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PubMed1984

Comparative effects of verapamil and sodium nitroprusside on contraction and 45Ca uptake in the smooth muscle of rabbit aorta, rat aorta and guinea-pig taenia coli.

The effects of verapamil and sodium nitroprusside on muscle tension and 45Ca uptake activated in different ways were compared in rabbit aorta, rat aorta and guinea-pig taenia coli. In rabbit aorta, K-induced contraction was specifically inhibited by verapamil and noradrenaline-induced contraction by sodium nitroprusside. In rat aorta, both K-induced and noradrenaline-induced contractions were inhibited by verapamil or by sodium nitroprusside also. In taenia, both K- and histamine-induced sustained contractions were inhibited by verapamil but not by sodium nitroprusside. The effect of verapamil was competitively antagonized by external Ca, while that of sodium nitroprusside was not. High K, noradrenaline and histamine increased the rate of 45Ca uptake in aortae and taenia. In rabbit aorta the increment in response to high K was specifically inhibited by verapamil and the increment induced by noradrenaline was specifically inhibited by sodium nitroprusside. In rat aorta, increments induced by both high K and noradrenaline were inhibited by verapamil and by sodium nitroprusside. In taenia, the increments induced by high K and by histamine were inhibited by verapamil but not by sodium nitroprusside. These results suggest different characteristics of Ca entry systems in these smooth muscles. In rabbit aorta, there seem to be two Ca channels, one of which is activated by high K and inhibited by verapamil, while the other is activated by noradrenaline and inhibited by sodium nitroprusside. In rat aorta, both K- and noradrenaline-activated Ca pathways are sensitive to both verapamil and sodium nitroprusside whereas, in taenia, both K- and histamine-activated Ca pathways are sensitive only to verapamil.

Animals↗
PubMed2003

Combined treatment of aortic type A dissection: ascending aorta repair and placement of a stent in the descending aorta.

BACKGROUND: The established treatment modality of acute Stanford type A dissection includes repairing the ascending aorta and a variable part of the aortic arch and leaving the descending aorta untreated. We report a simultaneous approach of open repair of the ascending aorta with the transluminal placement of a stent in the descending aorta to minimize the consequences of an untreated descending aorta. METHODS: Two cases of type A aortic dissection are described, one case with the entry port in the descending aorta and the second case with the entry port in the aortic arch. Both patients were treated by the replacement of the ascending aorta (and the aortic arch in the second case) and the placement of a stent in the descending aorta with a new device as the patients were under circulatory arrest and deep hypothermia. The device consists of a Djumbodis stent mounted on a compliant balloon. This stent is made of 316L stainless steel and can be adapted to the shape of the aortic arch or descending aorta. Three different lengths are available: 4 cm, 9 cm, and 14 cm. The device used in these patients has a diameter of 9 mm. RESULTS: The early results were satisfactory with a completely thrombosed false lumen in one case and a partially thrombosed false lumen in the other, according to immediate postoperative transesophageal echocardiography control. A follow-up computed tomographic chest scan was done at 12 months in the first case and at 7 months in the second case and confirmed the good surgical results. CONCLUSIONS: This preliminary study shows that combined surgical and endovascular treatment of acute type A dissection is feasible and that at least partial thrombosis of the false lumen can be achieved, potentially minimizing the risk of further dilatation or rupture. The early results are encouraging, but more cases and long-term results are required to demonstrate the effectiveness of this new combined treatment modality.

Aortic Dissection↗
PubMed1983

Comparison of the growth of the tunica media of the ascending aorta, aortic isthmus and descending aorta in infants and children.

This study concerns the normal histological growth of the aorta in infants and children. We measured, in post mortem material consisting of 69 hearts and great vessels of infants and children who died from non-vascular diseases, the internal diameters of the ascending aorta, aortic isthmus and descending aorta together with the thickness of the tunica media and the packing density of its elastic fibres. Age range was from 27 weeks of gestational age up to 10 years after birth. The growth of the tunica media of the ascending aorta was, in part, different from that of the aortic isthmus and descending aorta. Notwithstanding an increase in the thickness of the tunica media parallelling, in all three parts of the aorta, an increase in their internal diameters, the packing density of the elastic fibres of the tunica media of the aortic isthmus and of the descending aorta showed no tendency to increase with age. However, the packing density of the elastic fibres of the ascending aorta showed a continuing increase with age parallelling the increase of the internal diameter. This can probably be better explained as a result of functional difference than as a result of different embryological origin.

Aorta↗
PubMed1999

Combined resection of the aorta for an esophageal carcinoma invading the aorta through a right transthoracic approach.

