissection. Could you explain what it is?

Dr. Dhiren Shah: Good morning. I’m happy to explain. An aortic dissection is a serious condition where there is a tear in the inner layer of the aorta, the large blood vessel branching off the heart. This tear creates two channels: one in which blood continues to travel, and another where blood is trapped. This can lead to the rupture of the aorta or decreased blood flow to other parts of the body.

Interviewer: That sounds quite severe. What are the primary causes of an aortic dissection?

Dr. Shah: Yes, it is a severe condition. The primary causes include chronic hypertension, which puts pressure on the aortic walls over time, and genetic conditions such as Marfan syndrome, which affects the connective tissue. Other risk factors include atherosclerosis, trauma, certain inflammatory conditions, and in rare cases, pregnancy.

Interviewer: What symptoms should someone look out for?

Dr. Shah: Symptoms of an aortic dissection can be sudden and severe. They often include sharp, tearing chest or back pain, which can radiate to the neck or down the back. Other symptoms may include shortness of breath, loss of consciousness, stroke-like symptoms, weak pulse in one arm or thigh compared to the other, and even paralysis in severe cases. If someone experiences these symptoms, they should seek emergency medical attention immediately.

Interviewer: How is an aortic dissection diagnosed?

Dr. Shah: Diagnosis typically involves imaging studies. A chest X-ray may show a widened aorta, but more definitive tests include CT angiography, MRI, or transesophageal echocardiography (TEE). These imaging techniques allow us to see the tear and assess the extent of the dissection.

Interviewer: Once diagnosed, what are the treatment options?

Dr. Shah: Treatment depends on the location and severity of the dissection. There are two main types: Type A, which involves the ascending aorta and is typically more dangerous, and Type B, which involves the descending aorta.

For Type A dissections, emergency surgery is often required to repair or replace the damaged section of the aorta. This surgery might involve replacing part of the aorta with a synthetic graft. For Type B dissections, if they are stable, they may be managed with medications to control blood pressure and heart rate, allowing the aorta to heal. However, if complications arise, such as continued pain or organ damage, surgery or endovascular stenting may be necessary.

Interviewer: What is the prognosis for someone who has had an aortic dissection?

Dr. Shah: The prognosis varies. Early diagnosis and treatment are crucial. For Type A dissections, surgical intervention significantly improves outcomes, but the risk of complications and mortality remains high. Type B dissections have a better initial prognosis, especially if managed medically, but long-term follow-up is necessary to monitor for complications like aneurysm formation.

Interviewer: Are there any preventive measures one can take to reduce the risk of an aortic dissection?

Dr. Shah: Yes, managing risk factors is key. Keeping hypertension under control through lifestyle changes and medication is essential. Regular check-ups, especially for those with a family history or genetic conditions like Marfan syndrome, are important. Avoiding smoking and maintaining a healthy lifestyle with regular exercise and a balanced diet also contribute to reducing the risk.

Interviewer: What advancements in treatment and management have there been in recent years?

Dr. Shah: Advances in imaging techniques have improved our ability to diagnose aortic dissections quickly and accurately. In terms of treatment, the development of endovascular stenting has provided a less invasive option for managing Type B dissections and some Type A cases. This approach involves inserting a stent-graft through a catheter to reinforce the aorta and seal the tear, which can reduce recovery times and complications compared to open surgery.

Interviewer: That’s very informative, Dr. Shah. Before we conclude, is there any advice you would give to someone who might be at risk of an aortic dissection?

Dr. Shah: My advice would be to maintain regular medical check-ups, especially if you have risk factors like high blood pressure or a family history of aortic conditions. Be vigilant about managing your blood pressure and leading a healthy lifestyle. If you experience any sudden, severe chest or back pain, seek medical attention immediately. Early intervention can be life-saving.

Interviewer: Thank you so much for your time and expertise, Dr. Shah. This has been incredibly helpful.

Dr. Shah: You’re welcome. I’m glad I could provide some clarity on this important issue. Stay healthy and take care.