scholarly journals Aortic Arch Aneurysm. Compression Respiratory Complications as a Vital Indication for Emergency Surgery.

2021 ◽  
Author(s):  
Husam H. Balkhy ◽  
Roman Komarov ◽  
Vladimir Parshin ◽  
Alisher Ismailbayev ◽  
Nikolay Kurasov ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Emergency Surgery ◽  
Giant Aneurysm ◽  
Community Acquired Pneumonia ◽  
Pulmonary Complications ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Risk Of Rupture

Abstract Background: giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Aorta-tracheal fistula and tracheobronchial compression are formidable and well-known complications of aneurysms of the thoracic aorta. Twenty-two percent of aneurysms that size >6 cm are ruptured with 80% mortality rate.Case presentation: a 56-year-old man with severe multivascular coronary artery injury and giant aneurysm of ascending aorta and aortic arch, complicated by respiratory failure and recurrent community-acquired pneumonia. Preoperative chest CT showed giant partially-thrombosed ampullary false aneurysm of ascending aorta, aortic arch and initial part of the thoracic aorta, 80x100x65 mm in size. Patient successfully underwent simultaneous surgical intervention with artificial blood circulation, the total time of cardiopulmonary bypass was 190 minutes.Conclusions: tracheobronchial compression syndrome with the aortic arch aneurysms is one of the urgent conditions that needs emergency surgery. Urgent indications for surgery in such cases include both significant size of the aneurysm and high risk of rupture, as well as potential for developing critical respiratory failure and recurrent nonresolving pneumonias. Preoperative CT enables to find out the exact location and evaluate the degree of airway compression, which determines further intraoperative actions. We recommend to use bronchoscopy at all steps of treatment of such patients, from intubation in operating room to extubation in intensive care unit. Thus, aggressive surgical tactics along with careful pre-operative diagnostic are the key to success and the only chance for such patients.

Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Westhoff-Bleck ◽  
Meyer ◽  
Lotz ◽  
Tutarel ◽  
Weiss ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Aortic Valve ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

scholarly journals WALL STRESS IN ASCENDING AORTA ANEURYSMS AS A PREDICTIVE FACTOR OF BREAKAGE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
R J Burgos Lázaro ◽  
N Burgos Frías ◽  
S Serrano-Fiz García ◽  
V Ospina Mosquera ◽  
F Rojo Pérez ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Wall Stress ◽  
Middle Layer ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Resistance Factors ◽  
Risk Of Rupture ◽  
Traction Test

Abstract INTRODUCTION The surgical indication for ascending aortic aneurysms (AAA) is established when the maximum diameter &gt; 50 mm; It responds to Laplace's Law (T wall = P × r / 2e). The aim of the study is to define wall stress in AAA. MATERIAL AND METHODS 218 ascending aortic walls have been studied: 96 from organ donors, and 122 from AAA: Marfán 58 (47.5%), bicuspid aortic valve 26 (21.4%), and atherosclerosis 38 (31.1%). The samples were studied "in vitro", according to the model Young's (relationship between stress and deformed area), by means of the mechanical traction test (Tension = Force / Area). The analysis was performed with the stress-elongation curve (d Tension / d Elongation). RESULTS The stress of the aortic wall, classified from highest to lowest according to pathology and age was: cystic necrosis of the middle layer, arteriosclerosis, age &gt; 60 years, between 35 and 59, and &lt; 34 years. The stress of “control aortas” wall increased directly in relation to the age of the donors. CONCLUSIONS The maximum diameter of the ascending aorta, the patient's type of pathology and age are factors that affect the maximum tension of the aortic wall and resistance, factors that allow differentiation and prediction of the risk of rupture of the AAA. The validation of the results obtained through numerical simulation was significant and the uniaxial analysis has modeled the response of the vessels to their internal pressure.

Ascending Thoracic Aorta Exhibits Anisotropic Failure Behavior in Shear Lap Testing

2013 ◽  
Author(s):  
Colleen Witzenburg ◽  
Sachin Shah ◽  
Hallie P. Wagner ◽  
Janna Goodrich ◽  
Victor H. Barocas
Keyword(s):  
Arterial Pressure ◽  
Mechanical Behavior ◽  
Thoracic Aorta ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Failure Behavior ◽  
Thoracic Aortic Aneurysms ◽  
Wall Strength ◽  
Imminent Death ◽  
Aneurysm Dissection

Aneurysm dissection and rupture, resulting in imminent death, is the primary risk associated with thoracic aortic aneurysms (TAA). Nearly 60% of TAA involves the ascending aorta [1]. Dissection and rupture occur when the remodeled tissue is no longer able to withstand the stresses generated by the arterial pressure. As the ascending TAA grows, however, changes in its mechanical behavior, particularly wall strength, are unknown.

scholarly journals Bioelastic properties of the aorta in children, adolescents and young adults after cardiac transplantation: a cardiovascular magnetic resonance study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Mueller ◽  
K Gummel ◽  
B Reich ◽  
H Latus ◽  
C Jux ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Cardiac Transplantation ◽  
Ascending Aorta ◽  
Control Group ◽  
Cross Sectional ◽  
Descending Aorta ◽  
Aortic Isthmus ◽  
Myocardial T1 ◽  
Study Population

