The optimal management of Type A or ascending aortic dissection includes:

A. Aortography.

B. Hemodynamic monitoring and frequent recording of blood pressure, urinary output, and neurologic status.

C. Emergency operation.

DISCUSSION: Type A dissections are Type I or Type II dissections that originate in the ascending aorta. These may be associated with aortic insufficiency or hypertension or hypotension depending upon whether or not there has been bleeding into the pericardial space and an element of tamponade and/or neurologic deficit has occurred. Aortography is the best method to establish this diagnosis. Patients with dissecting aortic aneurysms originating in the ascending aorta are considered as emergencies. The operation involves grafting of the ascending aorta to prevent rupture in the mediastinum or into the pericardium with correction of the aortic insufficiency while redirecting the blood into the true lumen.