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At least 55 records · Page 3Linked to original sources
PubMed1997

Repair for aneurysms of the entire descending thoracic aorta or thoracoabdominal aorta using a deep hypothermia.

OBJECTIVE: Replacement of the entire descending aorta or of the thoracoabdominal aorta still has a significant risk for postoperative paraplegia. Surgical strategies using a deep hypothermia to protect the spinal cord or viscera are discussed. METHODS: From April 1994, 25 patients underwent graft replacement of the entire descending aorta (13 patients) or thoracoabdominal aorta (12 patients) using a deep hypothermia. Five patients had atherosclerotic aneurysms and 20 had aortic dissection. There were 20 males and 5 females, whose age ranged from 26 to 72 years old, 47 years old in average. Surgery consisted with proximal anastomosis using deep hypothermia (18 degrees C) with retrograde cerebral perfusion by elevating central venous pressure to 20 mmHg, reconstruction of the intercostal arteries, and distal open anastomosis, while perfusing the brain and heart. Proximal open anastomosis was used with retrograde cerebral perfusion technique in 18 patients. Averaged number of reconstructed intercostal arteries was 2.1 for each patient. RESULTS: No early mortality was found and one patient died of respiratory failure 6 months after surgery. One patient had a postoperative stroke and one had a delayed onset of paraplegia 2 days after operation. The cause of paraplegia was secondary hypoxemia and hypotension due to pneumonia. CONCLUSION: Utilization of the deep hypothermia in surgery for aneurysms of the entire descending aorta or of the thoracoabdominal aorta provided an adequate protection of the spinal cord as well as the abdominal viscera, eliminated clamp injury or cerebral embolization of debris or thrombi, and afforded excellent surgical exposures.

Adult↗
PubMed1985

[Obstructive calcification of the descending thoracic aorta and suprarenal abdominal aorta. 2 cases].

Two cases of obstructive calcification of the aorta treated by surgery are reported. The disease is extremely rare, notably in the aortic segments involved in these two cases. Its clinical features were similar to those of coarctation. Intraluminal proliferative calcifications were present in the descending thoracic aorta of the first patient who underwent aortic resection with Dacron replacement prosthesis and in the suprarenal segment of the abdominal aorta of the second patient for whom an extra-anatomical bypass between the ascending aorta and the upper abdominal aorta was performed. The first patients remains with moderate arterial hypertension after 4 years; arterial pressure returned to normal in the second patient and is still normal after 15 months.

Aorta, Abdominal↗
PubMed1985

Proliferation of smooth muscle cells in the thoracic aorta after injury to the abdominal aorta: evidence for a humoral mediator in experimental arteriosclerosis.

We tested the hypothesis that circulating humoral material(s) can induce vascular smooth muscle cells to synthesize DNA and to proliferate. Either the entire aorta or its abdominal segment was balloon de-endothelialized in four groups of rabbits. In the first group (control), the entire aorta was injured, and no further procedures were carried out. In a second group (reinjury), the abdominal aortic segment was reinjured 4 days after the initial de-endothelialization procedure. A third group (sham) had a second sham operation 4 days after initial injury. In a fourth group (abdominal only), the abdominal aortic segment was injured on two occasions 4 days apart. There was a rise in the specific activity of 3H-thymidine incorporation into smooth muscle cell DNA (DNA-SA) of the thoracic segments, which began 12 hours after reinjury, peaked within 24 hours at 335 +/- 63 dpm/micrograms DNA (+/- SEM), and returned to control level within 72 hours. The DNA-SA of the thoracic aorta of control rabbits and sham-operated animals 4.5 days after the initial injury was 86 +/- 19 and 48 +/- 8 dpm/micrograms DNA, respectively. There was no rise in DNA-SA in the thoracic aorta of animals in which the abdominal aorta was injured twice. Intimal cell nuclei per 0.1 mm internal elastic lamina were counted 3 days after the second injury and showed similar differences between doubly injured and control animals. Platelet accumulation, as measured by chromium 51 platelet attachment to the aortic surface, was increased in the abdominal segment 12 hours after reinjury.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1976

Prostaglandin endoperoxides, serotonin and the superfused rabbit aorta: possible pitfalls in the bio-assay of rabbit aorta contracting substance (RCS).

