Learning About Aortic Dissection in Children

The aorta is a large blood vessel that runs down the middle of your body. Aortic dissection happens when a small tear forms inside the lining of the wall of the aorta. Blood then flows in between the layers of the lining. This can cause sudden, serious problems with heart function and blood flow in the body.

A tear in the part of the aorta closest to the heart is called type A. Less common is a tear in the part of the aorta that runs down through the chest and may extend into the abdomen. This is called type B.

It's rare in children, but when it happens, it’s a medical emergency.

While aortic dissection is very serious, many children who get prompt treatment survive and recover.

An aortic dissection in a child may be caused by:

• A traumatic injury, such as from a car crash.
• Physical strain, such as when lifting weights or shoveling snow.
• High blood pressure or use of a drug that raises blood pressure (for example, cocaine).
• An aortic aneurysm. This is a bulge in a weakened area of the aorta’s wall.

Risk is higher in children who have genetic conditions or other conditions that are present at birth. These include Marfan syndrome, Turner syndrome, Ehlers-Danlos syndrome, and some forms of heart disease.

If your child has family members who have had an aortic dissection, this can be a risk factor too.

Symptoms of an aortic dissection include:

• Pain that doesn't go away and isn't due to common illnesses. It may be sharp pain in the chest, back, or belly that comes on quickly. It may also be severe chest pain that can move to the neck, jaw, shoulder, back, belly, or arms and legs.
• A big drop in blood pressure.
• A slower or weaker pulse.
• Weakness, confusion, or a headache.
• Fainting.
• Loss of feeling or movement on one side of the body.
• Shortness of breath.
• Trouble swallowing.
• A feeling of anxiety and dread.

The doctor will ask questions about your child's symptoms, past health, lifestyle, and family medical history. They'll do a physical exam. They may also ask if your child has been hit hard in the chest or has been doing strenuous exercise. Several specialists may see your child.

If the doctor thinks that your child may have an aortic dissection, the doctor may order:

• Blood tests. These tests can give your doctor clues about what is causing the symptoms.
• A chest X-ray.
• CT or MRI scans to help the doctor see the dissection.
• A transthoracic echocardiography or transesophageal echocardiography (TEE) to let the doctor look at blood vessels inside the chest.
• An intravascular ultrasound to get a better look at the blood vessels.

After an aortic dissection is diagnosed, quick action is needed. The treatment depends on where it's located.

• Type A dissections (near the heart) are treated with surgery. The surgeon removes the part of the aorta where the tear is found. The removed part can be replaced with a human-made graft.
• Type B dissections (in the lower chest and belly area) are usually treated with medicines.

Possible problems (complications) of an aortic dissection include:

• Aortic rupture. This is a tear all the way through the aorta. It can cause large amounts of bleeding in the body.
• A cardiac tamponade. The aorta bursts, and blood fills the sac that surrounds the heart. It can cause the heart to stop beating normally.
• Reduced blood flow to organs. The tear can block blood flow to the brain, kidneys, belly organs, or arms and legs. This can cause a stroke, kidney problems, or other serious issues.
• Heart problems. The dissection can affect the heart valve or blood flow to the heart muscle itself.

These complications are rare but can lead to death.

Call 911anytime you think your child may need emergency care. For example, call if:

• Your child has an ongoing sharp pain in the chest, back, or belly that comes on quickly, along with a big drop in blood pressure.

Contact your doctor now or seek immediate medical care if:

• Your child has a fever of 100.4 °F (38 °C) or higher, or as advised by your doctor.
• Your child's pain gets worse.
• Your child has symptoms that don’t get better or that get worse.
• Your child has new symptoms.