a Department of Cardiac, Thoracic and Vascular Surgery, German Heart Institute, Berlin, Germany
b Institute of the Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
- As he explains, there are different classification systems for acute aortic dissection, and possibilities for interventional treatment are developing rapidly. Since our article was primarily devoted to the pathogenesis, possible risk factors, genetic factors and basic means of diagnosis, including biomarkers, we neither discussed nor compared possible classification systems nor looked at interventional treatment procedures. In the introduction we referred to the most common systems of classification, which are used by the current European guidelines .
- The entities of acute aortic syndrome represent a continuum. We mentioned acute aortic syndromes as the overarching term in the introduction only, but then focused on aortic dissection rather than discussed the macroscopic continuum. Depending on the situation in the individual patient, different microscopic and molecular causes, as well as pathophysiological mechanisms including shear forces, can manifest themselves in different acute aortic syndrome entities. As pointed out by Dr Qanadli, intramural haematomas are often responsible for delaying the start of treatment.
No financial support and no other potential conflict of interest relevant to this article was reported.
Arnold von Eckardstein, MD, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, arnold.voneckardstein[at]ikc.usz.ch
1 Qanadli SD. Technical comment on: Gawinka et al Acute aortic dissection: pathogenesis, risk factors, diagnosis. Swiss Med Wkly. 2017;147:w14561. https://smw.ch/en/article/doi/smw.2017.14561/.
2 Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. doi:. http://dx.doi.org/10.4414/smw.2017.14489 PubMed
3 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al., The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J. 2014;35(41):2873–926. doi:.. Correction in: Eur Heart J. 2015;36(41):2779. . http://dx.doi.org/10.1093/eurheartj/ehu281 PubMed
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