The specificity of the isolated rabbit aorta for identification and assay of prostaglandin endoperoxides, formed during aggregation of platelet rich plasma (PRP) from rats, was investigated in the superfused organ cascade. The use of cumulative dose-response curves in this design is quicker than conventional step-wise dosing while delivering identical results. On the rabbit aorta, in contrast to the rat fundus strip, methysergide is too weak an antagonist to rule out responses due to 5-HT. After pretreatment with phenoxybenzamine, in the presence of methysergide, the rabbit aorta retains its sensitivity towards oxygenated fatty acids, while being virtually unreactive towards 5-HT. The prostaglandin endoperoxide PGH2 is more potent than prostaglandin E2 when assayed on the rabbit aorta, while on the rat fundus the situation is reversed. Combining the rabbit aorta and rat fundus strip with pre-filtration on Amberlite XAD-2 columns showed that during collagen induced aggregation rat PRP generated both a labile RCS-most probably a prostaglandin endoperoxide- and a lipophylic prostaglandin-like material, along with 5-HT.

Animals↗
PubMedDate not supplied

Tracking deforming aortas in two-photon autofluorescence images and its application on quantitative evaluation of aorta-related drugs.

This paper describes a novel approach to an objective measurement of aorta samples of rats and a quantitative evaluation of aorta-related drugs. Two-photon fluorescence microscopy is used for recording image sequences of deforming aorta. Time sequence snake models are used to track the structural deformations of aorta walls caused by drug stimulation of the elastic lamina in the aorta. Several objective and quantitative biomarkers extracted from these models are used as diagnostic indicators. In a preliminary study, the technique was successfully used for evaluating the effect of a newly developed drug-human erythrocyte-derived depressing factor quantitatively and objectively.

Animals↗
PubMed1982

Five methoxy-2-methyl-3-indole acetic acid. A metabolite and alkali hydrolysis product of indomethacin, markedly inhibits platelet aggregation only in the presence of aorta or a product released by aorta.

5-methoxy-2-methyl-3-indole acetic acid (5MIAA) is a metabolite and alkali hydrolysis product of indomethacin. This indole derivative was previously found to be an effective in vivo inhibitor of platelet aggregation in an experimental model of microvascular injury in the mouse. In a standard aggregometer assay, the in vitro inhibitory action of 5MIAA was weak and failed to explain its in vivo effect. The present study employed two assay systems testing the capacity of 5MIAA to increase the aggregate inhibiting activity of the aorta. In one series of experiments the aorta, the drug and platelet rich plasma were incubated together, and in another series aliquots of aortic incubation media were transferred to PRP. Both types of study showed that 5MIAA interacts with the aorta and with a substance(s) produced by aortic wall to markedly inhibit aggregation stimulated by arachidonic acid. Thus, when 100 micrograms/ml of 5MIAA, which by itself had a negligible effect on aggregation, was added to a cuvette containing both aorta and PRP, the inhibitory effect of the aorta was enhanced three fold. The substance with which 5MIAA interacts was eliminated by cyclooxygenase inhibitors, but direct tests of 5MIAA's ability to potentiate the effect of prostacyclin were unsuccessful.

Animals↗
PubMed1979

Late sudden death after surgical correction of coarctation of the aorta. Importance of aneurysm of the ascending aorta.