The prognosis of esophageal carcinoma invading the thoracic aorta has been extremely poor, as it has been either not resected or only palliatively resected. In recent years a remarkable improvement in survival has been achieved in advanced esophageal carcinoma through an aggressive dissection of the upper mediastinal lymph nodes. This implied that resection only of the aorta without lymph node dissection in these patients was not adequate for curability. Although a resection of the aorta would seem to be performed more easily through a left thoracotomy than through a right thoracotomy, the upper mediastinal lymph node dissection was unsatisfactory through a left thoracotomy. Therefore, we performed combined resection of the aorta using a temporary aorta-aorta bypass together with upper mediastinal lymph node dissection through a right thoracotomy for four patients with the esophageal carcinoma invading the thoracic aorta. This operative procedure was performed safely, and had the advantage that full observation on the extent of the carcinoma was attained together with subsequent radical lymph node dissection in the same field through only the right thoracic approach. This operation may provide a possibility for cure to patients with an esophageal carcinoma invading the aorta, who would otherwise receive only palliative treatment.

Aged↗
PubMed1977

Ascending aorta-abdominal aorta bypass: indications, technique, and report of 12 patients.

Use of the supraceliac segment of the abdominal aorta for ascending aorta-abdominal aorta bypass (AAAAB) offers a new technique for management of certain difficult surgical problems. Since 1973, we have performed AAAAB in 12 patients: 4 with recurrent coarctation of the thoracic aorta; 4 with coarctation of the thoracic aorta and associated cardiac lesions requiring a concomitant intracardiac procedure; 2 with recurrent aortoiliac occlusive disease (AIOD); 1 with interruption of the aortic arch requiring concomitant pulmonary artery banding; and 1 with coarctation of the abdominal aorta. In 3 of these patients (2 with recurrent AIOD and 1 with coarctation of the abdominal aorta) the distal anastomosis was made to the distal abdominal aorta or femoral arteries. Ten patients (83.3%) experienced satisfactory results; 2 patients (16.6%) died. The technique of AAAAB provides a practical solution to complex situations in which previous procedures preclude a standard operative approach, or when necessary concomitant procedures would otherwise require a two-stage operation.

Adolescent↗
PubMed1994

The effects of racemic cromakalim, BRL 38226 and levcromakalim on the membrane potential of the rat aorta and of BRL 38226 on the contractile activity of the rat aorta and portal vein.

The effects of racemic cromakalim and the (+)-3R,4S and (-)-3S,4R isomers, BRL 38226 and levcromakalim respectively, on the membrane potential of the rat aorta have been determined. In addition, preliminary studies of the effects of BRL 38226 on the contractility of the rat aorta and portal vein have been made. The rat aorta is hyperpolarized by racemic cromakalim at 10 microM and by levcromakalim at 1 microM, but is depolarized by BRL 38226 at 1 microM. In the presence of depolarization with 20 microM KCl, racemic cromakalim and levcromakalim, but not BRL 38226, reversed the depolarization of the rat aorta. In the presence of hyperpolarization with isoprenaline at 1 microM or in a CaCl2-free Krebs solution, racemic cromakalim and BRL 38226, but not levcromakalim reversed the hyperpolarization. Glibenclamide at 0.3 and 1 microM depolarized the rat aorta. Pretreatment with glibenclamide at 1 microM prevented the hyperpolarizing action of racemic cromakalim but did not alter the depolarizing action of BRL 38226. Pretreatment with BRL 38226 at 10 microM also prevented the hyperpolarizing action of racemic cromakalim. Contractility studies demonstrated that BRL 38226 and glibenclamide have no effect on the resting tone of the rat aorta in normal Krebs solution. However in a CaCl2-free Krebs solution, BRL 38226 and glibenclamide, 0.1-100 microM, caused small contractions. BRL 38226 and glibenclamide increased the spontaneous contractile activity of the rat portal vein in normal Krebs solution. The present study illustrates that levcromakalim opens the ATP-dependent potassium channels of the rat aorta to cause hyperpolarization. BRL 38226 and glibenclamide produce depolarization and contraction of the rat aorta and increase the contractile activity of the rat portal vein, possibly by blocking the ATP-dependent potassium channels.

Animals↗
PubMed1978

[Cardiovascular radiography, changes in the thoracic aorta, ECG and clinical parameters in hypertension. 2. Changes in the thoracic aorta in hypertension].

