Thoracic Aortic Aneurysm: Reading the Enemy’s Playbook

Abstract

Imagine if a sports team were able to read the opposing team’s playbook; this would be a boon of major proportions. Aortic diseases represent a virulent opponent for cardiac specialists and for our patients. Over the last 10 years, at the Yale Center for Thoracic Aortic Disease, we have made a concerted effort to learn more about the natural history of aortic diseases based on a data set including information on 3000 patients and 9000 years of patient follow-up and 9000 serial imaging studies. This analysis has given us glimpses into the playbook of thoracic aortic diseases; these glimpses have corrolaries in terms of the appropriate role and timing of surgical intervention.
Aortic dissection is one of the most catastrophic acute natural events that can befall the human being. The pain of this disorder is often described by those affected as the most severe pain imaginable. Because acute aortic dissection often masquerades as a heart attack, its true incidence is often underestimated. If a middle-aged or elderly person presents to the emergency room with acute onset of chest pain, clutches his chest, and promptly dies, he is likely to be signed out as a “myocardial infarctionâ€. In actual fact, many such presentations represent undiagnosed aortic dissections. It takes autopsy series to document the true incidence of acute aortic dissection. Such series have indicated that aortic dissection is actually the most common lethal condition affecting the human aorta, more common than the better appreciated ruptured abdominal aortic aneurysm... (excerpt)