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At least 19 recordsLinked to original sources
PubMed1991

[Operations for patients with coronary arterial obstructive disease and aortic disease].

Forty three patients combined with the coronary artery obstructive disease (CAOD) and the aortic disease (AoD) were classified into 5 groups. Group I: Nine patients underwent simultaneous surgical treatment for CAOD and AoD). Two patients died from non cardiac origins. Group II: Fourteen patients underwent the coronary artery bypass graft (CABG) prior to the operation for AoD. There was no operative death. Group III: There were 12 patients who underwent surgical treatment for AoD only. There were 3 operative deaths and 2 of them died from myocardial infarction. Group IV: There were 3 patients who underwent operation for AoD prior to CABG. Two of them were diagnosed CAOD at more than 22 months after the operation for AoD. Group V: Five patients who underwent no operation for CAOD or AoD. There were three deaths during the follow up period. The causes of their deaths were cardiac or non cardiac.

Aged↗
PubMed1998

Aortic intramural hematoma: an increasingly recognized aortic disease.

Aortic intramural hematoma (IMH) is a rarely diagnosed pathological condition that is not well characterized to date. We diagnosed IMH in 4 of 31 patients with suspected aortic dissection admitted to our coronary care unit from 1992 to 1995. In all 4 cases, IMH was located in the ascending aorta. At the time of hospitalization, all patients showed tachycardia, hypotension and pericardial effusion. Diagnosis of IMH was made by transesophageal echocardiography and computed tomography. We performed aortography in 2 patients, but it was non-diagnostic in both of them. One patient died before surgery. Autopsy confirmed the diagnosis of IMH and showed severe pericardial effusion. In another patient, the diagnosis was confirmed during successful surgery, while the remaining 2 patients recovered after medical therapy. The 3 surviving patients are still under follow-up control 12, 16 and 20 months after the initial acute event. We briefly discuss the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of IMH.

Aged↗
PubMed1997

[Combined surgery for coronary artery disease and thoracic aortic disease].

Combined surgery in 6 cases who had coronary artery disease and thoracic aortic disease simultaneously was analyzed. Case # 1 had ascending aortic replacement under deep hypothermic circulatory arrest because of iatrogenic aortic dissection caused by aortic clamp during the routine coronary artery bypass grafting (CABG). Case # 2 had DeBakey type II chronic dissection. Case # 3 had type I aortic dissection 4 years after the initial CABG. Both case # 2 and # 3 had ascending aortic replacement under retrograde cerebral perfusion along with CABG. Transverse aortic replacement was performed in case # 4, # 5 and # 6 under selective cerebral perfusion along with CABG. Case # 4 was associated with ascending-transverse aortic aneurysm. Case # 5 had aortitis syndrome complicated with severe coronary ostial stenosis and cervical branch stenosis. Case # 6 also had aortitis syndrome, severe coronary ostial stenosis, heavily calcified ascending-transverse aorta, and mitral and aortic regurgitation. This case had mitral and aortic valve replacement additionally. Case # 2 died of low cardiac output syndrome and multi-organ failure postoperatively. Case # 4 did not recover from profound shock that followed the preoperative acute myocardial infarction. The problems of low cardiac output syndrome caused by long interval of ischemic cardiac arrest, and also the problems of proximal anastomotic site of saphenous vein grafts were discussed.

Aged↗
PubMed2004

Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease.

OBJECTIVE: Atheromatous aortic disease is a risk factor for excessive mortality and stroke in patients undergoing coronary artery bypass grafting. Outcomes of off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass in patients with severe atheromatous aortic disease were compared by propensity case-match methods. METHODS: Routine intraoperative transesophageal echocardiography identified 985 patients undergoing isolated coronary artery bypass grafting with severe atheromatous disease in the aortic arch or ascending aorta. Off-pump coronary artery bypass grafting was performed in 281 patients (28.5%). Propensity matched-pairs analysis was used to match patients undergoing off-pump coronary artery bypass grafting (n = 245) with patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. RESULTS: Univariate analysis revealed decreased hospital mortality (16/245, 6.5% vs 28/245, 11.4%; P =.058) and stroke prevalence (4/245, 1.6% vs 14/245, 5.7%; P =.03) in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass. Freedom from any postoperative complication was higher in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass (226/245, 92.2% vs 196/245, 80.0%; P <.001). Multivariable analysis of preoperative risk factors showed that increased hospital mortality was associated with coronary artery bypass grafting with cardiopulmonary bypass (odds ratio = 2.7; P =.01), fewer grafts (P =.05), acute myocardial infarction (odds ratio = 11.5; P <.001), chronic obstructive pulmonary disease (odds ratio = 2.4; P =.03), previous cardiac surgery (odds ratio = 10.2, P =.05), and peripheral vascular disease (odds ratio = 2.1; P =.05). Cardiopulmonary bypass was the only independent risk factor for stroke (odds ratio = 3.6, P =.03). At 36 months' follow-up, comparable survival was observed in the off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass groups (74% vs 72%). Multivariable analysis revealed that renal disease (P <.001), advanced age (P <.001), previous myocardial infarction (P =.03), and lower number of grafts (P =.02) were independent risks for late mortality. CONCLUSIONS: Patients with severe atherosclerotic aortic disease who undergo off-pump coronary artery bypass grafting have a significantly lower prevalence of hospital mortality, perioperative stroke, and overall complications than matched patients who underwent coronary artery bypass grafting with cardiopulmonary bypass. Routine intraoperative transesophageal echocardiography identifies severe atheromatous aortic disease and directs the choice of surgical technique.