In 142 hypertensives and a control group of 230 normotensives the measure of the aorta after Kreuzfuchs was estimated. In the two groups a significant increase of the width of the aorta was found with growing age. Whilst the width of the aorta concerning the degree of severity I of hypertension on an average were slightly below those of normotensives, they were increased in the degrees of severity II and III, but a further increase could not be ascertained at the transition from degree of severity II to III. On the other hand, the duration of hypertension is of particular importance when a dilation of the aorta is present. Also between deformation of the heart and measure of the aorta close relations which may conclude to a homogenous development are to be seen particularly in the younger patients. The influence of the sclerosis of the aorta in the sense of an additional dilation of the aorta could not be clearly confirmed on the basis of our material. On the other hand, the frequency of calcium depositions significantly increased with growing age in the region of the aortic arce and in the group of younger patients with the duration of hypertension, whereas the different degrees of severity II and III had a smaller influence. It is interesting that several patients showed normal widths of the aorta despite a duration of the hypertension of more than 5 years and a degree of severity III.

Aorta, Thoracic↗
PubMed2006

Aneurysm hybrid treatment by simultaneous replacement of ascending aorta and aortic arch and endoluminal stenting of the descending aorta.

BACKGROUND: Resection of the descending thoracic aorta and replacement with a vascular prosthesis is associated with an increased risk of paraplegia, as opposed to endoluminal stenting. We report on the first case in which a thoracic aortic aneurysm was treated in a hybrid approach, combining surgery with the implantation of a new intraluminal stent during 1 procedure. METHODS: A 76-year-old man with long-standing hypertension suffered from acute chest pain. Magnetic resonance imaging (MRI) revealed a complex aortic aneurysm with increased diameters of the ascending aorta (55 mm), the aortic arch (75 mm), and the descending aorta (50 mm). Supracoronary replacement of the ascending aorta with a 30-mm prosthesis was carried out during cardiopulmonary bypass, cardioplegic arrest, and hypothermia (25 degrees C). Surgery and stenting were carried out during circulatory arrest and antegrade cerebral perfusion. Two stents (length: 23 cm and 17 cm) were placed in the descending aorta via the opened aortic arch under X-ray control, covering the left subclavian artery. Then aortic arch replacement was finished by anastomosing the distal end of the aortic prosthesis to the proximal stent's customized proximal end (Polyester cuff, length 25 mm/diameter 36 mm) together with the aortic wall. The brachiocephalic trunk and left carotid artery along with a vein graft to the left subclavian artery were implanted in the prosthesis. RESULTS: Postoperative course was uneventful except for a pericardial effusion. MRI revealed normal dimensions of the thoracic aorta with complete exclusion of the aneurysm and no leakage. CONCLUSION: Simultaneous replacement of ascending aorta and aortic arch with antegrade endoluminal stenting of the descending aorta using a new type of stent were safely and effectively performed in a patient with an aortic aneurysm.

Aged↗
PubMed1998

Spontaneous retrograde dissection of the entire thoracic aorta originating in the abdominal aorta. Case report and review of the literature.

Spontaneous retrograde thoracic extension of the abdominal aortic dissection is extremely rare and difficult to manage. Only five cases have been previously reported in the English literature (dissection reaching the ascending aorta in four, dissection limited in the descending thoracic aorta in one), and all the cases of dissection which reached the ascending aorta were lethal. We herein report one case of a 37-year-old man who was operated on for spontaneous retrograde dissection of the entire thoracic aorta originating in the suprarenal abdominal aorta. Preoperative aortogram revealed the site of the intimal tear just above the celiac artery. He urgently underwent graft replacement of the descending thoracic aorta and the abdominal aorta with reimplantation of the thoracoabdominal visceral arteries. Although the patient had to undergo the second operation for the dissection of the remaining thoracic aorta four months postoperatively, he has been doing well 18 months after the second operation.

Adult↗
PubMed1998

[A case of graft replacement of the ascending aorta to the aortic arch and the partial descending aorta in a single stage for thrombosed aortic dissection (DeBakey type II + IIIb)].

We report here a case of graft replacement of the ascending aorta to the aortic arch and the middle portion of the descending aorta in a single stage for thrombosed aortic dissection. The patient was a 53-year-old male who was transferred to our hospital with a diagnosis of thrombosed aortic dissection. Conservative therapy was continued but three weeks after the onset, chest enhanced CT scan and digital subtraction angiography revealed an opacified false lumen in the ascending aorta and a ulcer like projection in the middle portion of the descending aorta. He was therefore diagnosed as having redissecction in DeBakey type II + IIIb thrombosed aortic dissection. Graft replacement of the ascending aorta, the aortic arch, and a part of the descending aorta was performed in a single stage via median stenotomy with the aid of extracorporeal circulation and selective cerebral perfusion. Postoperative digital subtraction angiography showed satisfactory reconstruction of the thoracic aorta. The patient is still leading a normal life two years after the operation.

