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At least 91 records · Page 5Linked to original sources
PubMed1980

Two dimensional echocardiographic recognition of the descending thoracic aorta: value in differentiating pericardial from pleural effusions.

The course of the descending thoracic aorta has recently been visualized with two dimensional echocardiography and its presence confirmed with contrast studies. In the parasternal short axis view, we used the location of the descending thoracic aorta to differentiate pericardial from pleural effusions in 40 patients. Sixteen patients, each with an isolated pericardial effusion, had an echo-free space between the descending thoracic aorta and left ventricular posterior wall. Nine patients, each with an isolated pleural effusion, had an echo-free space posterior to the descending aorta. Fifteen patients, each with both a pericardial and pleural effusion, had echo-free spaces both between the descending thoracic aorta and left ventricular posterior wall and also posterior to the descending thoracic aorta. With one exception, all patients had anatomic confirmation of these findings. Forty-one patients undergoing cardiac surgery served as controls and none had a posterior echo-free space in relation to the descending thoracic aorta. At operation, no pericardial or pleural effusion was evident. The location of the descending thoracic aorta on two dimensional echocardiography serves as a valuable landmark in localizing the pericardial-pleural interface, thereby differentiating pericardial from pleural effusions.

Adolescent↗
PubMed1987

Tuberculous aneurysm of the descending thoracic aorta.

Tuberculous aneurysm of the descending thoracic aorta is a rare entity. To our knowledge the present case is the sixth on record to have been successfully treated surgically. These aneurysms present the usual difficulties of surgical therapy of the thoracic aorta: spinal cord and renal circulatory protection and the choice between distant or in situ revascularization. This case is of particular interest for its evolution and its treatment: resection of the aneurysm without shunting and insertion of a graft in situ covered by a flap of omentum.

Aorta, Thoracic↗
PubMedDate not supplied

Regionalization of endothelium-dependent relaxation in the thoracic aorta of pregnant and nonpregnant guinea pigs.

Regional variation in the response of the thoracic aorta to contractile agonists has previously been demonstrated. Since the net contractile response reflects the interaction between smooth muscle activation and the release of endothelial substances, we hypothesize that agonist-stimulated release of endothelium-derived nitric oxide (NO) also varies along the length of the thoracic aorta. The distribution of thoracic aorta estrogen receptors is also regionalized. Since pregnancy augments the release of endothelium-derived NO by acetylcholine (ACh) in some arterial beds, we further hypothesize that pregnancy enhances the stimulated release of NO from the thoracic aorta. Aortae were removed from nonpregnant and near term pregnant guinea pigs and cut into ring segments numbered sequentially proximal to distal. The rings were suspended at their optimal passive tension and submaximally contracted with prostaglandin F2 alpha. Endothelium-derived NO-dependent relaxation to ACh increased moving proximal to distal along the aorta independent of pregnancy and ACh relaxation was unaffected by pretreatment with physostigmine to inhibit cholinesterase. The magnitude of the relaxation to carbachol among the different segments was similar to ACh. Pregnancy decreased the ED50 for ACh of segments from the middle and distal segments of the thoracic aorta. Relaxation to the NO donor sodium nitroprusside and the nonreceptor-mediated endothelium-dependent relaxing agent A23187 was uniform along the length of the aorta and independent of pregnancy. These experiments demonstrate regional variation in the stimulated release of endothelium-derived NO in the guinea pig thoracic aorta which is increased by pregnancy.

Acetylcholine↗
PubMed1996

Role of endothelium in the vasodilating effect of progestins and androgens on the rat thoracic aorta.

1. In the rat thoracic aorta, contractions induced by noradrenaline were inhibited by the steroids progesterone, pregnanolone, testosterone and 5 alpha- and 5 beta-dihydrotestosterone. 2. Removal of endothelium did not prevent relaxation to the steroids, suggesting that the vasodilating effect of steroids occurred on the smooth muscle cells. 3. gamma-Aminobutyric acid (GABA) did not modify noradrenaline-induced contraction. Thus, the vasodilation elicited by steroids is not apparently mediated by GABA receptors. 4. On the basis that noradrenaline opens receptor-operated calcium channels to induce contraction, we suggest that relaxation by steroids involves a blockade of this type of channels.

