ISSN: 0443-511
e-ISSN: 2448-5667
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Diagnóstico y manejo del síndrome aórtico agudo / Diagnostic and management of acute aortic syndrome

Daniel Pérez-Camargo, Mathías Van-Hemelrijck, Juri Sromicki, Carlos Mestres

Resumen


Resumen

El síndrome aórtico agudo incluye un grupo de patologías graves de la aorta, con una mortalidad hasta del 90% en los primeros 40 días tras el inicio de los síntomas. Según la localización de la lesión el tratamiento puede ser médico o quirúrgico, el cual ha demostrado mejorar el pronóstico de estos pacientes tanto a corto como a largo plazo. El diagnóstico oportuno es esencial para incrementar la supervivencia y disminuir la tasa de complicaciones relacionadas; no obstante, debido a la baja incidencia y presentación clínica en ocasiones inespecífica, el diagnóstico puede retrasarse u obviarse, ocasionando consecuencias catastróficas para los pacientes. Este artículo se centrará en el abordaje diagnóstico del síndrome aórtico agudo tipo A, además de ofrecer una breve revisión respecto al tratamiento médico y quirúrgico de estas patologías.

 

Abstract

Acute aortic syndrome includes a group of serious aortic pathologies, with a mortality rate of up to 90% in the first 40 days after the onset of symptoms. Depending on the location of the lesion, the treatment will be medical or surgical which has been shown to improve the prognosis of these patients both in the short- and long-term. Timey diagnosis is essential to increase survival and decrease the rate of related complications; however, due to the low incidence and sometimes non-specific clinical picture, the diagnosis can be delayed or missed, leading to catastrophic consequences for the patients. This article will focus on the diagnostic approach of type A acute aortic syndrome, in addition to offering a brief review regarding the medical and surgical treatment of these pathologies. 

 


Palabras clave


Aorta; Aorta Torácica; Enfermedades de la Aorta; Rotura de la Aorta / Aorta; Aorta, Thoracic; Aortic Diseases; Aortic Rupture

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Referencias


 

Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35(41): 2873-926.

 

Bossone E, Ranieri B, Romano L, Russo V, Barbuto L, Cocchia R, et al. Acute Aortic Syndromes: Diagnostic and Therapeutic Pathways. Heart Fail Clin. 2020;16(3):305-15. doi: 10.1016/j. hfc.2020.03.002.

 

Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Di Eusanio M, Sechtem U, et al. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846- 60. doi: 10.1161/CIRCULATIONAHA.117.031264.

 

Harris KM, Braverman AC, Eagle KA, Woznicki EM, Pyeritz RE, Myrmel T, et al. Acute aortic intramural hematoma: An analysis from the international registry of acute aortic dissection. Circulation. 2012;126(11 Suppl.1). doi: 10.1161/ CIRCULATIONAHA.111.084541.

 

Evangelista A, Maldonado G, Moral S, Teixido-Tura G, Lopez A, Cuellar H, et al. Intramural hematoma and penetrating ulcer in the descending aorta: Differences and similarities. Ann Cardiothorac Surg. 2019;8(4):456-70. doi: 10.21037/acs.2019.07.05.

 

Evangelista A, Moral S, Ballesteros E, Castillo-Gandía A. Beyond the term penetrating aortic ulcer: A morphologic descriptor covering a constellation of entities with different prognoses. Prog Cardiovasc Dis. 2020;63(4):488-95. doi: 10.1016/j. pcad.2020.05.006.

 

Booher AM, Isselbacher EM, Nienaber CA, Trimarchi S, Evangelista A, Montgomery DG, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730.e19-730.e24. doi: 10.1016/j. amjmed.2013.01.020.

 

Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of Acute Aortic Dissections. Ann Thorac Surg. 1970;10(3):237-47. doi: 10.1016/s0003-4975(10)65594-4.

 

De Bakey ME, Henly WS, Cooley DA, Morris GC, Crawford ES, Beall AC. Surgical Management of Dissecting Aneurysms of the Aorta. J Thorac Cardiovasc Surg. 1965;49:130-49.

 

Czerny M, Schmidli J, Adler S, Van Den Berg JC, Bertoglio L, Carrel T, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: An expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg. 2019;55(1):133-62. doi: 10.1093/ejcts/ezy313.

 

Augoustides JGT, Geirsson A, Szeto WY, Walsh EK, Corne-lius B, Pochettino A, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: The Penn classification. Nat Clin Pract Cardiovasc Med. 2009;6(2):140-6. doi: 10.1038/ ncpcardio1417.

 

Sievers HH, Rylski B, Czerny M, Baier ALM, Kreibich M, Siepe M, et al. Aortic dissection reconsidered: Type, entry site, malperfusion classification adding clarity and enabling outcome prediction. Interact Cardiovasc Thorac Surg. 2020; 30(3):451-7. doi: 10.1093/icvts/ivz281.

 

Bossone E, Labounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J. 2018;39(9):739-49. doi: 10.1093/eurheartj/ehx319.

 

Ferrera C, Vilacosta I, Cabeza B, Cobiella J, Martínez I, Sanz MSP, et al. Diagnosing aortic intramural hematoma: Current perspectives. Vasc Health Risk Manag. 2020;16:203-13. doi: 10.2147/VHRM.S193967.

