REVIEW article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
This article is part of the Research TopicInnovative Monitoring and Management of Perioperative Complications in Cardiac SurgeryView all 12 articles
Acute aortic dissection-induced acute respiratory distress syndrome: pathogenesis and clinical implications
Provisionally accepted
- 1The first Clinical Medical College of Lanzhou University, Lanzhou, China
- 2The First Hospital of Lanzhou University, Lanzhou, China
- 3Lanzhou University, Lanzhou, China
- 4Department of Intensive Care Unit, Gansu Provincial Maternity and Child Health Hospital/Gansu Provincial General Hospital, Lanzhou, China
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Acute aortic dissection, a life-threatening cardiovascular emergency, is frequently complicated by acute respiratory distress syndrome. This complication exacerbates perioperative risks, poses challenges for clinical management, and impacts patient postoperative recovery. However, a comprehensive understanding of its pathogenesis remains elusive. This review synthesizes evidence to delineate aortic intimal tearing trigger the key initiating events comprising systemic inflammatory response, renin-angiotensin system dysregulation, high mobility group box 1 release, coagulation/fibrinolysis disorder, platelet hyperactivation/consumption, and intestinal ischemia/reperfusion injury. These upstream pathways converge on the lung, inducing injury through sustained inflammation, damage to pulmonary vascular endothelium and alveolar type II epithelial cells, microvascular constriction, microthrombosis, and alveolar fibrin deposition. Notably, crosstalk among some of these pathways may amplify lung injury. By systematically presenting these mechanisms, this review highlights translational opportunities for early diagnosis, monitoring disease progression, and designing targeted therapies to mitigate lung injury and enhance outcomes in these patients.
Keywords: Acute Aortic Dissection, Acute Respiratory Distress Syndrome, Lung Injury, Pathogenesis, diagnosis, intervention
Received: 27 Jun 2025; Accepted: 29 Oct 2025.
Copyright: © 2025 Zhou, Wu, Wang, Liu, Xu, Song and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jian Liu, medecinliujian@163.com
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