DOI QR코드

DOI QR Code

A Case of Ascending Aortic Dissection with Severe Aortic Regurgitation Diagnosed by Echocardiography

심장초음파검사로 진단된 중증 대동맥판역류를 동반한 상행대동맥박리증 1예

  • Kim, Sung-Hee (Department of Clinical Laboratory Science, Daejeon Health Institute of Technology) ;
  • Lee, Ok-Kyoung (Department of Clinical Laboratory Science, Daejeon Health Institute of Technology)
  • 김성희 (대전보건대학교 임상병리과) ;
  • 이옥경 (대전보건대학교 임상병리과)
  • Received : 2020.10.07
  • Accepted : 2020.10.19
  • Published : 2020.12.31

Abstract

Aortic dissection refers to the separation of the aorta into a true and false lumen as the medial membrane of the aorta is torn along the long axis due to a high aortic pressure when a minute rupture occurs in the aortic lining. The mortality rate is very high, and aortic dissection occurs 2~5 times more in men than women. The prevalent age range is 50~70 years old. In this case, the authors experienced a diagnosis of aortic dissection that occurred in a young woman in her 30s, which does not occur frequently. In the process of tracking severe aortic regurgitation, aortic valve prolapse was initially suspected. We report this case because aortic dissection could be diagnosed by observing the intimal flap of the ascending aorta in the process of confirming this suspected part.

대동맥박리(aortic dissection)란 대동맥 내막에 미세한 파열이 발생하면 높은 대동맥 압력으로 인해 대동맥의 중막이 장축으로 찢어지면서 대동맥이 진성 내강(true lumen)과 가성 내강(false lumen)으로 분리되는 것을 말하며 사망률이 아주 높은 질환으로 빈도를 보면 남자가 여자보다 2~5배 정도 많이 발생하고, 호발하는 연령대는 50~70세 사이로 알려져 있다. 본 증례에서는 자주 발생되지 않는 젊은 30대 여자에게서 발생된 대동맥 박리증 진단을 직접 경험하였던 바 중증 대동맥판 역류증(severe aortic regurgitation)을 추적하는 과정에서 처음에는 대동맥판 탈출증(aortic valve prolapse)을 의심하였다. 이 의심된 부분을 확인하는 과정에서 상행대동맥의 내막피판 관찰을 통해 대동맥 박리증을 진단할 수 있었기에 이를 보고하는 바이다.

Keywords

References

  1. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection(IRAD): new insights into an old disease. JAMA. 2000;283:897-903. https://doi.org/10.1001/jama.283.7.897
  2. Flachskampf FA, Daniel WG. Aortic dissection. Cardiol Clin. 2000;18:807-817. http://doi.org/10.1016/S0733-8651(05)70181-8
  3. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385:800-811. http://doi.org/10.1016/S0140-6736(14)61005-9
  4. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237-247. http://doi.org/10.1016/s0003-4975(10)65594-4
  5. Kilic A, Tang R, Whitson BA, Sirak JH, Sai-Sudhakar CB, Crestanello J, et al. Outcomes in the current surgical era following operative repair of acute Type A aortic dissection in the elderly: a single-institutional experience. Interact CardioVasc Thorac Surg. 2013;17:104-109. https://doi.org/10.1093/icvts/ivt155
  6. Castaner E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardo Y. CT in nontraumatic acute thoracic aortic disease: typical and atypicalfeatures and complications. Radiographics. 2003;23:S93-100. https://doi.org/10.1148/rg.23si035507
  7. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Eng J Med. 1993;328:35-43. https://doi.org/10.1056/NEJM199301073280107
  8. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002;122:311-328. https://doi.org/10.1378/chest.122.1.311
  9. Erbel R, Mohr-Kahaly S, Rennollet H, Drexler M, Wittlich N, Iversen S, et al. Diagnosis of aortic dissection: the value of transesophageal echocardiography. Thorac Cardiovasc Surg. 1987;35:126-133. https://doi.org/10.1055/s-2007-1020273
  10. Wilson SK, Hutchins GM. Aortic dissecting aneurysms: causative factors in 204 subjects. Arch Pathol Lab Med. 1982;106:175-180.
  11. Eitan S, Leon L, Jack S, Mordechay F, Morris JL, Bernardo AV. Dissecing aortic aneurysm in pregnant woman without Marfan syndrome. Surg Gynecol Obtet. 1988;167:163-165.
  12. Nevin MK, Joseph VC, Michael GM, Fober DM, Rober BW. Treatment by emergency cesarean section immediately followed by operative repair of the aortic dissection. Am J Cardiol. 1984;54:699-701. https://doi.org/10.1016/0002-9149(84)90290-X
  13. Lee HM, Hong EP, Lee DH, Lee JC, Han SS. Aortic dissection in pregnant woman. The Yeungnam Univ. Med. J. 1993;10;253-259. https://doi.org/10.12701/yujm.1993.10.1.253
  14. O'Gara PT, DeSanctis RW. Acute aortic dissection and its variants. Toward a common diagnostic and therapeutic approach. Circulation. 1995;92:1376-1378. https://doi.org/10.1161/01.cir.92.6.1376
  15. Wheat MW Jr. Acute dissection of the aorta. Cardiovasc Clin. 1987;17:241-262.
  16. Eisenberg MJ, Rice SA, Paraschos A, Caputo GR, Schiller NB. The clinical spectrum of patients with aneurysms of the ascending aorta. Am Heart J. 1993;125:1380-1385. http://doi.org/10.1016/0002-8703(93)91011-3
  17. Pessotto R, Santini F, Pugliese P, Montalbano G, Luciani GB, Faggian G. Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation. Ann Thorac Surg. 1999;67:2010-2013. https://doi.org/10.1016/S0003-4975(99)00417-8
  18. JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): digest version. Circ J. 2013;77:789-828. http://doi.org/10.1253/circj.cj66-0057