Aortic dissection. The last frontier.

Aortic dissection is a medical or surgical emergency, or both, that is catastrophic if not diagnosed and treated promptly. It is the most common aortic pathological lesion in the United States warranting emergent diagnosis and treatment. In untreated or unrecognized patients with aortic dissection, the prognosis is decidedly dismal, with the early mortality (first 48 hours) being as high as 1%/hr, 80% within 2 weeks, and 90% within 3 months.1'2 Patients with operated aortic dissection have a significant in-hospital and follow-up mortality, up to 21% for proximal aortic dissection and 29% for distal aortic dissection.34 The rate of reoperations ranges between 7% and 20%.3-5 Factors identified with reoperation include age, site of intimal tear, and presence or absence of pericardial fluid but not the type of surgical procedure or the type of dissection.6 Hence, critical to determination of outcome and management is not only prompt and accurate diagnosis but also detailed information on associated findings such as the extent of dissection, the location of