Abstract Background Long-term complications after cardiac transplantation are common and typically include arterial hypertension and coronary allograft vasculopathy. Few studies also suggested that heart transplant recipients have an increased arterial stiffness. Purpose This prospective study aimed to assess the bioelastic properties of the aorta as well as LV function, morphology and structure in children and young adults after cardiac transplantation. Methods CMR studies from 34 patients (median age: 17.1 years, range: 8–24 years) who underwent cardiac transplantation in childhood were analysed. Aortic anatomy and distensibility were assessed at five locations of the thoracic aorta using steady-state free precession cine sequences. Pulse wave velocity (PWV) of the aortic arch and the descending thoracic aorta was measured from 2-dimensional phase contrast images. Size and function of the left atrium and the ventricles were assessed from a stack of short axis slices. Myocardial T1 times were determined using a standard MOLLI sequence. Results Cross-sectional areas of the ascending aorta and the aortic arch tended to be lower in patients compared to controls (ascending aorta 464.5±172.5 mm2 vs. 515.3±186.3 mm2, aortic arch 342.4±113.3 mm2 vs. 376.9±148.5 mm2) whereas cross-sectional areas of the descending aorta tended to be higher (aortic isthmus 283.7±102.1 mm2 vs. 257.9±89.5 mm2, aorta descendens diaphragmal 218.4±75.8 mm2 vs. 214.2±75.0 mm2) and showed a correlation with systolic blood pressure (r=0.33). PWV was higher in the aortic arch (4.8±2.4 m/s vs. 3.6±0.7 m/s). Aortic distensibility was slightly higher at all measuring points in the study population compared to the control group and showed an increase with rising distance from the heart (ascending aorta 10.5±5.8 10–3 mm Hg-1, aortic isthmus 13.1±7.5 10–3 mm Hg-1, descending aorta 16.6±6.8 10–3 mm Hg-1). Biventricular volumes were slightly reduced in the patient group compared to the control group but this was not statistically significant. Only left ventricular mass messured during the systolic phase was higher in the study population compared to the control group (males 55.1 g/m2 vs. 53.0 g/m2, females 46.2 g/m2 vs. 45.2 g/m2). T1 mapping demonstrated increased T1 times in the heart-transplanted group compared to published data in healthy adults. In particular, T1 times of the lateral and inferior myocardial segments were higher. Conclusion Patients who underwent cardiac transplantation in childhood seem to have a reduced bioelasticity of the thoracic aorta. Increased myocardial T1 times suggesting alterations in myocardial structure. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals A 52-year-old man with asymptomatic giant thoracic-abdominal aortic aneurysm

2021 ◽  
Author(s):  
Jianying Deng ◽  
Wei Liu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Clinical Symptoms ◽  
Ascending Aorta ◽  
Local Hospital ◽  
Replacement Surgery ◽  
Aortic Replacement ◽  
Abdominal Aortic ◽  
Risk Of Rupture

A 52-year-old man was admitted to our hospital for “CT-diagnosed thoracic-abdominal aortic aneurysm”. One week ago, the patient had repeated dry coughs and went to the local hospital for treatment. A chest radiograph revealed a huge mass in the left thoracic cavity. A further chest CT examination revealed a thoracic-abdominal aortic aneurysm and was transferred to our hospital for surgical treatment.The patient is almost healthy, with no fever, no severe chest and abdomen pain, no dyspnea, no dysphagia or other clinical symptoms. Ten years ago, the patient underwent “ascending aorta and total aortic arch replacement surgery” in another cardiovascular hospital due to aortic dissection involving the ascending aorta and aortic arch (Debakey I).The patient’s thoracic-abdominal aortic aneurysm is huge and has a high risk of rupture. Recently, the patient has undergone thoracic-abdominal aortic replacement surgery and is recovering well.

scholarly journals Successful case of Benthal de Bono surgery in Cabrol modification with one-step aortic arch prosthesis and repeat coronary artery bypass surgery in a patient with de Bakey type 1 acute aortic dissection

2021 ◽  
Vol 38 (3) ◽  
pp. 153-158
Author(s):  
B. K. Kadyraliev ◽  
V. B. Arutyunyan ◽  
S. V. Kucherenko ◽  
V. N. Pavlova ◽  
E. S. Spekhova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Root ◽  
Artery Bypass ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Golden Standard ◽  
Valve Reconstruction

The ascending aortic aneurysm occurs in 45 % of cases from the total number of aortic aneurysms of various localization. The incidence rate of combination of the aortic disease with aneurysm per 100 000 of the population is 5.9. The problem of prosthetics of the aortic root and aortic valve due to aneurysm and the changed AV is rather actual. The main principle of aneurysm surgery is the prevention of the risk of dissection and rupture with reconstruction of normal dimensions of the ascending aorta. Currently, there are different techniques for the treatment of root aneurysms and ascending aorta. The standard techniques are aortic root replacement, aortic valve reconstruction with replacement of aortic root or ascending aorta and partial or full replacement of aortic arch depending on the situation. The Bentall De Bono operation at present remains a golden standard of surgical treatment of the aneurysms of the root and ascending aorta with changed aortic valve. This surgery can have the following complications: thrombotic, thromboembolic followed by conduit dysfunction, formation of false anastomosis aneurysms, hemorrhage, compression of coronary artery orifices due to tension in the zone of coronary anastomoses.

