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At least 109 records · Page 6Linked to original sources
PubMed1996

Evaluation of thoracic aortic disease with the use of helical CT and multiplanar reconstructions: comparison with surgical findings.

PURPOSE: To assess the accuracy of helical computed tomography (CT) in differentiating different types of thoracic aortic disease, to determine the incremental value of multiplanar reconstructions, and to determine if helical CT could help to reliably predict the need for intraoperative hypothermic circulatory arrest. MATERIALS AND METHODS: Forty-nine patients underwent pre-operative helical CT with multiplanar reconstructions. Images were reviewed for type and location of pathologic lesions and for features that indicated the need for hypothermic circulatory arrest. The incremental yield of multiplanar reconstructions compared with that of axial images was assessed. Imaging findings were compared with surgical findings. RESULTS: The types of lesions present in the patients included 36 aneurysms (three were ruptured), six penetrating ulcers, five dissections, and two pseudoaneurysms. The accuracy of diagnosis was 92% (45 of 49 patients) with the use of CT (both with and without multiplanar reconstruction). The necessity of hypothermic circulatory arrest was successfully predicted in 94% (45 of 48 patients) of cases. CONCLUSION: Helical CT, both with and without the use of multiplanar reconstruction, enabled highly accurate differentiation among diseases of the thoracic aorta and prediction of the need for hypothermic circulatory arrest.

Aorta, Thoracic↗
PubMed2003

Surgical management of ascending aortic disease.

Two cases of aortic pathology have been presented--namely, ascending aortic aneurysm and ascending aortic dissection. These entities are distinct, but can be superimposed. Surgical resection is the procedure of choice for both these entities, in contradistinction to descending aortic dissections. Although dealing with these entities can indeed be a humbling experience, lifesaving treatment can be delivered by a combination of a high index of suspicion, early diagnosis, and prompt surgical therapy.

Adult↗
PubMed2001

Possibilities of transesophageal MRI for assessment of aortic disease: a review.

The thoracic aortic wall is a common site of atherosclerotic plaque in humans. Tools for serial, non-invasive assessment of these plaques are of value for addressing gaps in our basic understanding of the biology of plaque rupture and its relationship to atherosclerotic disease progression as well as for monitoring response to anti-atherosclerotic interventions in therapeutic clinical trials. Common approaches to assessment of the wall of the thoracic aorta in vivo are limited. Here we discuss some of the challenges and limitations encountered by conventional techniques and review a novel approach, transesophageal MRI (TEMRI). Initial experiences in applying the TEMRI approach to assessment of aortic morphology and pathology are discussed.

Aorta, Thoracic↗
PubMed2006

Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease.

BACKGROUND: Surgical revascularization of the left subclavian artery (LSA) has been performed to warrant arm perfusion and to prevent paraplegia during thoracic stent graft (SG) procedures. We retrospectively investigated the outcome after intentional occlusion of the left subclavian artery during SG repair for thoracic aortic diseases. METHODS: From December 2000 to June 2005, 11 patients (mean age, 57 +/- 19 years) with a short (<1 cm) proximal aspect of a thoracic aortic lesion underwent intentional LSA coverage to expand the proximal landing zone for SG fixation. Three patients were treated in the emergency setting. We did not perform a prophylactic revascularization of the LSA prior to SG implantation. A preliminary balloon occlusion test of the LSA was not performed in this series. The SG was positioned so that its covering was immediately distal to the left common carotid artery. RESULTS: SG implantation was technically successful in all patients. Intraoperative mortality was not observed; no patient suffered any impairment of left carotid artery flow. Aortography after SG implantation showed no direct flow in the LSA and refilling of the LSA via the ipsilateral vertebral artery. After the intervention, mean systolic pressure in the left arm decreased by 38 +/- 17 mmHg. The stented length of the aorta was 171 +/- 73 (median, 150). During hospitalization, no patient showed any signs of left arm malperfusion. Paraplegia was not observed. One patient developed transient ischemic attack. During a mean follow-up of 19 +/- 8 months (range, 3-36), all patients were completely asymptomatic and had no functional deficit or temperature differential between arms. No leakage was detected. CONCLUSION: Intentional LSA occlusion seems to be well tolerated. Prophylactic surgical maneuvers may be relegated to an elective measure after an endovascular aortic intervention when intolerable signs or symptoms of ischemia occur.

