HEART & AORTA – Aortic dissection (dissecting aortic aneurysm)

This specimen consists of the upper part of the heart, opened to display the aortic valve, posterior wall of the ascending aorta, aortic arch and upper portion of the descending aorta. There is a dissection of the aorta occupied by clotted blood, extending from the aortic valve ring through the full length of the aorta. The dissection does not extend into the arteries arising from the arch. An incision has been made in the intima just above the aortic valve ring to show clot present at that point. The incision passes through a transverse tear, approimately 1.5cm long. The tear is present in the posterior wall of the aorta approximately 2cm above the aortic valve ring. The intima of the posterior aortic wall is bulging due to the presence of underlying clot. Much of the aorta is severly atheromatous, but there is a bland area in the arch. Atherosclerosis weakens artery walls, facilitating dissection.
This 75-year-old woman complained of pain in the stomach and loss of use of her legs a week before her death. On the day before death, she complained of pain in her chest, right side of the face and in her shoulder-blades. Physical examination and an ECG were apparently normal. The following day she was found dead in bed. The cause of death was cardiac tamponade from rupture of a dissecting aneurysm of the aorta into the pericardial sac. The dissection extended from the aortic valve ring to the diaphragm.