Follow-up studies averaging 12 years postcorrective surgery of 343 patients with coarctation of the aorta disclosed 38 late deaths, 15 of which were sudden, unexpected and probably cardiovascular. All but two patients were normotensive postoperatively, and in 4 of these the cause of death was proven dissecting aneurysm of ascending aorta. In another patient this aneurysm was repaired surgically and in 3 other patients chest X-ray had shown a dilated ascending aorta before death. At follow-up the ascending aorta was dilated angiographically in 4 survivors, who had moderate systolic hypertension and aortic valve disease. The high incidence of aneurysm of ascending aorta in patients with coarctation is probably due to hypertension during the growth period, possibly in combination with congenital weakness of the aortic wall, and to concomitant aortic valve lesion.

Adolescent↗
PubMed2000

A study of the junction between glutaraldehyde-treated allogeneic aorta and host aorta.

BACKGROUND AND AIM OF THE STUDY: Stentless aortic valve bioprostheses have become popular because of their superior hemodynamics and expected increased durability. However, the stentless bioprosthesis differs from stented valves in that glutaraldehyde (GA)-treated tissue is implanted in direct contact with the native aorta. The effect of GA-treated tissue on host tissue has not been reported. METHODS: In order to analyze the effect of GA in the healing process, sheep descending aortic conduits treated with 0.625% GA were inserted in the descending thoracic aorta of 10 adult sheep. The implants were removed after 4, 5, 10, 12, 15, 25, 30, 32, 60 and 120 days. The upstream and downstream junctions were evaluated macro- and microscopically, and by immunohistology for smooth muscle cell alpha-actin and von Willebrand factor. RESULTS: By day 60 of implantation, the GA-treated conduits were calcified. By days 60 and 120, the calcification had spread to the host aorta, and was seen as foci of calcification in the junctional area. Acellular areas were also seen in the host aorta near the anastomosis. A fibrotic layer spanning the abluminal aspect of the junction between the implant and host aorta was present at day 4 and continued through 120 days. This layer was characterized by a progressive increase in collagenous matrix and cellularity, as well as new blood vessel formation. The luminal aspect of the junction had a neointimal layer of variable thickness containing alpha-actin-expressing cells covered by a monolayer of von Willebrand factor-expressing cells, seen at 15-30 days and present through 120 days. CONCLUSION: In our model, implanting GA-fixed tissue in direct contact with living tissues resulted in cell death and calcification of host tissue within 60 days. The integrity of the junction did not appear to be compromised. This may be of interest in light of the increased popularity of the stentless aortic bioprosthesis.

Actins↗
PubMed1988

Traumatic fracture of the abdominal aorta. Rupture of a calcified abdominal aorta with minimal trauma.

We report the case of an elderly man whose infrarenal abdominal aorta ruptured when the patient fell getting out of bed. Unique features of this case are the lack of aneurysmal disease, the insignificant nature of the trauma, and the severe, rigid atherosclerotic plaque in the infrarenal aorta. Pathologic examination of the resected aorta demonstrated the point of rupture to be at the junction of atherosclerotic plaque and normal aorta, suggesting that atherosclerosis is a predisposing factor in traumatic rupture of the abdominal aorta.

Abdominal Injuries↗
PubMed1992

Rationale and technique for replacement of the ascending aorta, arch, and distal aorta using a modified elephant trunk procedure.

Replacement of the aortic arch during repair of either extensive aortic aneurysmal disease or aortic dissection can be a major undertaking. Borst introduced an "elephant trunk" technique whereby a tubular aortic graft prosthesis was inserted into the distal aorta while repairing the ascending aorta and aortic arch. The distal elephant trunk prosthesis was then used for a second stage operation that involved replacement of sections of the distal aorta. Since then, a few problems have been encountered with the standard elephant trunk procedure and this has led to a modification of the elephant trunk technique, which enables a more accurate and secure distal aortic arch anastomosis to be performed. Using the standard technique described by Borst, the surgeon has to suture in the groove between the tubular graft and the aortic wall, which can increase the risk that torsion on the suture needle will tear the aortic wall resulting in aortic rupture. Indeed, this complication has been noted in the postoperative period when performing the standard technique. Subsequently, the technique was modified with inversion of the graft in itself, placement of the graft in the descending aorta, and performance of the distal anastomosis using a technique similar to that described by Griepp. This has improved the ease of performing the procedure and the results of the technique such that a better than 90% survival rate can be expected for the first and the second stage repairs.

