Clinical and Radiological Features of Type A Aortic Dissection: A Retrospective Observational Study—An Indian Perspective

Introduction: Acute aortic dissection remains a hazardous and unpredictable condition. Although it is the most common acute aortic disease requiring surgical intervention, still up to 35% of patients are misdiagnosed on the initial presentation. Presentation of aortic dissection is protean, contributing to confusion in diagnosis and a delay in appropriate, timely intervention. Early and accurate diagnosis and treatment are crucial for survival. The clinical diagnosis of aortic dissection depends on awareness of the entity, keen clinical suspicion, and an understanding of its varied manifestations. Unfortunately, many patients die before they can receive hospital treatment. Materials and Methods: A total number of 208 patients diagnosed with Type A aortic dissection (TAAD) and operated on in our center from June 2014 to June 2019 were included in the study. After review of the medical records of 178 patients, data were available for 162 patients. The aim was to delineate presentation patterns, various clinical manifestations, and radiological features of Stanford TAAD. Univariate analysis was used to provide frequency distribution and percentage distribution of qualitative demographic and comorbidity variables. Mean ± standard deviation was reported, whereas for non-normally distributed quantitative variables, median ± (min-max) was reported. Data analysis was performed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Chicago, IL). Results: A total of 162 patient records were reviewed; 131 (80.8%) patients were male, and 31 (19.2%) were female. The mean age of all patients was 43.3 years (± 13.49). A total of 146 patients (90.1%) had TAAD, and 16 patients (9.8%) had chronic TAAD. Severe pain was the most common presenting symptom, and 88.9% of patients reported chest pain. Four patients (2.7%) had renal malperfusion, and 23 (14%) had lower limb ischemia, with three having bilateral lower limb ischemia. Five patients had cerebrovascular accidents of new onset on presentation. Chest radiography showed mediastinal widening in 143 patients (88.8%). Two-dimensional (2D) echocardiography patients (87%) had dilated ascending aortas, with dissection flaps seen in 131 (81.4%) patients. Computed tomography (CT) dimensions-aortic valve annulus mean diameter was 31.5 mm (± 7.1), with the maximum diameter being 50 mm and minimum diameter being 16 mm. Conclusion: The clinical characteristics and radiological features of TAAD in the past 10 years in our center were analyzed. We also compared our data with those reported by International Registry for Aortic Dissection, Japan Registry of Aortic Dissection, and German Registry for Acute Aortic Dissection Type A. Acute chest pain was the most common presenting complaint. CT angiography was the investigation of choice, with TTE being a helpful supportive tool. The majority of our patients had TAAD despite aortic diameter being less than 55 mm. Our demographic data and clinical presentation were similar to Chinese data, owing to similar socio-economic backgrounds.