Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T12:12:17.669Z Has data issue: false hasContentIssue false
  • English
  • Français

Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes

Published online by Cambridge University Press:  24 May 2005

Eli Zalzstein ,
Robert Hamilton ,
Nili Zucker ,
Samuel Diamant  and
Gary Webb
Eli Zalzstein
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
Robert Hamilton
Affiliation:
Cardiology Division, The Hospital for Sick Children, Toronto, Canada
Nili Zucker
Affiliation:
Pediatric Cardiology Unit, Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
Samuel Diamant
Affiliation:
Pediatric Cardiology Unit, Tel Aviv Medical Center, Tel Aviv, Israel
Gary Webb
Affiliation:
Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. Methods: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. Results: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. Conclusion: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

Keywords

Aortic aneurysmMarfan syndromechest trauma
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 4 , August 2003 , pp. 341 - 344
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Epperlein S, Mohr-Kahaly S, Erbel R, Kearney P, Meyer J. Aorta and aortic valve morphologies predisposing to aortic dissection. Eur Heart J 1994; 15: 1520–1527.Google Scholar
Erbel R, Zamorano J. The aorta: aortic aneurysm, trauma, and dissection. Crit Care Clin 1996; 12: 733–766.Google Scholar
Westbay S. Management of aortic dissection. Curr Opin Cardiol 1995; 10: 505–510.Google Scholar
Chang RA, Rossi NF. Intermittent cocaine use associated with recurrent dissection of the thoracic and abdominal aorta. Chest 1995; 108: 1758–1762.Google Scholar
Strauss RG, McAdams AJ. Dissecting aneurysm in childhood. J Pediatr 1970; 76: 578–584.Google Scholar
Vogt BA, Birk PE, Panzarino V, Hite SH, Kashtan CE. Aortic dissection in young patients with chronic hypertension. Am J Kidney Dis 1998; 33: 374–378.Google Scholar
Hirt AE, Johns VJ, Kime SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine 1958; 37: 217–279.Google Scholar
Matter SG, Kumar AG, Lumsden AB. Vascular complication in Ehlers–Danlos syndrome. Ann Surg 1994; 60: 827–831.Google Scholar
Moriyama Y, Nishida T, Toyohira H, et al. Acute aortic dissection in a patient with osteogenesis imperfecta. Ann Thorac Surg 1995; 60: 1397–1399.Google Scholar
Beitzke A, Stein J-I, Gamillscheg A, Rigler B. Dissection of the descending aorta after balloon angioplasty of native coarctation. Pediatr Cardiol 1997; 18: 222–225.Google Scholar
Lindsey J, Jr. Coarctation of the aorta, bicuspid aortic valve and abnormal ascending aortic wall. Am J Cardiol 1988; 61: 182–184.Google Scholar
Schor JS, Horowitz MD, Livingstone AS. Recreational weight lifting and aortic dissection: case report. J Vasc Surg 1993; 17: 774–776.Google Scholar
Rashid J, Eisenberg MJ, Topol EJ. Cocaine-induced aortic dissection. Am Heart J 1996; 132: 1301–1304.Google Scholar
Schoen FJ, Cotran RS. Blood vessels. In: Cotran RS, Kumar V, Collins T (eds). Robbins Pathological Basis of Disease, 6th edn. W. B. Saunders, Philadelphia, 1999, pp 493–541.
Niwa K, Perloff JK, Bhuta SM, et al. Structural abnormalities of the great arterial wall in congenital heart disease. Circulation 2001; 103: 393–400.Google Scholar
Cooper DR, Lucke WC, Moseson DL. Aortic dissection in adolescence. Am Fam Physician GP 1986; 34: 137–142.Google Scholar
Fikar CR, Koch S. Etiologic factors of acute aortic dissection in childhood and young adults. Clin Pediatr (Bologna) 2000; 39: 71–80.Google Scholar
Slater EE, DeSanctis RW. The clinical recognition of dissecting aortic aneurysm. Am J Med 1976; 60: 625–633.Google Scholar