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Type A Aortic Dissection

Contributed by : Dr Lim Chong Hee
Cardiothoracic Surgeon & Surgical Oncologist

An Aortic Dissection is a serious condition in which a tear occurs in the inner layer of a weakened area of your aorta,the body’s main artery.

Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). If the blood goes through the outside aortic wall, aortic dissection is often deadly.

Acute type A aortic dissection (AAD) is a life-threatening emergency that carries a high mortality rate without surgical treatment.

A unique Type A aortic dissection repair reinforced by the deployment of the AMDS stent was carried out in May 2022, by Dr Lim Chong Hee, a leading SG Cardiothoracic Surgeon.
It is the first  case of an Aortic Dissection repair using the AMDS stent in Singapore.
(At global level, the first case was reported in PubMed in March 2022 – under Thoracic Endovascular Aortic Repair Stent deployed in the Ascyrus Medical Dissection Stent).

Dangerous and rare conditions of the heart 

 

Aortic dissection is a serious condition where the wall of the aorta tears and there is a false lumen forming in the wall of the aorta.

This condition may present acutely and may be life threatening.

Symptoms of acute aortic dissection include severe chest pains radiating to the back, as if someone had driven a knife through your back, shortness of breath and loss of consciousness.

According to the Stanford classification, acute aortic dissection can be divided into two types, A and B.

Type A is when the dissection involves the ascending aorta and type B is where it involves parts other than the ascending aorta.

The classification has implications to management and outcomes.

Type A acute aortic dissection is life threatening and presents as a surgical emergency.

Death can occur within minutes or hours if the dissection causes the aorta to rupture, bleeding into the pericardium resulting in cardiac tamponade, or from a massive heart attack if the dissection involves the coronary arteries.

Surgical intervention is urgent and life saving.

The aim is to interrupt the dissection in the ascending aorta and to prevent the false lumen from expanding in the future.

The AMDS aortic stent is the latest technology for heart surgeons when it comes to repair of ascending aortic dissections. It is a self-expanding stent deployed at the same setting of the aortic surgery repair. This device is placed into the true lumen of the aorta down to the descending aorta. It is self expanding and will over a short period of time gradually compress the false lumen and obliterate it.

This device is available in Singapore.

Short video of CT scan of aortic dissection and after repair.