Anastomosis, Surgical↗
PubMed1977

Surgical treatment of aneurysms of the ascending aorta. With special reference to cystic medial necrosis of the aorta.

The clinical series comprised 14 patients with aneurysms of the ascending aorta. In the autopsy series, there were additionally 19 patients, who had died suddenly as a results of free perforation or dissection of the ascending aorta. In the clinical series, the cause of the aneurysmal formation was cystic medial necrosis in 10 patients, 8 of whom had severe aortic valve insufficiency. Twelve patients were operated on using extracorporeal circulation, Both the ascending aorta and aortic valve were replaced with prosthesis in 6 cases. Three patients underwent emergency surgery due to pericardial tamponade. All three died, despite a technically successful operation. One patient out of 9 electively operated upon died. A follow-up examination was carried out on the 5 surviving cystic medial necrosis patients. Aneurysms of the sinuses of Valsalva developed after supracoronary resection in 2 patients. The results showed that elective operations in the event of aneurysms of the ascending aorta can be carried out with an acceptably low mortality rate. However, after supracoronary resection, in cases of cystic medial necrosis, the risk of developing aneurysms of the proximal aortic remnant seems obvious. Therefore, in patients in whom the whole aortic root is involved, total removal of the ascending aorta and re-implantation of the coronary ostia into the prosthetic tube is preferable.

Adolescent↗
PubMed2003

Surgical treatment of multiple mycotic aneurysms: in the ascending aorta, aortic arch, and descending aorta.

We report a clinical case of multiple mycotic aneurysms, in the ascending aorta, aortic arch, and descending aorta. The patient underwent surgery to replace the ascending aorta and aortic arch by means of a highly modified "elephant trunk" technique and with the aid of arterial cannulation from the right subclavian artery, which provided antegrade cerebral perfusion. Samples of purulent material taken from the aneurysmal wall yielded cultures positive for Staphylococcus aureus. The patient was treated with antibiotics for 6 weeks and then underwent a 2nd procedure for the aneurysmal resection of the descending thoracic aorta and the abdominal aorta, through a thoracic laparo-phrenicectomy. We comment on the clinical and surgical aspects of the case.

Aged↗
PubMed1994

[Aortic valve replacement in a patient with severely calcified small aorta valve and ascending aorta].

A 74-year-old male with severely calcified aortic valve and ascending aorta underwent aortic valve replacement. Cannulation as well as cross clamping of the ascending aorta was avoided because there might be a definite risk of cerebral embolism caused by liberated atheromatous debris on manipulation of the ascending aorta. The extracorporeal circulation was established by femoral arterial and right atrial cannulation, and the aorta was cross-clamped at the soft distal arch. Selective cerebral perfusion catheters were inserted via a longitudinal aortotomy made at a soft anterior portion of the ascending aorta, through which the valve replacement procedure was carried out. The aortic valve annulus was narrow (barely 21 mm in diameter), so that the interrupted mattress suturing technique with the pledgets placed below the annulus in the left ventricular outflow tract was adopted. By this supraannular suturing method a bioprosthesis was easily secured above the annulus as the thickened annulus was compressed between the sutures and the device.

Aged↗
PubMed1998

Aortic valve replacement through the transected aorta in a patient with aortic stenosis and a calcified ascending aorta.

This report describes a surgical approach of aortic valve replacement in a patient with a calcified ascending aorta, calcified aortic valve stenosis and coronary artery disease. The aortic valve was replaced with a 19 mm St. Jude Medical prosthetic valve through the transected aorta while the distal ascending aorta was cross-clamped at a narrow but not calcified band approximately 4.5 cm distal to the aortic anulus. These procedures were successfully done and no neurological deficit was found after surgery. The aortic valve replacement through the transected aorta may be one of the alternatives in selected patients with porcelain aortas and calcified aortic valves.