Androgens↗
PubMed2005

[Value of transoesophageal echocardiography for the diagnosis of embolic lesions from the thoracic aorta].

Atherosclerotic plaques of the thoracic aorta are a well-recognized source of systemic embolism, especially cerebral embolism, in patients 60 years of age or older. The most helpful and readily available imaging technique to detect aortic plaques is transesophageal echocardiogram. Aortic plaques>4mm in thickness are the more likely to cause peripheral embolism. Moreover, plaque morphology is important to consider, since ulcerated plaques and plaques with mobile intra-aortic components ("debris") as well as hypoechoic and noncalcified plaques are at the higher risk of embolism. In addition to these common atherosclerotic lesions, rare cases of mobile thromboses of the aortic arch without aortic debris have been described in younger patients. Finally, a particular situation is that of cholesterol embolism following invasive intra-aortic maneuvers on atherosclerotic aortas. While the diagnosis of these lesions is well established, their management and treatment remain controversial.

Aorta, Thoracic↗
PubMed1980

Traumatic rupture of the thoracic aorta.

Traumatic rupture of the thoracic aorta is found in 10% to 15% of fatal automobile accidents. Ten to twenty percent of patients initially survive the injury and are seen in the emergency department. A high index of suspicion from history and physical examination and liberal use of aortography are key in diagnosis.

Accidents, Traffic↗
PubMed1992

[Possibilities and limits of biplane transesophageal echocardiography in dissection of the thoracic aorta].

Dissecting aneurysms of the thoracic aorta can be rapidly and accurately diagnosed by transoesophageal echocardiography. The recent advent of the transoesophageal echocardiographic probe with transverse and longitudinal imaging transducers that add orthogonal viewing planes is an important advance in the evaluation of both the anatomic and haemodynamic status of the patient. It allows a still better understanding of the pathologic changes and therefore helps in surgical decision making. With the capabilities of colour flow Doppler, biplane transoesophageal echocardiography proves to be an ideal tool for the preoperative confirmation of the suspected diagnosis, intraoperative assessment and post-operative ambulatory follow-up and should be applied whenever possible.

Aortic Dissection↗
PubMedDate not supplied

Central cannulation through a standard left thoracotomy for surgery on the descending thoracic aorta.

Surgery on the descending thoracic aorta is often performed with hypothermic cardiopulmonary bypass established via the femoral vessels. This, however, produces retrograde flow, which may potentially dislodge atheromatous debris from a diseased descending aorta or results in malperfusion due to cannulation of the false lumen in patients with descending aortic dissection. In view of this, we have described a technique of central cannulation of the ascending aorta and main pulmonary artery, established via a standard left thoracotomy, providing antegrade flow and limiting the cerebral ischemic time.

Aorta, Thoracic↗
PubMed1989

Traumatic rupture of the thoracic aorta.

Traumatic rupture of the thoracic aorta is a lethal injury associated with high speed accidents. In multiply injured patients a high index of suspicion is required to allow prompt diagnosis of this condition. Urgent surgery is life saving in the majority of patients.

Adult↗
PubMed1998

[Diagnostic and therapeutic observations drawn from the surgical experiences of 108 traumatic ruptures of the descending thoracic aorta].