 

Bonser RS, Ranasinghe AM, Loubani M, Evans JD, Thalji NMA, Bachet JE, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58(24):2455-74. doi: 10.1016/j.jacc.2011.06.067.

 

Lepor NE, McCullough PA. Differential diagnosis and overlap of acute chest discomfort and dyspnea in the Emergency Department. Rev Cardiovasc Med. 2010;11(Supl. 2):13–23.

 

Gupta R, Munoz R. Evaluation and Management of Chest Pain in the Elderly. Emerg Med Clin North Am. 2016;34(3):523-42. doi: 10.1016/j.emc.2016.04.006.

 

Ohle R, Kareemi HK, Wells G, Perry JJ. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Metaanalysis. Acad Emerg Med. 2018;25(4):397-412. doi: 10.1111/ acem.13360.

 

Ohle R, Mc Isaac S, Perry JJ. A simple intervention to reduce your chance of missing an acute aortic dissection. Can J Emerg Med. 2019;21(5):618–21. doi: 10.1017/cem.2019.1.

 

Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-11. doi: 10.1016/ S0140-6736(14)61005-9.

 

Nazerian P, Giachino F, Vanni S, Veglio MG., Castelli M, Lison D, et al. Diagnostic performance of the aortic dissection detection risk score in patients with suspected acute aortic dissection. Eur Hear J Acute Cardiovasc Care. 2014;3(4):373-81. doi: 10.1177/2048872614527010.

 

Park SW, Hutchison S, Mehta RH, Isselbacher EM, Cooper J V., Fang J, et al. Association of painless acute aortic dissection with increased mortality. Mayo Clin Proc. 2004;79(10):1252-7. doi: 10.4065/79.10.1252.

 

Di Eusanio M, Patel HJ, Nienaber CA, Montgomery DM, Korach A, Sundt TM, et al. Patients with type A acute aortic dissection presenting with major brain injury: Should we operate on them? J Thorac Cardiovasc Surg. 2013;145(Suppl.3):S213-21. e1. doi: 10.1016/j.jtcvs.2012.11.054.

 

Goldberg JB, Lansman SL, Kai M, Tang GHL, Malekan R, Spielvogel D. Malperfusion in Type A Dissection: Consider Reperfusion First. Semin Thorac Cardiovasc Surg. 2017;29 (2):181-5. doi: 10.1053/j.semtcvs.2016.10.017.

 

Hayashi T, Tsukube T, Yamashita T, Haraguchi T, Matsukawa R, Kozawa S, et al. Impact of controlled pericardial drainage on critical cardiac tamponade with acute type a aortic dissection. Circulation. 2012;126(11 Suppl.1):S97-101. doi: 10.1161/ CIRCULATIONAHA.111.082685.

 

Rogers AM, Hermann LK, Booher AM, Nienaber CA, Williams DM, Kazerooni EA, et al. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: Results from the international registry of acute aortic dissection. Circulation. 2011;123(20):2213-8. doi: 10.1161/ CIRCULATIONAHA.110.988568.

 

Nazerian P, Mueller C, Vanni S, Soeiro ADM, Leidel BA, Cerini G, et al. Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes. Eur Heart J. 2019;40(24):1952-60. doi: 10.1093/ eurheartj/ehz207.

 

Ranasinghe AM, Bonser RS. Biomarkers in acute aortic dissection and other aortic syndromes. J Am Coll Cardiol. 2010; 56(19):1535-41. doi: 10.1016/j.jacc.2010.01.076.

 

Peng W, Peng Z, Chai X, Zhu Q, Yang G, Zhao Q, et al. Potential biomarkers for early diagnosis of acute aortic dissection. Hear Lung. 2015;44(3):205-8. doi: 10.1016/j.hrtlng.2015.01.006.

 

Bima P, Pivetta E, Nazerian P, Toyofuku M, Gorla R, Bossone E, et al. Systematic Review of Aortic Dissection Detection Risk Score Plus D-dimer for Diagnostic Rule-out Of Suspected Acute Aortic Syndromes. Acad Emerg Med. 2020;27(10):1013- 27. doi: 10.1111/acem.13969.

 

Gorla R, Erbel R, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, et al. Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes. Eur Hear J Acute Cardiovasc care. 2017;6(5):379-88. doi: 10.1177/2048872615594500.

 

Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, et al. Magnitude of soluble ST2 as a novel biomarker for acute aortic dissection. Circulation. 2018;137(3):259-69. doi: 10.1161/ CIRCULATIONAHA.117.030469.

 

David TE. Aortic valve sparing operations: A review. Korean J Thorac Cardiovasc Surg. 2012;45(4):205-12. doi: 10.5090/ kjtcs.2012.45.4.205.

 

Shrestha M, Bachet J, Bavaria J, Carrel TP, De Paulis R, Di Bartolomeo R, et al. Current status and recommendations for use of the frozen elephant trunk technique: A position paper by the Vascular Domain of EACTS. Eur J Cardiothorac Surg. 2015;47(5):759-69. doi: 10.1093/ejcts/ezv085.

 

Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/ SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. Journal of the American College of Cardiology. 2010;55(10).

 


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