1
Department of Addiction Studies, School of Medicine, Shahroud University of Medical Sciences, Shahroud, IR Iran.
2
Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, IR Iran.
3
Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, IR Iran.
4
Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Science, Shahroud, IR Iran.
Abstract
Prolonged survival with pharmacological management alone in patients with Stanford type A aneurysmal aortic dissection remains uncommon. We herein describe an elderly woman with severe heart failure (left ventricular ejection fraction [LVEF]: 15%–20%), a 9-cm aortic root aneurysm, and a restrictive dissection flap extending from the root to the abdominal aorta who has survived 6 years under medical therapy.
The patient had a history of mild hypertension previously undertreated with oral antihypertensive agents. Remarkably, she maintained routine daily activities despite medical advice to the contrary. Serial examinations during this period demonstrated a 5% decline in LVEF and a 1 cm expansion of the aneurysm diameter, while the dissection flap remained stable.
This case suggests that conservative pharmacological management in Stanford type A aortic dissection with large root aneurysm and severe LV systolic dysfunction (particularly in older, less active patients) may yield favorable outcomes. Nonetheless, we emphasize that this approach should only be considered for patients who are not candidates for other treatment options. (Iranian Heart Journal 2025; 26(3): 83-91)
Patterson BO, Thompson MM. Aortic dissection. Vascular Surgery: CRC Press; 2017. p. 467-80.
DeMartino RR, Sen I, Huang Y, Bower TC, Oderich GS, Pochettino A, et al. Population-based assessment of the incidence of aortic dissection, intramural hematoma, and penetrating ulcer, and its associated mortality from 1995 to 2015. Circulation: Cardiovascular Quality and Outcomes. 2018; 11(8):e004689.
Yuan X, Mitsis A, Nienaber CA. Current understanding of aortic dissection. Life. 2022; 12(10):1606.
Cerneviciute R, Bicknell CD. Acute type B aortic dissection. Surgery (Oxford). 2021;39(5):275-82.
Gudbjartsson T, Ahlsson A, Geirsson A, Gunn J, Hjortdal V, Jeppsson A, et al. Acute type A aortic dissection–a review. Scandinavian Cardiovascular Journal. 2020; 54(1):1-13.
Ogino H, Yoshino H, Shimokawa T, Akutsu K, Takahashi T, Usui M, et al. A new insight into superacute care for type A acute aortic dissection in the Tokyo Acute Aortic Super Network. The Journal of Thoracic and Cardiovascular Surgery. 2024; 167(1):41-51. e4.
Criado FJ. Aortic dissection: a 250-year perspective. Texas Heart Institute journal. 2011; 38(6):694-700. PubMed PMID: 22199439. Pubmed Central PMCID: PMC3233335. Epub 2011/12/27. eng.
Harris KM, Nienaber CA, Peterson MD, Woznicki EM, Braverman AC, Trimarchi S, et al. Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection. JAMA cardiology. 2022 Oct 1; 7(10):1009-15. PubMed PMID: 36001309. Pubmed Central PMCID: PMC9403853 fees from W.L. Gore & Associates and Medtronic outside the submitted work. Dr Gleason reported serving on a medical advisory board for Abbott outside the submitted work. Dr Eagle reported grants from W.L. Gore & Associates, Medtronic, and Terumo during the conduct of the study. No other disclosures were reported. Epub 2022/08/25. eng.
Smedberg C, Hultgren R, Leander K, Steuer J. Pharmacological treatment in patients with aortic dissection. Open heart. 2022 Nov; 9(2). PubMed PMID: 36396295. Pubmed Central PMCID: PMC9677041. Epub 2022/11/18. eng.
Li F-R, Wu X, Yuan J, Wang J, Mao C, Wu X. Comparison of thoracic endovascular aortic repair, open surgery and best medical treatment for type B aortic dissection: A meta-analysis. International Journal of Cardiology. 2018 2018/01/01/; 250:240-6.
Swerdlow NJ, Wu WW, Schermerhorn ML. Open and endovascular management of aortic aneurysms. Circulation research. 2019; 124(4):647-61.
Haller SJ, Azarbal AF, Rugonyi S. Predictors of abdominal aortic aneurysm risks. Bioengineering. 2020; 7(3):79.
Lundgren F, Troëng T. Treatment choice and survival after ruptured abdominal aortic aneurysm: A population-based study. Journal of Vascular Surgery. 2020; 72(2):508-17. e11.
Harris KM, Nienaber CA, Peterson MD, Woznicki EM, Braverman AC, Trimarchi S, et al. Early mortality in type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. JAMA cardiology. 2022; 7(10):1009-15.
Huo Y, Zhang H, Li B, Zhang K, Li B, Guo S-H, et al. Risk factors for postoperative mortality in patients with acute Stanford type A aortic dissection. International Journal of General Medicine. 2021:7007-15.
Ali A, Khwaja S, Saavedra J, Eckroth-Bernard K, Javed U, Venugopal C, et al. Experience with Thoracic EndoVascular Aortic Repair (TEVAR) treatment of uncomplicated Stanford type B aortic dissection, 2022 Updates. Medical Research Archives. 2022; 10(12).
Sen I, Erben YM, Franco-Mesa C, DeMartino RR, editors. Epidemiology of aortic dissection. Seminars in vascular surgery; 2021: Elsevier.
Chorfa SH. Aortic Dissection: Diagnostic Imaging Findings from Acute to Chronic Longitudinal Progression. EC Emergency Medicine and Critical Care. 2023; 7:01-8.
Bossone E, Rampoldi V, Nienaber CA, Trimarchi S, Ballotta A, Cooper JV, et al. Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. The American journal of cardiology. 2002; 89(7):851-5.
Reed MJ. Diagnosis and management of acute aortic dissection in the emergency department. British Journal of Hospital Medicine. 2024; 85(4):1-9.
Mohseni,F. , Rafaiee,R. , Yousefi,M. and Shiebani,H. (2025). Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report. Iranian Heart Journal, 26(3), 83-91.
MLA
Mohseni,F. , , Rafaiee,R. , , Yousefi,M. , and Shiebani,H. . "Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report", Iranian Heart Journal, 26, 3, 2025, 83-91.
HARVARD
Mohseni F., Rafaiee R., Yousefi M., Shiebani H. (2025). 'Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report', Iranian Heart Journal, 26(3), pp. 83-91.
CHICAGO
F. Mohseni, R. Rafaiee, M. Yousefi and H. Shiebani, "Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report," Iranian Heart Journal, 26 3 (2025): 83-91,
VANCOUVER
Mohseni F., Rafaiee R., Yousefi M., Shiebani H. Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report. Iranian Heart Journal, 2025; 26(3): 83-91.
