DK2985_C000 1..28 - AlSharqia Echo Club

274 Transesophageal EchocardiographyType A orProximalType B orDistalType 1 Type 2 Type 3Hypertension may be related to several factors includingpain, anxiety, and preexisting elevated blood pressure.Hypotension may result from severe AR, dissection andocclusion of a coronary ostium, cardiac tamponade orright ventricular failure from right pulmonary artery compression.Patients may also present with neurologic symptomsincluding stroke, Horner’s syndrome, or paraplegia.These result from compromised perfusion or direct compressionby expanding anatomical structures.B. Classification of Aortic DissectionFigure 12.20 Classifications of aortic dissection: Stanfordtype A or B, DeBakey types I–III.patients will demonstrate a pulse deficit or asymmetry inarterial blood pressure in at least one limb due to the occlusionof one or more aortic branches caused by aortic dissection.Hypertension or hypotension may be present.Two classifications are currently used for aortic dissectionand both are based on the anatomical location of the tear(Fig. 12.20). In the Stanford classification, any involvementof the ascending Ao is categorized as type A (Fig. 12.21)and all other tears are categorized as type B. The DeBakeysystem categorizes dissection limited to the ascending Ao astype I; tears which propagate past this area are classified astype II; finally, tears limited to the descending Ao arelabeled as type III with the IIIa designation denoting atear limited to the supradiaphragmatic region and a IIIbindicating extension below the diaphragm.(A)(B)TLFL(C)(D)LALCCRAFALSE LUMENRCCINTIMAL FLAPFigure 12.21 Acute aortic dissection Stanford type A (A, B) with extension up to the aortic valve (C, D). The true lumen (TL) has asmaller diameter and is more pulsatile compared with the false lumen (FL) (LA, left atrium; LCC, left coronary cusp; RA, right atrium;RCC, right coronary cusp).