Treatment Of 36 Cases Of Aortic Dissection

BACkGROUND Aortic Dissection is a rare disease with potential risk and high mortality. This disease was first reported by Laennel in 1820. Most patients were attacked in their age of 40 to 70. Morbidity is about 5～10 patients in one million people per year. The morbidity of male is higher than female. The ratio is about 2～3:1. The morbidity is low, but the onset of it is abrupt and it has a high mortality. And the clinical manifestation is similar to acute coronary syndrome and pericarditis. So it is usually misdiagnosed by doctors. John Hunter and Cooper started to carry out the surgery therapy of this disease firstly at the beginning of 19 century. It wasn't succeeded but caused the revolution of aorta therapy in 1940s. And on one hand, in the influence of the rapid development of science and technology in 1960s, the method of operation had been improved, conservative treatment had been pay much attention to, and interventional therapy, which based on the development of technology, was introduced. On the other hand, many patients had been cure along with the medical reform. The mortality of AD decreased from 100% to 18%. Now there are three kinds of therapy about AD, operative therapy, conservative therapy and interventional therapy. And the ways of operative therapy and interventional therapy become varied because of further research. And stimulated by the technology revolution, more studies of AD will be launched. AIM Summarize the experience of diagnosis and treatment of aortic dissection patients who had been in hospital from January 2006 to January 2011 in the Research Institute of Cardiovescular Diseases of our hospital.METHOD METHOD:We have 69 AD patients in our hospital from January 2006 to January 2011.54 patients are male and 9 are female.54 patients are male and 9 are female.35 of them suffer from hypertension(50.7%),6 of them have Marfan's syndrome(8.7%),13 of them suffer from cardio valve disease(18.9%).57 of them were diagnosed definitely by three-dimensional spiral CT and cardio CDUS(82%), and 6 of them were misdiagnosed cases(9%).17 patients had accepted operative treatment in total,5 of them accepted Bentall operation,1 of them accepted Bentall and ascending aorta replacement operation,2 of them accepted Bentall and semi-arch replacement operation,2 of them accepted the operation of ascending aorta,1 of them accepted both the operation of ascending aorta and covered stent implanted therapy,4 of them were treated by the operation of Bentall and total arch replacement and covered stent implanted therapy,1 of them accepted both total arch replacement operation and covered stent implanted therapy,1 of them accepted ascending aorta and total arch replacement operation and covered stent implanted therapy.8 patients took the covered stent implanted therapy only.3 patients patients died after ineffectual rescue work(4.3%). And 35 patients left demanded to leave hospital after conservative therapy.RESULT There are 69 patients who suffered from AD in total.3 of them died of cardiac and respiratory arrest after ineffectual treatment. Among the 35 patients who accepted conservative therapy,6 of them died when they accepted their treatment (17.1%). Among the 17 patients who accepted operative therapy,15 patients were cured (88.2%),1 of them died (5.9%).6 patients who accepted interventional therapy were cured. Follow up observation shows that 22 patients loss of follow-up (31.9%, including 5 patient who accepted operation,2 patients who accept interventional therapy, and 16 patients left are conservative therapy); 8 patients got well after operation and 5 got well after interventional therapy; In 35 patients who accepted conservative treatment,3 of them have no abnormalities(8.6%),3 of them still have recurrent complications(8.6%, all of them have fluctuant blood pressure, one of them suffered from cerebral infarction).6 patients had already died(17.1%),4 of them died of renal failure and two of them died of unknown reasons.CONCLUSION AD has a high mortality. Conservative therapy could decrease its mortality to a certain extent, but the long-term prognosis is still bad. Operative therapy has a higher risk comparing with conservative treatment, but it's more effective in long-term observation. The cure rate of interventional therapy is high, but its application is still limited. The current situation of our country is that people in some area have poor health concept and most people know little about this kind of disease. And our medical environment and technology need to improve, too.