Aortic Dissection↗
PubMed1986

Diagnostic and surgical management of patients with aneurysms of the thoracic aorta with various causes. Echocardiography and contrast enhanced computed tomography in prophylactic replacement of the ascending aorta.

Sixty eight patients with aneurysms of the thoracic aorta were studied. Forty one had aortic dissection, 24 had dilatation only, and three had transverse aortic rupture. Sixteen had Marfan's syndrome; 17 had hypertension; and in eight there were other causal factors. In 17 the cause of the aneurysm was unknown. Histological examination did not help to establish the cause of aneurysm. Echocardiography failed to detect dissection of the ascending aorta in four (21%) out of 19 cases studied. The mortality rate in the whole series was 26%. Early (operative and hospital) and late deaths occurred in 20% and 6% of patients respectively. The early mortality rate was 40% in the 24 emergency cases of dissection of the ascending aorta, 9% in patients operated on for dilatation of the ascending and transverse aorta without dissection, and 8% in patients with chronic dissection of the ascending aorta who had elective operation. Early and late mortality rates were no higher in patients with Marfan's disease than in any of the other groups. It is suggested that contrast enhanced computer tomography should be performed in all patients with pronounced aortic root dilatation and in patients with Marfan's disease with symptoms which suggest dissection, even if they have only slight aortic root dilatation. Preventive replacement of the ascending aorta should be considered in more patients to reduce the number of emergency operations, in which the mortality rate is high. There is no definite limit of aortic root dilatation above which preventive replacement of the ascending aorta should be routinely considered.

Adolescent↗
PubMed1999

[Combined resection of the descending aorta under a simple temporary bypass for advanced lung cancer invading the aorta].

Three patients with advanced lung cancer invading the descending aorta underwent concomitant resection under a simple temporary bypass using thin-wall metallic cannulas. In each case, invasion to the descending aorta was suspected by CT and MRI. In case 1, resection of adventitia of the aorta was performed under a temporary bypass between the left subculavian artery and the descending aorta. In case 2 and 3, tubular resection and reconstruction of the aorta were carried out under a temporary bypass between proximal site of descending aorta from involved level and distal site. Complete resections of tumors were performed in all cases. During and after operation, vital signs were stable and no ischemic disorder of lower limbs and abdominal organs were observed. Case 1 died 7 months postoperatively because of recurrence in small intestine. Case 2 and 3 are alive at present, 21 and 5 months postoperatively, respectively. This procedure has advantages of safety, simplicity, and low invasiveness, in the cases the left subcuravian artery or the descending aorta is available for proximal site of the temporary bypass.

Aorta, Thoracic↗
PubMed1995

Percutaneous transluminal coronary angioplasty of aorta ostial, non-aorta ostial, and branch ostial stenoses: acute and long-term outcome.

The acute and long-term outcome of 198 patients who underwent coronary angioplasty of ostial stenoses was evaluated. Procedural success was achieved in 85% of aorta ostial stenoses, 90% of non-aorta ostial stenoses, and 87% of branch ostial stenoses (P = 0.84). A major complication occurred in 5.9%, 6.3%, and 6.9% of patients who underwent aorta ostial, non-aorta ostial, and branch ostial stenosis angioplasty, respectively (P = 0.97). A greater residual stenosis (P = 0.005) resulted from angioplasty of aorta ostial lesions despite a greater inflation frequency (P < 0.001), inflation pressure (P < 0.001), and total inflation duration (P < 0.001). The restenosis rate was higher for aorta ostial lesions (71%) when compared to non-aorta ostial (60%) and branch ostial lesions (32%) (P = 0.01). However, since the denominator included only the 49% who returned for repeat coronary angiography, the exact angiographic restenosis rate cannot be determined. The cumulative probability of survival was 99% at 1 year and 93% at 3 years. The 1 and 3 year freedom from death, myocardial infarction, bypass surgery, and repeat angioplasty was 70% and 57%, respectively. At census, 57% were asymptomatic, and only 9% suffered severe angina. Coronary angioplasty of ostial stenoses can be carried out with an acceptable success and complication rate, and provides good symptomatic relief and favourable long-term outcome. Randomized trials to compare new angioplasty technology with balloon angioplasty will be necessary to select the best device therapy for ostial lesions.

