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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
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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

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