Traumatic rupture of the thoracic aorta should be suspected when automobile (62.9%), motorcycle (11.1%), ski-doo (2.7%), deltaplane (0.9%), or skiing accidents (0.9%), cause a sudden and rapid deceleration. It was also encountered with a vertical fall of 10 meters and more (4.6%), when a pedestrian was struck by a vehicle (4.6%) or the chest damaged by a high velocity flying object (4.6%). A lateral impact was found in 33% of injured patients and 52.7% were not wearing seat belts. Ruptured aorta was found as a single lesion in only 12% of the cases and among associated orthopedic lesions (63.8%) and abdominal injuries (28.7%), about 2/3 of them involved the left side of the body. The most reliable clinical sign of descending aortic rupture is the pseudo-coarctation syndrome found in 53% in the acute phase by simple pulse palpation and in 56% with blood pressure measurements. As soon as the diagnosis is suspected, associated hypertension present in 50% should be medically treated to avoid sudden exsanguination. Surgical repair should be undertaken with a perfusion technique which is an integral part of the ressuscitation procedure. A Gott shunt was used in 81 patients and a partial left heart bypass with a Bio-Medicus pump in 25 cases. This active atrioaortic bypass is physiologically superior. The pump flow (3727 +/- 612 ml/min.) is superior to the shunt flow (2833 +/- 576 ml/min.). Proximal pressure with the pump is better controlled (111 +/- 20 mmHg) than with the shunt (152 +/- 30 mmHg) and the mean distal pressure obtained with the pump is higher (81 +/- 19 mmHg) than with the shunt (64 +/- 22 mmHg). One case of paraplegia occured (0.9%) with an unfunctionnal Gott shunt. The survival rate is 95.4% (63/66 cases) in the acute phase and 100% (42/42 cases) in the chronic phase.

Accidental Falls↗
PubMed1988

Surgical treatment of acute traumatic tear of the thoracic aorta.

Acute traumatic tear of the thoracic aorta is a severe injury with a high mortality rate. This condition requires expeditious evaluation and prompt surgical intervention in order to improve patient survival. The experience at the authors' institution from 1971 to 1987 includes 41 patients who sustained acute traumatic tear of the thoracic aorta and reached the hospital alive. The purpose of the study was to evaluate the surgical management of this injury with regards to mortality rate and the incidence of spinal cord injury. Five patients died from exsanguination before definitive repair could be undertaken. Thirty-six patients had repair of traumatic aortic tear in the area of the isthmus. Nine patients were operated upon with the clamp and sew technique, 20 patients had a heparin-bonded shunt placed, and seven patients were treated by repair with cardiopulmonary bypass. There were five operative deaths that were not related to the technique employed. Two patients without preoperative evidence of spinal cord injury developed paraparesis. No patient had postoperative paraplegia. Despite rapid transport, expeditious evaluation, and emergency thoracotomy, some patients die from exsanguination prior to definitive repair. Even with the provision of distal aortic perfusion during clamping, the risk of spinal cord injury is not eliminated.

Adolescent↗
PubMed1997

[Surgical therapy for prosthetic infections of the thoracic aorta. Conservative approach].

The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage especially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a descending thoracic aorta prosthesis infection.

Aorta, Thoracic↗
PubMed2001

Endothelium-dependent relaxation by cilostazol, a phosphodiesteras III inhibitor, on rat thoracic aorta.

The relaxation effect of cilostazol, a phosphodiesterase III inhibitor, on the thoracic aorta was investigated. Cilostazol induced the relaxation of the thoracic aorta precontracted by phenylephrine in a concentration-dependent manner. The concentration-dependent relaxation was shifted to the right in the endothelium denuded aorta compared with that of intact endothelium, suggesting that this relaxation was partly dependent on endothelium. Cilostazol-induced relaxation of thoracic aorta tone was reversed by treatment with N(G)-nitro L-arginine (L-NNA), a competitive inhibitor of nitric oxide (NO) synthase. Cilostazol also significantly increased the NO level in the porcine thoracic aorta. In rats treated with cilostazol, the urinary excretion of nitrites, a stable metabolite of NO, and basal production of NO of the aortic ring were significantly greater than in those without treatment. These findings indicate that cilostazol-induced vasodilation of the rat thoracic aorta was dependent on the endothelium, which released NO from aortic endothelial cells.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1998

CT angiography of the abdominal and thoracic aorta.

Evaluation of the abdominal and thoracic aorta is one of the most common indications for CT angiography (CTA). CTA largely has replaced conventional angiography in the assessment of aortic aneurysms and dissections because it provides all the relevant anatomic information at reduced cost, morbidity, and radiation exposure. This article will focus on the technique, interpretation, and pitfalls in the CTA evaluation of the abdominal and thoracic aorta.