scholarly journals Rare types of aortic arch aneurysms

2016 ◽  
Vol 20 (4) ◽  
pp. 16
Author(s):  
V. S. Arakelyan ◽  
N. A. Gidaspov ◽  
V. G. Papitashvili
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Conflict Of Interest ◽  
Congenital Anomalies ◽  
Cerebral Perfusion ◽  
Primary Objective ◽  
Aortic Aneurysms ◽  
Number Of Patients ◽  
Brachiocephalic Arteries

<p>The study focuses on modern approaches to diagnostics and surgical treatment of patients with aneurysms of the thoracic aorta combined with congenital pathologies of the aortic arch and brachiocephalic arteries. The effect of hypothermia, extracorporeal blood circulation, cerebral perfusion, preventive transposition of the aberrant subclavian arteries is evaluated in the context of prevention of postoperative complications. 34 patients with aneurysms of the thoracic aorta were included in the study. Aortic aneurysms were found in 22 of patients with congenital aortic arch defects and in 12 patients with an abnormal position of the arch and/or brachiocephalic arteries. Aberrant origin of the subclavian arteries is the most common defect of the arch in the case of thoracic aorta aneurysms. Aortic arch kinking and congenital anomalies of the aortic arch significantly influence the tactic of surgical treatment of aneurysms because of a high probability of clamping the aortic arch branches and neurological complications. Therefore, prevention of cerebral complications is the primary objective of surgery. Cerebral perfusion or staged surgical interventions also find extensive use. A congenital aortic arch in a number of patients determines a surgical approach and influences the choice of techniques. Surgical treatment of aortic aneurysms associated with congenital anomalies or kinking of the aortic arch depends on a set of several factors. The surgical decision must be based on precise preoperative diagnosis and detailed analysis of all individual anatomical characteristics of the aortic arch and its branches. The safety and efficacy of operations can only be achieved on the basis of a differentiated and individual approach.</p><p>Received 6 October 2016. Accepted 11 December 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />All authors meet ICMJE authorship criteria and contributed equally at all stages of the research.</p>

scholarly journals The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus.

2020 ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Dermot O'Rourke ◽  
Karen Reynolds ◽  
James Edwards ◽  
...  
Keyword(s):  
Aortic Root ◽  
Complex Structure ◽  
Aortic Pressure ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Pressure Testing ◽  
Risk Of Rupture ◽  
In Series ◽  
Susceptible Populations

Abstract BackgroundThe aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.MethodsWe developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.ResultsIn the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure.ConclusionOur results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.

Abstract 277: The Relationship Between Aortic And PA Diameter Among Individuals With Genetic Conditions Of The Thoracic Aorta: A Report From The NIH Gentac Registry

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Emad M Tantawy ◽  
Federico M Asch ◽  
Gaby Weissman ◽  
Wm Guy Weigold ◽  
Scott A LeMaire ◽  
...  
Keyword(s):  
Body Size ◽  
Linear Regression ◽  
Pulmonary Artery ◽  
Thoracic Aorta ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Aortic Dilatation ◽  
Descending Thoracic Aorta ◽  
The Relationship ◽  
Aortic Dimensions

Background The aorta and pulmonary artery (PA) share structural similarities, and thus genetic conditions affecting the thoracic aorta may also affect the PA. We evaluated the relationship between aortic and pulmonary artery dimensions on chest CT among a subset of participants in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions Registry (GenTAC). Methods Data Adults in GenTAC without a history of aortic surgery or aortic dissection (N = 144) and with computed tomography of the chest were included. Standardized double oblique measurements of the pulmonary artery, and thoracic aortic dimensions at 8 sites (sinus of Valsalva through the suprarenal aorta) were measured in a core laboratory. The relationship between the PA and aortic dimensions were analyzed using bivariate correlations, and multivariable linear regression controlling for age and body size. Results Mean age was 45±13 years. The mean maximum ascending aortic dimension was 3.8±0.9 cm (range 2.4-7.9 cm); mean PA dimension was 3.1±0.5 cm (1.8-4.8 cm). Using a cutoff of 2.8 cm defining the 90 th percentile value for PA diameter, 65% of the study population had dilated PA. Correlations between the aortic and pulmonary artery diameter were higher for the descending aorta than the ascending aorta. The highest observed correlation between PA and aortic diameter was observed for the thoracoabdominal aorta at the level of the diaphragm (r = 0.40; P <0.001). In a linear regression model evaluating relationships between PA diameter and various aortic segments, after controlling for age and body size, the PA and descending thoracic aorta were independently related (partial correlation r = 0.28; P<0.001). Similar relationships were not observed for the ascending aorta. Conclusions A dilated PA is common among individuals with genetically-associate thoracic aortic dilatation. The diameter of the PA relates modestly to aortic dimensions, most strongly with the descending thoracic aorta.

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