Aortic dissection. Dr. Anton Titov, MD. You are a cardiac surgeon with particular interest in surgery of aorta, aortic heart valve and mitral heart valve. let's start with aortic valve disease. What is acute aortic syndrome? Dr. Anton Titov, MD. What causes acute aortic syndrome? How to diagnose and treat patients with acute aortic syndrome? Dr. Tsuyoshi Kaneko, MD. Acute aortic syndrome is an acute aortic disease that happens. It consists of three medical problems. One problem is called aortic dissection. Second problem is called intramural hematoma. The third problem in acute aortic syndrome is penetrating aortic ulcer. Acute aortic syndrome is a combination of these 3 diseases, because these 3 diseases occur in acute fashion. For sake of time I will only focus on aortic dissection. Because this represents over 90% of acute aortic syndrome. the cause of acute aortic dissection is hypertension, high blood pressure, connective tissue disorders. Dr. Tsuyoshi Kaneko, MD. Patients also have a history of aortic aneurysms. There are some other risk factors that can be predisposing to aortic dissections. But these causes are the main three risk factors. This doesn't mean you must have high blood pressure. Then you will have an acute aortic dissection. But if you have hypertension, you do have a risk factor. You are predisposed to this acute aortic syndrome. The typical presentation of acute aortic dissection is chest pain or back pain. This is type of pain that you have never experienced before. it will be a severe chest pain or back pain. Dr. Anton Titov, MD. Usually aortic dissection is diagnosed with CT scan. You can diagnose it with echocardiogram. But usually diagnosis of acute aortic syndrome is done by CT scan. It is crucial to go to an emergency room as soon as possible when you experience acute chest pain or acute severe back pain. Dr. Tsuyoshi Kaneko, MD. Aortic dissection is a very high-risk disease. In the first 48 hours, the risk of dying from aortic dissection is 1% every hour. If you do not treat aortic dissection for 48 hours, there's about 50% chance of dying. Dr. Anton Titov, MD. The only method to treat aortic dissection is through an emergency operation. Especially if it occurs in the front of the aorta, which is called ascending aorta. it is crucial for you to go to the emergency room if you have aortic dissection. You have to go to a center where they perform open cardiac surgery to fix this type of aortic disease. Dr. Tsuyoshi Kaneko, MD. Aortic dissection requires urgent cardiac surgery. It's also important to have a high index of suspicion for aortic dissection. There was a producer of a famous musical on Broadway. It was Jonathan Larson, 35 y.o., “Rent". He had acute chest pain. He was in New York and he was initially misdiagnosed. He died from misdiagnosed aortic dissection. Dr. Tsuyoshi Kaneko, MD. Yes. Recently there was a case in Japan that one of the performers actually doing a musical died on the stage. He just collapsed and died. They later found it was acute aortic dissection. acute aortic dissection can be very abrupt. But if you can go to the emergency room in a timely fashion there is a chance to survive acute aortic syndrome. Dr. Anton Titov, MD. You have to go to the operating room very fast for heart surgery. And you also must ask doctors for the CT scan, not just electrocardiogram.That is, if you can talk. That's correct, absolutely!