Physiopathology of acute aortic dissection: an intimal tear occurs on a weakened aorta (cystic medial necrosis due to arterial hypertension or to dysplasia of connective tissue as Marfan syndrome) leading to the separation of the layers within the aortic wall by the blood flow. The result is the creation of a false lumen (double-barreled aorta) and the propagation of the dissection. This false lumen extends proximally, resulting in a an aortic insufficiency, or distally towards the remaining aorta and collaterals. This false lumen can be compressive on arterial branches (coronary arteries, supra-aortic arteries, visceral arteries, limbs arteries….) leading to ischemia in the interested territory (malperfusion). The false lumen increases in diameter because subjected to systemic pressure. Spontaneous evolution is towards tamponade (pericardial effusion of blood), either progressively or acutely by aortic rupture, leading to death. Urgent surgical treatment is required (aortic replacement). Pr Blin, Pr Chavanon, H Fournié, Chirurgie Cardiaque CHU Grenoble, France
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