Asymptomatic, Chronic Type-A Dissection of a Large Ascending Thoracic Aortic Aneurysm in a Young Patient

Abstract

INTRODUCTION Incidence of thoracic aortic dissection (TAD) in the general population is very low, ranging from 2.6 3.5 cases per 100,000 persons per year, but it is associated with a high rate of mortality and morbidity.1-3 Based on the nature of its onset and anatomical location, TAD is classified as either acute or chronic Stanford type-A dissection involving the ascending aorta and type-B distal to the left subclavian artery.4,5 Acute type-A dissection is highly lethal with a 30-day mortality of 50% compared to 10% of type B.2 Most acute TAD patients presented with a sudden onset of severe chest, abdominal, or back pain, but 6.4% of them may have painless dissection.6 The majority of patients with TAD were older with a mean age of 63 years while only 7% of them were less than 40 years of age.7 Common predisposing factors for TAD are hypertension, atherosclerosis, and a history of cardiac surgery2, while in young patients they are more likely Marfan’s syndrome, bicuspid aortic valve, and prior aortic surgery.7 We report a case of a healthy, young male veteran who presented with asymptomatic, chronic type-A dissection of a large aortic aneurysm, complicated by severe aortic regurgitation (AR). Several physical signs characteristic of chronic, severe AR were found in this patient.