Adult↗
PubMed1990

Current role of conventional and digital aortography in the diagnosis of aortic disease.

The availability of the less invasive techniques such as CT, MRI, and digital angiography require reexamination of the indications for conventional screen-film aortography. Because of poor image quality, IV digital subtraction angiography should be limited to congenital aortic disease and follow-up cases. Intraarterial digital angiography can be used as a supplement to or as a replacement for conventional aortography in most cases. Care should be used in substituting intraarterial digital angiography for conventional studies in aortic dissection and aortic rupture; continuing problems with digital subtraction artifacts may introduce error in cases with subtle abnormalities. In aortic aneurysm, CT is usually sufficient for diagnosis and surgical planning with angiography used for inconclusive examinations or more accurate determination of branch involvement. CT is the primary diagnostic examination in suspected chronic or subacute dissection and is the method of choice in sequential studies of patients following medical or surgical therapy for dissection. In acute aortic dissection, either angiography or CT may be used and are equally diagnostic. Angiography is most helpful in aortic dissection with suspected brachiocephalic vessel involvement, coexistant coronary artery disease, or in cases of indeterminate CT. In blunt chest trauma, aortography remains the examination of choice in the diagnosis of aortic transection. CT may play a role in excluding aortic damage in stable patients with a low clinical suspicion of aortic transection.

Acute Disease↗
PubMed2001

Utility of the full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease.

The objective of this study was to demonstrate the use of the full root bioprosthesis (Medtronic Freestyle) in the patient with complex aortic valve-ascending disease. Of 148 patients undergoing stentless aortic valve replacement since 4/98, 22 required concomitant replacement of the entire ascending aorta with a Dacron graft (beveled to include hemi-arch) for either "porcelain" aorta (8) or diffuse aneurysmal dilatation (14): 17/22 had aortic stenosis, 4/22 had aortic insufficiency, and 1 had bioprosthetic degeneration. All patients had right axillary cannulation, circulatory arrest at 18 C, and retrocerebral perfusion through the superior vena cava. Valve sizes included 23 mm (7), 25 mm (2), and 27 mm (13). Average age was 69.5 years, average intensive care unit stay was 64 hours, and average postoperative length of stay was 6.5 days. Although the initial intent was full root replacement, 7 patients had calcified coronary ostia precluding reimplantation. Subcoronary implantation techniques were modified to interdigitate the outflow suture lines between and through islands of calcium buttressed with small pericardial pledgets on the outside of the native aorta. All valves demonstrated either no or trace aortic regurgitation on pre-discharge transesophageal echocardiography, 30-day mortality was 0, and there were no neurologic sequelae. The full root bioprosthesis has great utility in surgery for complex aortic valve-ascending aortic disease. Axillary artery cannulation and retrograde cerebral perfusion provide a reproducible neurologically safe approach in this group of patients at high risk for intraoperative neurologic morbidity.

Adult↗
PubMed1998

Proximal aortic perfusion for complex arch and descending aortic disease.

OBJECTIVE: Cannulation of the femoral artery is used routinely for hypothermic circulatory arrest operations on the aortic arch. A two-stage approach is advocated for combined arch and descending aortic disease. These methods are associated with important neurologic injury through embolism or malperfusion. We therefore changed to a central cannulation technique through extended left thoracotomy. METHODS: Eighteen patients with arch or combined pathologic conditions underwent one-stage repair with hypothermic circulatory arrest using ascending aortic cannulation and venous drainage from the pulmonary artery. Emergency operations were performed for bleeding or dissection. Cerebral and myocardial perfusion were restored during descending aortic replacement. RESULTS: One elderly patient died of gastrointestinal hemorrhage after initial recovery (overall mortality 5.6%, range 0.14% to 27%, p = 0.05). One possible transient monoparesis occurred but without computed tomographic scan evidence of embolism. No other significant events and no morbidity occurred from the surgical methods. CONCLUSIONS: Extended left thoracotomy with central cannulation allows safe one-stage replacement of the arch and descending aorta using anterograde cerebral perfusion. We believe that this method will reduce cerebral complications in arch and descending aortic operations.

