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Fig. 7.3. Acute Type A dissection. PA (a) and lateral (b) chest films show an ectatic and dilated aorta. (c) Aortogram of above patient reveals abnormal aortic narrowing throughout its length and aortic valve regurgitation.

Fig. 7.4. Acute Type B dissection. Chest film (a) showing no specific indications of aortic dissection, although the aortic knob is somewhat blunted.

Fig. 7.3d. Visceral arteriogram reveals the celiac, mesenteric, and renal vessels arising from the true lumen. This patient underwent resuspension of the aortic valve and replacement of the ascending aorta. Courtesy Dr. Michael Janusz, University of British Columbia.

Fig. 7.4. Acute Type B dissection. Chest film (a) showing no specific indications of aortic dissection, although the aortic knob is somewhat blunted.

Fig. 7.4b. Aortogram showing narrowing of the true lumen of the aorta secondary to extrinsic narrowing by the false lumen.

type B dissections are generally managed only with antihypertensives and no surgery. The reason that type A dissections require surgery is because of the high risk of complications arising from the ascending aortic dissection. This includes dissection into the coronary ostia with infarction, rupture into the pericardium resulting in tamponade, acute aortic insufficiency from dissection into the aortic valve, or free rupture and exsanguination. One year survival rates for patients with acute type A dissections are in the range of 60% for surgical management versus 5% for medical management; surgical management is clearly preferred. Conversely, medical management is superior for Type B dissections, in the range

Fig. 7.4c-d. CT scan at the level of the aortic arch and carina revealing a false lumen in the descending thoracic aorta. The proximal aorta is not involved.

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