To the Editor.—The management of dissecting aortic aneurysms remains controversial. There appears to be general agreement that surgery is indicated for complications such as retrograde leak with pericardial tamponade, free aortic insufficiency, localized rupture, occlusion of a major artery, or continued dissection under adequate antihypertensive therapy. All these complications may be readily diagnosed except for a small retrograde leak into the pericardium with increasing low cardiac output secondary to pericardial tamponade.
Report of a Case
We recently admitted a 47-year-old white male messenger of normal habitus; he complained of severe chest pain. Aortography revealed an aortic dissection with associated aortic insufficiency. Clinically, the patient responded well to antihypertensive therapy as originally described by Wheat and Palmer.1The patient refused an operation and the problem of management was as follows: should the patient manifest low cardiac output, would it be due to a myocardial factor or pericardial tamponade?So