Aortic Dissection↗
PubMed2006

C-reactive protein in aortic valve disease.

Aortic Valve Disease, includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum CRP, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression.

Animals↗
PubMed2000

[Two cases of acute aortic disease complicated by ischemic cerebrovascular disease].

Ischemic cerebrovascular diseases are commonly induced by atherosclerosis and cardiogenic embolization but rarely they occur in association with Takayasu's arteritis and aortic lesion such as aortic dissection and aneurysm. Here we experienced two cases of acute aortic disease complicated by ischemic cerebrovascular disease (CVD). Patient 1 was a 77-year-old male. He complained of dyspnea and left hemiparesis. He was brought to our hospital by ambulance. Left hemiparesis and dyspnea improved soon. The patient only complained of left lower extremity pain and physical examination revealed hypotension. Brain CT showed no abnormality but chest CT revealed aortic dissection. The resection of the intimal tear and replacement of ascending aorta and aortic arch with 28 mm Hemashield graft were performed under hypothermia and selective cerebral perfusion. The postoperative course was uneventful and he has been doing well. Patient 2 was a 67-year-old female. She was found lying unconscious and brought to our hospital by ambulance. Physical examination revealed right hemiparesis and hypotension. Brain CT demonstrated low density area in the left corona radiata and ruptured aortic aneurysm was seen in abdominal CT. Just after the examination, the patient suddenly complained of severe back pain and died despite cardiopulmonary resuscitation. Aortic lesions can manifest ischemic symptom involving multiple organs following their vascular disorder. Aortic dissection rarely occurs in association with ischemic CVD and in that case it is likely to be seen by neurologists. Aortic dissection and aneurysm deteriorate so suddenly that immediate diagnosis and proper treatment are needed.

Acute Disease↗
PubMed1999

Imaging of thoracic aortic disease.

Computed tomography, magnetic resonance imaging, and transesophageal echocardiography represent the relatively noninvasive techniques available for imaging thoracic aortic disease, especially in the evaluation of aneurysms and dissections. The article discusses the technique and application of these modalities in the evaluation of thoracic aorta. Imaging appearances of the commonly encountered pathologies of the thoracic aorta are presented and discussed, and potential pitfalls of technique and diagnosis are addressed.

Aortic Dissection↗
PubMed2005

Endovascular stent-graft treatment of thoracic aortic disease.

Aneurysmal diseases of the thoracic aorta are life-threatening conditions. In such cases, stent-graft treatment has been proposed as an alternative to surgery. The morbidity and mortality associated with endovascular repair are significantly lower than those associated with open surgery. In the largest surgical series, the mortality ranged from 5% to 20%. In studies of endovascular repair, the 30-day mortality was 0%-20% and the periprocedural stroke rate was 0%-7%. Often, open surgery is prohibited in patients with these high-risk lesions; thus, in many cases endovascular treatment is the only alternative. Thoracic aortic diseases that can be treated with endovascular stent-graft placement include aneurysms, dissection, traumatic rupture, traumatic pseudoaneurysms, intramural hematoma, penetrating atherosclerotic ulcers, and aortic rupture. Thorough preprocedure imaging is essential for selecting patients, choosing the stent-graft devices, and planning the intervention. Prerequisites for endovascular stent-graft placement are an adequate neck for graft attachment and adequate vascular access. When the ascending aorta or aortic arch is involved, surgical and endovascular procedures can be combined and performed simultaneously, allowing treatment of a wider range of cases. An experienced interdisciplinary team is needed to manage such cases.

Aortic Dissection↗