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Original Articles: Adult Cardiac

Invited Commentary

Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu, 740, São Paulo, 04023-900 Brazil

(Email: wjgomes.dcir{at}epm.br).

A large body of contemporary evidence has shown that patency or thrombosis of the false lumen after type B aortic dissection is a determinant of late prognosis. On the other hand, the prognostic implications of partial thrombosis of the false lumen have been an object of controversy. Previous authoritative work reporting outcomes from the International Registry of Acute Aortic Dissection (IRAD) found false lumen partial thrombosis a significant predictor of post-discharge mortality, as compared with false lumen patency [1].

This study from Sueyoshi and colleagues [2] aimed to investigate whether a partially closed false lumen could affect aortic enlargement in patients with type B aortic dissection. A sizeable number of patients were enrolled, with careful follow-up and data collection, making that an important contribution to understand the natural history of such condition [2].

The finding of Sueyoshi and colleagues [2] that partially thrombosed false lumen is not a significant risk factor for aorta enlargement confronts the previous report, lending no support to the association with an increased risk of death. In addition, the results reinforce that the highest growth rate of the affected aorta was observed in patients with patent false lumen; therefore, careful follow-up is highly recommended in this type of situation. A completely thrombosed false lumen was also associated with a significantly reduced risk for increased diameter.

Therefore, the conclusion of this study frontally contradicting prior consistent evidence makes this subject interesting for further investigation intended to settle this debate.

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1. Tsai TT, Evangelista A, Nienaber CA, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection N Engl J Med 2007;357:349-359.[Medline]
2. Sueyoshi E, Sakamoto I, Uetani M. Growth rate of affected aorta in patients with type B partially closed aortic dissection Ann Thorac Surg 2009;88:1251-1257.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Walter J. Gomes Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gomes, W. J. Search for Related Content PubMed PubMed Citation Articles by Gomes, W. J. Related Collections Great vessels Related Article