Aortic dissection: natural course of disease? Report of two cases representing the extremes of the condition

Objective: In a time when diagnostic methods and above all, surgical as wel l as interventional radiological treatment for aortic aneurysms and aortic dissections have reached a point nobody could think of a few years back, th e present authors feel that it is worth while to remind oneself of the natu ral course of disease in these conditions. Taking into consideration the hi gh morbidity and mortality rate in surgically treated patients with aortic dissection, and the high complication rate per- and postoperatively, it als o seems right to ask if a more expectative and conservative approach to the condition sometimes perhaps may be justified. Methods and material: Two ca se reports are given. One was a 15-year-old boy with Stanford (Daily) type B dissection who statistically ought to have a good prognosis, but who died within 2 h after onset of symptoms. The other patient, a middle-aged woman with Stanford type A dissection, survived for 25 years without operation. Conclusion: These two cases, though not unique viewed separately, we consid er to represent the extremes of the condition and also a natural course of disease, while none of them was operated on. (C) 2001 Elsevier Science Irel and Ltd. All rights reserved.