Aneurysm↗
PubMed1985

Spatial dispersion of spindle cells in the human thoracic aorta.

The intima of the human thoracic aorta thickens with age. Those portions of thickened intima that lack foci of atheronecrosis or foam cells are populated by smooth muscle cells, which are usually characterized in sections by spindle-shaped nuclei, and by occasional superficial monocytic macrophagic cells. Populations of these cells were censused by counting nuclear profiles at 40 anatomically defined sites in each of 200 aortas aged 10 to 69 years. The different depths within the intima between the lumenal surface and the media with minor exceptions did not significantly differ in cell numbers. The density of cells decreased with thickness at all ages and with age at all thicknesses after completion of growth and maturation. The total numbers of cells in 100-microns lengths of intima, assessed in longitudinal tissue sections, were virtually constant with aging after 20 to 29 years. The dispersion of cells over the intima in the lateral walls of the thoracic aorta followed a negative binomial distribution, which has an upward skewed unimodal form. Because of the sampling properties of this form of distribution the mean of eight to 12 measurements appears to be adequate to describe the spindle cell numbers in the nonnecrotic parts of an aorta.

Adolescent↗
PubMed1988

[Magnetic resonance of the thoracic aorta].

Various pathological conditions of the thoracic aorta were studied by MR Imaging in 31 patients: 23 were aneurysms (branching and non-branching), 2 arterio-venous fistulae, 2 aortic prostheses, 2 Marfan's syndromes, 1 coronary sinus aneurysm, and 1 isthmic stenosis. MRI studies were always performed on patients who had been examined by other imaging procedures. A comparative study was carried out on the results of MRI, angiography, computerized tomography, and ultrasounds. The possibility of propedeutic protocol was explored. Our experience, in accordance with the literature on the subject, indicates MRI as the procedure of choice in the study of aneurysms of the thoracic aorta. The advantages offered by MRI--the high natural contrast between circulating blood and the supporting structures, the possibility of obtaining multiplanar images as well as data on intraluminal, parietal, and extraparietal conditions--make it a highly competitive procedure if compared to either CT or angiography. While awaiting further evidence, the use of a propedeutic protocol in non-aneurysmatic diseases is still not advisable, due to insufficient patient population, and to the lack of a consistent literature on the subject.

Adult↗
PubMed2005

The BICIRCUIT system: innovative perfusional options for surgical treatment of the thoracic aorta.

PURPOSE: Surgical treatment of the thoracic aorta may become challenging when a rapid switch from left heart bypass (LHB) to cardiopulmonary bypass (CPB) is required. DESCRIPTION: We designed a BICIRCUIT system using a centrifugal pump, a heparinized CPB circuit with a hollow fiber oxygenator, two 3/8 x 3/8 x 3/8 connectors (one placed at the bell inlet draining blood from the left atrium or the venous reservoir and the second placed at the bell outlet directing blood to the oxygenator or femoral artery). Our priming volume was 1100 mL; when switching from LHB to CPB, no additional priming volume was required. The inlet cannula was inserted in the left atrium (for LHB) or femoral vein (for CPB); the outlet cannula was placed in the femoral artery. EVALUATION: We used the BICIRCUIT in 18 patients: 7 patients with a thoracoabdominal aneurysm, 7 patients with a traumatic rupture of isthmic aorta, and 4 patients with a Stanford type B aortic dissection. Conversion to CPB was required in 3 patients because of hemodynamic deterioration and in 1 patient because of hypothermic circulatory arrest. As we observed progressive worsening of blood gases in another patient during LHB, we also used the blood oxygenator without changing the position of the cannulas. No system failures were observed. Postoperative spinal disturbances did not develop in any patients. All patients were successfully discharged. CONCLUSIONS: Our BICIRCUIT system offers three different options: LHB, LHB along with blood oxygenation, and CPB. Each option can be safely achieved and adds to the armamentarium of surgeons and perfusionists in caring for patients with pathology of the thoracic aorta.

Aortic Dissection↗