Research Survey

Aortic Dissection Research Questionnaire:

* Indicates required field

Type of aortic dissection? (please refer to website if any information is needed) *

What state did you live in when you had the aortic dissection? *

Which country did you live in when you had your aortic dissection? *

What day of the week did you have your aortic dissection? *

What month of the year did your aortic dissection happen in? *

What time of the day did you start having symptoms of the aortic dissection? *

Did you know you had an aneurysm before the aortic dissection? *

Where was the aortic aneurysm? *

Did you develop an aortic dissection during a cardiac operation (open heart surgery)? *

If your diagnosis is a type B aortic dissection, did you have an ascending aortic aneurysm prior to the aortic dissection? *

If your diagnosis is a type B aortic dissection, did you have a descending thoracic aortic aneurysm prior to the aortic dissection? *

Did you have any aortic surgery prior to the aortic dissection? *

Did you have an aortic valve replacement prior to your aortic dissection? *

Do you have a bicuspid aortic valve? (see website for definition and diagram) *

Did you have high blood pressure before the aortic dissection? *

Did you take medications for high blood pressure? *

What type of blood pressure medication did you take before the aortic dissection? *

Beta-blocker (lopressor, atenolol etc.) ARB (losartan, coozar etc.) Calcium channel blocker (cardizem, norvasc, etc.) ACE-I (lisinopril, enalopril etc.) I don't know I can not remember

Do you have a connective tissue disorder? *

Was the diagnosis of your connective tissue disorder after the aortic dissection? *

Have you had genetic testing? *

What did the genetic testing reveal? *

Do you have a family history of aortic dissection? *

Do you have a family history of connective tissue disorder? *

Do you have a family history of an aortic aneurysm? *

Where does your family member have or had their aortic aneurysm? *

Did the emergency room physician make the diagnosis of the aortic dissection? *

What test confirmed the aortic dissection? *

Did you have surgery at the hospital that the diagnosis was made in? *

Where you transferred to a large, tertiary medical center? *

What operation did you have? *

Ascending aortic replacement and aortic valve repair Bentall procedure David procedure (valve-sparing root replacement) Ascending aortic replacement and aortic valve replacement Descending aortic replacement TEVAR (stent grafting) I do not know

Did you have additional surgery at the time of the first operation? *

If your aortic valve was replaced, what type of valve was used? *

How long did it take from time of diagnosis to surgery? *

Did you have any complications after the surgery? *

Second major complication? *

Where did you go after the treatment of your aortic disssection? *

What medications are you taking now? (please list) *

Have you needed additional surgery since your original surgery? *

Where did you have your additional surgery? *

Did you have your additional surgery by the original surgeon? *

Your additional surgery was? *

planned emergency unplanned but not emergent I did not need any additional surgery

Have you had imaging since your aortic dissection? *

What type of imaging have you had since your aortic dissection to monitor your aortic diameters? *

How often are you having aortic imaging? *

Do you know your aortic diameters? *

What is the largest aortic diameter? *

What area of the my aorta has the largest diameter? *

Who follows you after the aortic dissection and schedules your aortic imaging? *

Who monitors your blood pressure? *

Have you had any problems in the months or years after the dissection and/or repair? *

What was the time period from the original aortic dissection and the complication/problem? *

Has any family member discovered to have an aortic aneurysm since your aortic dissection? *

Has any family member(s) developed an aortic dissection after you had yours? *

Do you have any first-degree family member(s) who have died of an aortic rupture or aortic dissection? *

How would describe your quality of life? *

I refrain from strenuous activities? *

With regards to my aortic dissection, I characterize my outlook on life? *

I exercise.... *

Have I been diagnosed with depression? *

I frequent a support group for patients who suffered an aortic dissection? *

Do you keep up to date with research progress in the field of aortic dissection? *

Where do you look for updates on aortic dissection? *

medical journals my physicians internet Disease-specific websites (i.e. Marfan Foundation website)

Do you think your primary care physician knows enough about aortic dissection? *

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