Réanimation

, Volume 22, Issue 6, pp 600–609

Prise en charge chirurgicale de la dissection aortique

Mise au Point / Update
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Résumé

La dissection aortique, qu’elle soit aiguë ou chronique représente toujours un défi pour le clinicien. Relativement rare, au pronostic spontané sombre à court terme, sa prise en charge n’est pas toujours aisée. Des études récentes basées sur le Registre international des dissections aortiques ont permis de mieux identifier les différentes formes de présentation de cette pathologie et d’apporter des outils cliniques pour aider le clinicien. Néanmoins, le diagnostic en urgence repose toujours sur une imagerie spécifique dont l’échographie transoesophagienne et la tomodensitométrie. La prise en charge chirurgicale en urgence est primordiale lorsque la dissection intéresse l’aorte ascendante. Elle le devient rarement en cas de dissection n’intéressant que l’aorte descendante. Passé le cap aigu grâce à une sanction chirurgicale urgente et adaptée, la dissection aortique va évoluer vers une pathologie chronique avec un risque anévrysmal et de rupture de l’aorte restante disséquée responsable d’une morbimortalité importante à moyen et long termes. C’est pourquoi un patient opéré d’une dissection aortique devra être suivi à vie, spécifiquement à la recherche de ces complications et pris en charge précocement par son chirurgien le cas échéant.

Mots clés

Aorte Dissection Urgence Chirurgie 

Surgical management of acute aortic dissection

Abstract

Acute or chronic aortic dissections still represent a major challenge for the clinician. Despite its rarity, management is not easy, generally resulting in a bad short-term prognosis. Yet, recent studies based on the International registry of acute aortic dissection assessed clinical tools to help the clinician identifying the various presentations of aortic dissection. Emergency diagnosis relies on specific imaging including transesophageal echocardiography and computed tomography. Emergent surgical treatment is mandatory when the dissection involves the ascending aorta. Once the critical phase treated, the aortic dissection usually progresses to a chronic disease with aneurismal transformation and risks of tearing in the remaining dissected aorta, leading to significant mid- and long-term morbidity and mortality. Therefore patients previously treated for aortic dissection have to be tightly monitored during their whole life and rapidly reoperated if required.

Keywords

Aorta Dissection Emergency Surgery 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2013

Authors and Affiliations

  • L. Fournot
    • 1
  • D. Boulate
    • 2
  • M. Kirsch
    • 3
  • P. Leprince
    • 3
  1. 1.Service de chirurgie cardiaque, CHU sudCHU d’AmiensAmiens cedex 1France
  2. 2.Service de chirurgie thoraciquevasculaire et transplantation cardiopulmonaireLe Plessis-RobinsonFrance
  3. 3.Service de chirurgie thoracique et cardiovasculaire, Institut de cardiologie, groupe hospitalier Pitié-SalpêtrièreUniversité Paris VI, Pierre et Marie CurieParis cedex 13France

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