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Aortic dissection is a surgical emergency which poses a challenge to numerous clinicians across different specialties due to its high rate of associated morbidity and mortalities. Acute type A aortic dissection, which involves the ascending aorta and beyond, is a lethal condition. It is therefore vital to understand the pathophysiology that underlies this condition and the tools that aid its early detection. Haemodynamics factors including lumen wall shear stress and pressure, geometrical factors as entry tear location and size, and the composition of the aortic wall are well known to affect the disease progression. The studies on these factors are well established in Type B aortic dissection but not clearly emphasised in the setting of acute type A aortic dissection. The aim of this paper is to provide a comprehensive review of available literature on the relationship between tear size, location and the pressure of false lumen in acute type A aortic dissection., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)