RAPID NONINVASIVE DIAGNOSIS AND SURGICAL REPAIR OF ACUTE ASCENDING AORTIC DISSECTION - IMPROVED SURVIVAL WITH LESS ANGIOGRAPHY

Angiography has been considered the gold standard for the diagnosis of acute dissection of the ascending aorta, but it may increase mortalit y by imposing an unnecessary delay before surgical repair. In addition , coronary angiography has often been considered essential as well. Fr om 1988 to 1993, 37 patients (median age 61 years, 30 men and 7 women) had acute dissection of the ascending aorta. All of the initial 15 pa tients (group I) had angiography, even though the diagnosis of aortic dissection had already been made noninvasively in 14; six (40%) of 15 died, three of aortic rupture and none of complications of coronary ar tery disease. Among the next 22 patients (group II), 21 had a noninvas ive diagnosis of acute dissection of the ascending aorta (eight by ech ocardiography; 13 by computed tomography), and 19 (86%) were operated on, without angiography; two died (9%, p = 0.03 versus group T) and ne ither death was due to aortic rupture or coronary artery disease. Over all, either root or selective coronary angiography was attempted in 18 of 37 patients, but it documented coronary artery disease in only two patients (11%). Coronary artery disease was found in four other patie nts at autopsy; three of them, including two that died of aortic ruptu re, had angiography that faded to reveal the coronary artery disease. Noninvasive diagnosis of acute dissection of the ascending aorta is re liable and avoids the risks and delays inherent in invasive angiograph y. Rapid noninvasive diagnosis of aortic dissection and avoidance of r outine angiography appear to improve survival by expediting surgical i ntervention and thus decreasing the risk of aortic rupture.