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(Circulation. 2003;108:628.)
© 2003 American Heart Association, Inc.

Review: Clinical Cardiology: New Frontiers

Aortic Dissection: New Frontiers in Diagnosis and Management

Part I: From Etiology to Diagnostic Strategies

Christoph A. Nienaber, MD; Kim A. Eagle, MD

From the Division of Cardiology at the University Hospital Rostock (C.A.N.), Rostock School of Medicine, Rostock, Germany, and the Division of Cardiology at the University of Michigan (K.A.E.), Ann Arbor, Mich.

Correspondence to Christoph A. Nienaber, MD, FACC, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany. E-mail christoph.nienaber@med.uni-rostock.de

Key Words: aorta • aneurysm • blood pressure • inflammation • peripheral vascular disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Cardiovascular disease is the leading cause of death in most Western societies and is increasing steadily in many developing countries. Aortic diseases constitute an emerging share of the burden. New diagnostic imaging modalities, longer life expectancy in general, longer exposure to elevated blood pressure, and the proliferation of modern noninvasive imaging modalities have all contributed to the growing awareness of acute and chronic aortic syndromes. Despite recent progress in recognition of both the epidemiological problem and diagnostic and therapeutic advances, the cardiology community and the medical community in general are far from comfortable in understanding the spectrum of aortic syndromes and defining an optimal pathway to manage aortic diseases.^1–13 This comprehensive review is organized in two parts, with a focus on the etiology, natural history, and classification (with vascular staging) of aortic wall disease in Part I and emphasis on therapeutic management and follow-up in Part II. Both parts may help to better integrate the complexities of acute aortic syndromes.

I. Etiology of Aortic Dissection

All mechanisms weakening the aorta’s media layers via micro apoplexy of the vessel wall lead to higher wall stress, which can induce aortic dilatation and aneurysm formation, eventually resulting in intramural hemorrhage, aortic dissection, or rupture (Table 1).

View this table: [in this window] [in a new window]   TABLE 1. Risk Conditions for Aortic Dissection

Three major inherited connective tissue disorders are currently known to affect the arterial walls: (1) Marfan’s syndrome, (2) Ehlers-Danlos syndrome, and (3) familial forms of thoracic aneurysm and dissection.

Marfan’s Syndrome
Among hereditary diseases, Marfan’s syndrome (MFS) is the most prevalent connective tissue disorder, with . . . [Full Text of this Article]

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