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ABSITE

CARDIAC

CABG
IMA graft to LAD has predicted
A. Patency of 80 % at 5 years

B. Patency of 90% at 20 years


C. Patency of 60% at 10 years
D patency of 70% at 10 years

Aortic dissection
A DeBakey type III (Stanford type B) thoracic aortic dissection:
. A originates in the ascending aorta
B. requires prompt operation to prevent aneurysm rupture
C. most often occurs in association with Marfan syndrome
D. is usually accompanied by profound hypotension
E. is best diagnosed by transesophageal echocardiography (TEE

Aortic dissection

Aortic dissection
Thoracic aortic dissection is a catastrophic disease affecting mainly middle-aged and

elderly men that requires prompt diagnosis and treatment.


Because of intrinsic structural deficiencies of the thoracic aorta in patients with Marfan
syndrome, aortic dissection originating at the aortic root is a common cause of death.
DeBakey and Stanford classifications are most frequently used to characterize thoracic
aortic dissections.
Aneurysms are divided clinically into DeBakey types I and II and Stanford type A

dissections involving the ascending aorta and aortic arch, and DeBakey type III and
Stanford type B involving the descending thoracic aorta and originating from tears in
the aortic wall distal to the left subclavian artery.
Types I and II require operation.
The single best diagnostic study remains controversial, but because of its simplicity,
ready availability, noninvasiveness, and transportability, transesophageal
echocardiography (TEE) with color flow mapping has emerged as the best available
diagnostic study. Although 370aortography has been the gold standard, its sensitivity
(88%) is less than that of TEE (97% to 100%).

Aortic dissection
Dissections involving the ascending aorta generally require immediate

operation, whereas dissections involving the descending aorta (DeBakey


type III or Stanford type B) can be treated expectantly, using intensive
drug therapy to decrease force (dp/dt) of cardiac contraction and to lower
systemic blood pressure.
It is important to decrease left ventricular force before lowering the blood
pressure because if vasodilators are given before adequate betablockade is established, ventricular contractions will be enhanced with the
possibility of extending the dissection.
Five-year survival exceeds 90% among patients with uncomplicated type
III dissections treated nonoperatively. Type III dissections rarely require
early or immediate operation for rupture of the aneurysm that develops as
a result of the dissection. Continued follow-up and continuous medical
treatment is necessary because 30% to 40% of patients may die from
aortic rupture or other dissection-related complications.