What Happens Next?

Prognosis

It is thought that once the false lumen is surgically sealed off, the body will slowly resorb the blood in the false lumen and reduce it to normal size. Without surgery, spontaneous healing is uncommon as continued blood flow into the false lumen prevents healing. However, many patients, especially those with Type B dissections, do not require surgery to reduce the false lumen.

If a dissection involves the descending aorta, with medical treatment patients can still have excellent long-term survival. Long term survival in these cases is estimated at 60-80% at 4-5 years and 40-45% at 10 years.

If a dissection involves the ascending aorta, after surgical treatment survival is also considered good. Survival at 1-3 years was 96 and 91% in data from 1996-2003 published by IRAD. In a study of patients from 1978-1995, 5 to 10 year survival was 68 and 52% respectively.

Improvements in surgical and medical care have likely led to better long-term outcomes. For all patients who have suffered an aortic dissection, blood pressure control is essential. Many physicians feel that as long as patients continue to control blood pressure and watch their physical activity, patients can continue to live full, long lives.

Follow-up

The risk of further complications is greatest in the first two years after the first event. Many patients receive a baseline MRI before leaving the hospital. At 3, 6, and 12 months, many physicians recommend an MRI to monitor the dissection, even if the patient does not have any symptoms. Afterwards, patients should follow up regularly with a cardiologist, and receive MRI screening every 1 to 2 years. Among other things, patients are followed for signs of dissection progression, redissection, or aneurysm formation.

Limitations

It is recommended that strenuous physical activity is avoided. For example, in weight lifters, blood pressure can increase to greater than 300 mmHg--nearly 3 times higher than normal. Normal daily activities are such as cooking, bathing, driving, and climbing stairs are not restricted. However, many cardiologists place weight limits on patients; some patients are even limited to only lifting 10 lbs, which thus would affect some activities such as laundry. While many patients are able to physically return to their previous physical conditioning and feel able to engage in strenuous activities such as sports, they should exercise caution. Strenuous activities such as sports will increase the stress on the aortic wall, increasing the risk for enlargement of the weakened aorta or even re-dissection. Cardiologists will usually tell patients that mild to moderate aerobic exercise is OK. However, limitations are usually developed on an individual basis and should be discussed with a cardiologist.

Prevention

After suffering a dissection, patients should receive life-long therapy with medications that will reduce blood pressure and ensure that significant rises in blood pressure do not occur. Usually, medications called "beta blockers" are used for this purpose. These medications work by blocking the action of adrenaline in the body. Arteries in the body widen and the force of the heart's contraction is decreased, resulting in an overall decrease in blood pressure. In addition, beta blockers help reduce the rate of rise in blood pressure. This minimizes the stress experienced by the aortic wall.

Key Points

  • Blood pressure control is essential after a dissection.
  • Physical activity should be limited to mild-to-moderate exertion.
  • Patients should followup regularly with a cardiologist.