Aged↗
PubMed2005

Coronary artery disease and obstructive aortic disease in situs inversus.

A case of ischemic heart disease (IHD) in a patient with complex dextrocardia is presented. Management of such a patient poses special problem, and a difference in the technique of performing coronary angiography is required. With the right sided aortic arch, Judkins catheters rotated in the direction opposite to normal, result in successful coronary artery engagement. The occurrence of obstructive aortic (atypical coarctation) and large vessel disease was noted in the same patient.

Aortic Coarctation↗
PubMed2000

[Guidelines of the Spanish Society of Cardiology on aortic diseases].

Acute aortic pathology is an urgent clinical situation, of which prognosis mainly related to prompt and accurate diagnosis as well as a quick treatment. In this paper we review the aortic pathology, specially focused on aortic dissection. We review its etiology, clinical presentation and diagnostic methods. In addition the medical therapy and the surgical indications of aortic aneurysm, dissection and aortic intramural haematoma are described.

Aortic Aneurysm↗
PubMed2005

Endovascular repair for concomitant multilevel aortic disease.

OBJECTIVE: Patients with multilevel aortic disease represent a small subgroup with the need for extensive surgical treatment at considerable risk. We present our experience of endovascular exclusion for simultaneous thoracic and abdominal aortic disease in four patients. METHODS: Between January 2002 and January 2005, four patients underwent endovascular repair for simultaneous thoracic and abdominal aortic disease. Mean age was 69+/-10 years (range, 60-81). Thoracic lesions included penetrating aortic ulcer (n=2, ruptured=1), atherosclerotic aneurysm (n=1), and chronic type B dissection (n=1). Abdominal aortic disease included atherosclerotic infrarenal (n=3) and juxtarenal (n=1) aortic aneurysms. Thoracic aortic stent-grafts had been the following: Excluder/TAG (n=3) or Talent (n=1) straight tube devices. Abdominal aortic stent-grafts used were as following: Excluder (n=3) or Zenith (n=1). All patients were followed-up with CT-angiography and chest X-rays 1, 4, 12 months after the procedure, and once per year thereafter. RESULTS: Stent-graft deployment was technically successful in all cases. Intraoperative mortality was not observed. Mean procedure time was 94+/-34 min (range, 70-145). Early postoperative complications occurred in one patient that developed acute renal failure but dialysis was not required. Mean hospitalisation was 8+/-5 days (range, 4-15). Late death occurred in one patient for an undetected ruptured thoracic type 1 endoleak. All three survivors are currently well 16.5 months (range, 3-36) after surgery. No neurological complications developed. CONCLUSION: Simultaneous abdominal and thoracic endovascular repair for multilevel aortic disease is feasible and could be a viable alternative in high-risk patients, who otherwise may not be suitable candidates for conventional repair.

Aged↗
PubMed2002

Thoracic aortic disease: endovascular stents.

Aortic disease is a serious, often life-threatening condition. The keys to instituting appropriate therapy in diseases of the aorta include accurate and rapid diagnosis and anatomical assessment. Endovascular aortic repair is a new alternative to conventional surgical approaches. Because arterial rupture is a risk of this procedure, appropriate facilities for resuscitation must be present during the procedure. This paper reviews the important aspects of aortic anatomy, echocardiographic imaging of the thoracic aorta, aortic pathology, endovascular surgery, and the role of echocardiography in the evaluation of the surgical outcome.

Aortic Dissection↗
PubMed1976

Turbulent blood flow in the ascending aorta of humans with normal and diseased aortic valves.

