Often Undetected, Aortic Dissection Can Be Treated if Caught Early

Until actor and comedian John Ritter died suddenly in September 2003, most of us had never heard of an aortic dissection – the undetected tear in Ritter’s aorta which tragically proved fatal to the popular television star.

An aortic dissection results when a split occurs in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body. A dissection differs from an aortic aneurysm, which is a weak spot in the wall of the aorta and is more common.

“A dissection allows blood to flow between the inner and outer layers of the aortic vessel, potentially blocking blood flow to vital organs such as the brain,” says John Robertson, M.D., chief cardiovascular and thoracic surgeon at Saint John’s Heart Institute. “A dissection also places the aortic wall at increased risk for rupture, creating an acute, life-threatening condition that can only be treated by immediate surgery.”

There are two types of aortic dissection. In type A, the tear occurs in the ascending, or beginning, part of the aorta. A type B is located in the descending, or lower, part of the aorta. A Type A dissection is the more life-threatening of the two and requires swift surgical attention. A Type B dissection can be treated with medical therapy, new stent grafts or surgery, depending on the severity of the disorder, according to Dr. Robertson.

Symptoms of an acute aortic dissection include the sudden onset of severe chest pain – either in the front or back of the chest – sometimes accompanied by sweating. Other symptoms can include faintness, shortness of breath, weakness and fatigue. Some individuals may display no pre-existing symptoms, however, making this disorder especially dangerous and difficult to detect, says Dr. Robertson.

Upon medical examination, a physician may find additional physical problems associated with aortic dissection that could include abnormal blood pressure (either high or low); a loss of pulse in an arm or leg due to aortic blockage, and pulmonary edema (fluid in the lungs). A dissection can also lead to stroke and other neurological conditions due to obstruction of the carotid arteries – the two neck arteries that supply blood to the brain.

The risk factors for aortic dissection include high blood pressure – a condition found in 70 percent of patients with dissection – and hardening of the arteries. People with a genetic condition known as cystic medial necrosis are also at higher risk because they are more susceptible to a tearing of the aortic wall, as are patients with a congenital aortic valve disorder. In addition, otherwise healthy women in their third trimester of pregnancy face increased risk, due to high blood pressure (also called hypertension).

As experts in the accurate detection and treatment of aortic dissection, the cardiovascular surgeons at Saint John’s Heart Institute employ the latest diagnostic tools, treatments and surgical innovations.

“We have the sophisticated technology and expertise to detect aortic dissections, and weare highly experienced in the surgical repair of a dissection, should immediate surgery become necessary in a life-threatening emergency,” says Dr. Robertson.

Saint John’s is also opening a state-of-the-art Critical Care Center in its North Pavilion to provide cardiac patients with the latest medical advances available for intensive care.

Heart Institute patients will be housed in the Critical Care Center in the hospital’s North Pavilion when it opens in late 2004. The Critical Care Center, which occupies the entire second floor of the North Pavilion, features 32 private patient care rooms (see Cover Story).

To learn more about Saint John’s Heart Institute, please call Saint John’s at (310) 829-5511 or visit the health center’s website at http://www.stjohns.org