Adult↗
PubMed2000

The application of color power angiography to the longitudinal quantification of blood flow volume in the fetal middle cerebral arteries, ascending aorta, descending aorta, and renal arteries during gestation.

OBJECTIVE: This study was undertaken to determine by means of color power angiography the longitudinal changes in the diameters and the flow volumes of 4 major fetal arteries during gestation. STUDY DESIGN: The middle cerebral artery, the ascending aorta, the descending aorta, and the renal arteries in 81 appropriate-for-gestational-age fetuses were examined longitudinally between 24 and 38 weeks' gestation by means of color power angiography. In addition to measurement of the diameters of these arteries, Doppler velocimetry was performed. Flow volume was calculated from the cross-sectional areas of the arteries and the velocity integral of the Doppler waveforms. RESULTS: The mean (+/-SD) gestational age at delivery and birth weight were 39.8 +/- 1. 6 weeks and 3326 +/- 345 g, respectively. The diameters and flow volumes of all the arteries increased significantly as gestational age advanced. Flow volume increased from 39 +/- 19.0 mL/min to 140 +/- 63.9 mL/min in the middle cerebral artery, from 216.2 +/- 77.6 to 937.4 mL/min in the ascending aorta, from 124.4 +/- 76.6 to 390.0 mL/min in the descending aorta, and from 27.5 +/- 16.8 to 80.3 +/- 57.3 mL/min in the renal arteries. When blood flow volume was adjusted to milliliters per kilogram body weight, an initial significant fall in blood flow was seen in all the vessels to a minimal level at 30 weeks' gestation; blood flow rose thereafter, although not significantly, until term. The ratios of flow volume in the ascending aorta to those in the other vessels increased with gestation, with the highest ratio being that between the ascending aorta and the renal arteries. CONCLUSION: Identification of fetal arteries with color power angiography is easy and highly sensitive. The distributions of blood flow in various fetal arteries exhibited regional differences, with significantly more blood flow to the brain. These normative baseline values may be useful in the diagnosis of congenital cardiac anomalies and also in the diagnosis and monitoring of fetuses with intrauterine growth restriction.

Angiography↗
PubMed1986

Collagen in human aorta. Changes in the type III/I ratio and concentration of the reducible crosslink, dehydrohydroxylysinonorleucine in ascending aorta from healthy subjects of different age and patients with annulo-aortic ectasia.

The type III/I + III collagen ratio was studied in intima-medial samples of ascending aortas obtained from patients with the Marfan syndrome or other annulo-aortic ectasia (dilatation of the ascending aorta) and from control subjects, using electrophoretic analysis of cyanogen bromide peptides. The [3H]borohydride-reduced crosslinks of collagens were analysed by ion-exchange chromatography. Type III/I + III collagen ratios were twice as high in adult aortas as those found in skin samples of the same age. This ratio was lower in fetal and very young aortic samples and in 6-8 out of 12 pathological aortas (including one sample from a Marfan patient) when compared with adult controls. In contrast, the type III/I + III collagen ratio was high in fetal or very young skin and the values obtained from several patients did not differ from those of the control skin samples. In one pathological aorta out of six studied, the concentration of the reducible crosslink, dehydrohydroxylysinonorleucine, was higher than in controls, suggesting increased collagen synthesis or impaired maturation of collagen. These changes point to altered collagen metabolism in aortas of patients with annulo-aortic ectasia.

Adolescent↗
PubMed2001

[Magnetic resonance imaging of dilatation of the ascending aorta after repair of coarctation of the aorta].

The authors studied the risk factors for dilatation of the ascending aorta in patients operated for coarctation of the aorta. A prospective study of the diameters of the ascending aorta by magnetic resonance imaging was undertaken in 46 patients with an average age of 30 months (range 6 days to 11 years) at surgery, and 10 years of age (6 months to 31 years) at the time of the investigation. The diameters were measured at the level of the sinus of Valsalva, at the sino-tubular junction, and compared with reference tables with respect to body surface area. Twenty six per cent of patients had dilatation of the ascending aorta. The predisposing factors were investigated. Age, type of surgery, postoperative hypertension. Doppler gradient in the isthmic region, anatomical appearances of the repair observed by MRI were not predictive of this complication. On the other hand, age of patients at MRI and bicuspid aortic valves (present in 66% of cases) (p < 0.05) were significant risk factors. These results indicate that regular follow-up by echocardiography or MRI of the diameter of the ascending aorta is necessary in patients operated for coarctation of the aorta and with bicuspid aortic valves.

Age Factors↗