Turbulent blood flow may contribute to a variety of pathophysiological effects. Because of its postulated importance, this study was undertaken to determine whether turbulent flow does in fact occur in the human body. In 15 persons (seven normal, seven aortic valvular disease, one prosthetic aortic valve), point velocity was measured in the ascending aorta with a hot-film anemometer probe. In one normal individual with a high cardiac output, turbulent flow occurred above the aortic valve during peak flow which corresponded to a peak Reynolds number of 10,000. In the other six normal subjects (peak Reynolds numbers of 5,700-8,900), flow was highly disturbed during peak ejection. Each of the subjects with aortic valvular disease and the subject with a prosthetic aortic valve showed turbulent flow during nearly the entire period of ejection, with Fourier components of velocity of significant magnitude up to 320 Hz (the maximum frequency we could evaluate with the equipment available). The turbulence energy density was higher in subjects with abnormal valves (3.2-14.6 ergs/cm3), than in normal subjects (0.6-2.9 ergs/cm3). In subjects with aortic stenosis, turbulence was observed throughout the ascending aorta and in the innominate artery. In others, the turbulence dissipated more proximally. The results of this study indicate that turbulent flow can occur in the ascending aorta of subjects with normal cardiac function; and it occurs consistently in the ascending aorta of individuals with abnormal aortic valves.

Aorta↗
PubMed2003

The clamshell approach for the treatment of extensive thoracic aortic disease.

OBJECTIVE: Management of extensive thoracic aortic disease may present an immense technical challenge. The choice of surgical access and subsequent exposure determines whether a single-stage or a 2-stage approach can be adopted. METHODS: Fifteen patients with extensive thoracic aortic disease underwent resection of the ascending aorta, the aortic arch, and varying segments of the descending aorta. Four patients had concomitant coronary artery bypass grafting and 3 patients had aortic valve reconstruction. All patients were treated with a single-stage approach via a bilateral anterior thoracosternotomy (clamshell incision). RESULTS: There was 1 hospital death (6.6%). Two patients required reoperation for bleeding (13.3%). Two patients needed mechanical ventilation for more than 48 hours. Three patients suffered a stroke (20%). Two patients (13.3%) had transient neurologic dysfunction. None of the patients had renal failure. There were no wound infections in this group. CONCLUSION: The single-stage approach, via a clamshell incision, is a safe and effective procedure for patients who require treatment of extensive thoracic aortic disease and concomitant cardiac lesions.

Aged↗
PubMedDate not supplied

Stent-graft placement for the treatment of thoracic aortic diseases.

The recent development of aortic stent-grafts has brought the management of thoracic aortic diseases into the realm of interventional radiology. Stent-graft placement is now an alternative to surgery for the treatment of descending thoracic aortic aneurysms, ulcers, and fistulas and is sometimes indicated in cases of mycotic aneurysm, posttraumatic aortic rupture, or thoracic descending aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent-graft, and planning the intervention. Stent-graft treatment of long atherosclerotic aneurysms, lesions close to aortic branch vessels, and aortic dissections is subject to technical pitfalls, and adverse events such as endoleaks, stent migration or misplacement, aortic perforation, and vascular trauma will require specific interventions, although they occur in only a minority of patients. Thoracic stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases and is already the best option in many affected patients who are poor surgical candidates.

Aorta, Thoracic↗
PubMed2002

Emergency surgery results in life-threatening thoracic aortic disease.

OBJECTIVE: Emergency surgery for thoracic aortic aneurysm continues to involve high mortality. We review our experience in emergency surgery for life-threatening thoracic aortic disease. METHODS: Between September 1994 and June 2000, 65 consecutive patients--38 men and 27 women aged 18 to 84 years (mean: 64.3 years)--underwent emergency surgery for thoracic aortic disease. Of these, 40 (61%) were treated for acute type A dissection, 16 (25%) for aortic rupture, and 9 (14%) for impending aneurysmal rupture. Ascending aorta repair was conducted in 21, aortic arch repair in 30, distal arch repair in 2, descending aorta repair in 9, and thoracoabdominal aorta repair in 3. Of the 65, 42 were under 70 years old and 23 were 70 years of age and older. RESULTS: Overall, 8 (12%) died in the hospital--3 (7.5%) of acute type A dissection, 3 (19%) of ruptured aneurysm, and 2 (22%) of impending rupture. Of these, 3 (7.1%) were younger than 70 years and 5 (22%) 70 years and older. The following perioperative factors significantly influenced hospital mortality: pump time (p = 0.019), postoperative severe cardiac failure (p = 0.006), postoperative respiratory failure (p = 0.045), and postoperative acute renal failure (p = 0.0007). Of the 57 survivors followed up for an average of 2.8 years (1 month to 6 years), 3-year survival was 73% overall--88% in patients younger than 70 years and 38% in those 70 years and older (p = 0.0004). Seven of the 9 patients suffering strokes during surgery died in the hospital (2) or after discharge (5). Overall hospital and late deaths involved 2 of 4 patients younger than 70 years and all of 5 patients 70 years and older. CONCLUSION: The majority of patients undergoing emergency surgery for life-threatening thoracic aortic disease can undergo graft replacement with acceptable mortality, morbidity, and late survival, but early and late mortality for patients older than 70 remains extremely high.

