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Acute aortic dissection Stanford type A in a 34-year old skydiver

A 34-year old man was referred to us with sudden severe chest pains. He had no previous diseases. Clinical examination was normal apart from the chest pains. A CT scan was performed, which showed an aortic dissection of Stanford type A (figure 1 A, B). The patient then underwent emergency surgery. A tear was seen in the ascending part of the aorta. Using the heart-lung machine and brief hypothermic circulatory arrest, the ascending portion of the aorta was replaced by a tube graft. The patient was extubated on the first postoperative day. Three weeks after the operation, the patient was discharged free from symptoms.

Fig 1: A: The lateral view shows the dissection of the ascending aorta with division into a true (*) and false lumen (**) (PA pulmonary artery, LV left ventricle). B: Axial view showing the true and false lumen.

Acute aortic dissection is a relatively rare disease that requires very rapid diagnosis and treatment. The wall of the aorta consists of 3 layers. When the innermost layer tears in an aortic dissection, the blood can pass between these layers. Organ perfusion can be impaired or a life-threatening pericardial effusion can occur.

Based on the location of the tear, aortic dissection can be divided into two different types (Stanford classification):

  • Stanford type A: dissection starts in the ascending part of the aorta
  • Stanford type B: dissection starts after the origin of the arteries to the arms and head

While acute type A dissection requires surgical treatment as soon as possible together with rapid diagnosis, on account of the life-threatening complications, a type B dissection can initially be treated conservatively.

This event often occurs in elderly persons. The main risk factor is raised blood pressure.  Since this patient is still very young, he had comprehensive investigations to establish the cause of the aortic dissection. Persistent excessively high blood pressure was ruled out. There was no evidence of a congenital connective tissue disease (e.g. Marfan syndrome) and trauma (e.g. a road traffic accident) at the immediate time of pain onset was also ruled out. The further history finally showed that the patient was a skydiver. During landing, skydivers may be exposed to massive braking forces due to the impact with the ground. This deceleration injury might therefore have been the cause of the acute aortic dissection.