Adolescent↗
PubMed2005

Transferring diagnosis versus actual diagnosis at a center for thoracic aortic disease.

BACKGROUND: Lack of physician awareness of thoracic aortic disease has received increased media attention. As a referral center for thoracic aortic disease our institutional experience confirms discrepancies between the transferring diagnosis and the actual pathologic diagnosis. A retrospective review was undertaken to identify the incidence and sources for disparate diagnoses. METHODS: Medical records from 100 consecutive patients transferred to The University of Florida--Shands Hospital between April 2002 and October 2003 were reviewed. To identify sources for error, the charts of 24 patients with diagnostic discrepancies were examined in detail with attention to outside radiologic reports, level of physician experience, and additional diagnostic testing required. RESULTS: The transferring diagnosis of 24 patients was different from the final aortic pathologic disease. The most common discrepancies were misclassifications of dissections and aneurysms. Seven patients had either no leak or no dissection. Two patients had misleading "pulsation artifacts" on their computed tomographic scans. In half of the patients diagnostic differences were secondary to initial misinterpretation by the referring radiologist. Seventeen of 24 patients underwent additional diagnostic testing. Misdiagnoses were more common when the referring physician was not a surgeon (15 of 24). The diagnosis of 5 patients was confirmed only in the operating room. CONCLUSIONS: A significant incidence of disparate diagnosis was identified between transferring facilities and our referral center. Discrepancies were secondary to initial radiographic misinterpretation and the complexity of thoracic aortic pathologic disease. Medical schools and continuing medical education programs should place increased emphasis on thoracic aortic disease in their curricula.

Adolescent↗
PubMed1996

Twenty-four-hour ambulatory blood pressure and vasoactive hormones in valvular aortic disease.

The aim of this study was to assess the blood pressure profile and vasoactive hormones in valvular aortic disease. Thirteen aortic stenosis and/or aortic regurgitation patients were matched with 13 control subjects. Ambulatory blood pressure monitoring was performed for 24 h. Arterial and venous plasma concentrations of renin, angiotensin II, aldosterone, arginine vasopressin, atrial natriuretic peptide, immunoreactive endothelin and cyclic-GMP were measured. The mean 24-h blood pressure was higher in the patient group (94.9 mmHg) compared with control subjects (88.2 mmHg) (p < 0.0001), despite no differences in daytime blood pressures. The nocturnal blood pressure fall was attenuated in the patients (systolic/diastolic blood pressure -8.5/-3.5; -20.3/-14.3 mmHg (p < 0.001/p < 0.01)); in heart rate too the nightly fall was blunted in the patients (-4.8/ -13.4/min (p < 0.0013)). PRA, Ang II, AVP, ANP, ir-ET and cGMP were significantly increased in the patients compared to the controls. Nightly systolic blood pressure fall was inversely related to arterial (r = -0.75, p < 0.003) and venous (r = -0.65, p < 0.04) plasma renin activity and arterial aldosterone (r = -0.64, p < 0.05) in valvular aortic disease patients. In conclusion, valvular aortic disease patients have attenuated falls in blood pressure and heart rate during the night. Increased activity in the renin aldosterone system may be involved in this abnormal blood pressure regulation.

Adult↗
PubMed1996

[Aortic inner surface morphology in aortic disease by three-dimensional transesophageal echocardiography].

Aortic inner surface morphology in various pathologies was investigated using three-dimensional (3D) transesophageal echocardiography to clarify the feasibility and limitations for clinical application. Transesophageal echocardiography was performed in 16 patients with aortic disease (12 aortic dissection, 4 aortic sclerosis) and 5 with normal aorta. The transesophageal transverse view of the descending aorta was taken every 2 mm by manually withdrawing the probe. Each image was recorded using VTR during one heart beat, then stored in the memory of a personal computer as a data base for the subsequent 3D reconstruction. The aortic inner surface was displayed using distance and gradient shading. Three-dimensional reconstruction images were obtained in all patients. The aortic inner surface was reconstructed as a wall with ringed protrusion in patients with normal aorta and a rugged wall with various sized protrusions in patients with atherosclerotic plaques by 3D transesophageal echocardiography. However, it was impossible to differentiate calcified lesions from non-calcified areas of plaques. In aortic dissection, 3D reconstruction provided information regarding the spatial anatomy of the dissection in 10 of 12 patients, accurate shape and location of the intimal tears in 3 of 5 patients, and movement of the intimal flap in 9 of 12 patients. However, reconstruction of the false lumen failed in two patients who had false lumens filled with spontaneous contrast echo. Three-dimensional transesophageal echocardiography is potentially useful for estimating the inner surface morphology and spatial extent and actual location of the aortic abnormalities, but there are limitations in evaluating tissue characterization and reconstructing the lumen with spontaneous contrast echo.

Adult↗