Aged↗
PubMed2000

Simultaneous coronary artery bypass grafting and ascending aorta bifemoral bypass in small aorta syndrome.

A 55-year-old man with severe coronary artery disease and aortoiliac occlusive disease with small aorta syndrome was admitted to our department with angina pectoris and bilateral claudication. Intravenous subtraction angiography showed total occlusion of the right common iliac artery and 99% stenosis of the left common iliac artery with a markedly hypoplastic infrarenal aorta only 9 mm in diameter. It also revealed 90% stenosis at the origin of the left subclavian artery. Coronary angiography showed total occlusion of the left anterior descending artery and 90% stenosis of the circumflex artery. Simultaneous coronary artery bypass grafting and an ascending aorta-bifemoral bypass were conducted using an in-situ right internal mammary artery graft, an autologous saphenous vein graft, and a Y-figured expanded polytetrafluoroethylene graft. Postoperative angiography showed grafts to the coronary and bifemoral arteries were patient. This combined procedure is useful for patients with coronary artery disease and aortoiliac occlusive disease, especially in those with small aorta syndrome.

Aorta↗
PubMed1999

[Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy].

We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. Transesophageal echocardiography was used to measure the diameter and the length of descending aorta and the graft. And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.

Aortic Dissection↗
PubMed1992

[Interposition of a prosthetic graft between the ascending aorta and the abdominal aorta in the treatment of complicated or longstanding coarctations in adults].

Although the direct approach to the aortic isthmus is unquestionable for an isolated coarctation of the thoracic aorta, recurrent coarctations of coarctation with associated cardiac lesions require a concomitant procedure, raise difficult surgical problems and expose to a high operative risk. Another technique consists of performing an ascending aorta-abdominal aorta by-pass, with a prosthetic tube. From 1977 to 1988, this technique was performed in 8 patients: 3 with recurrent coarctations, 4 with coarctation associated with a surgical aortic insufficiency (2 ascending aortic aneurysms with aortic insufficiency) and 1 with abdominal aorta coarctation. The mean age was 48.3 years (range from 31 to 72 years), the mean follow-up was 44.3 months (range from 4 months to 10 years 5 months). There was no mortality and no morbidity during the follow-up. The functional result is good, without high blood pressure and with no blood pressure difference between the arms and the legs. Postoperative angiographies showed that all the by-passed were patent.

Adult↗
PubMed1989

Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients.

Ascending aorta and/or aortic arch reconstruction by composite valve graft (281, 39%), separate valve graft (117, 16%), graft only (256, 36%), and other procedures (63, 9%) was used for aneurysm or dissection caused by trauma (6), infection (20), aortitis (46), dissection (261: acute 72, chronic 189), and medial degeneration (384) in 717 patients during the 9-year period between Jan. 11, 1980, and Jan. 16, 1989. Of these, 150 had 173 previous heart or aortic operations and needed reoperation for progression or recurrence of aneurysm, rupture, valvular insufficiency, aortocutaneous or aorta-heart chamber fistulas, great vein or airway obstruction, and infection. Concurrent distal aneurysmal disease was present or developed in 267 (37%) patients, being most prevalent in patients with arch involvement (211/395, 53%). These patients were treated either simultaneously or later. The ages ranged from 10 to 88 years, median 61. Aneurysm symptoms were mild or absent in 593 (83%) and severe in 124 (17%). The 30-day survival rate was 91%. The independent determinants predictive of 30-day death were increasing age, severe aneurysm symptoms, diabetes, previous proximal aortic operation, need for cardiac support, postoperative tracheostomy, postoperative heart dysfunction, and stroke. Of the 319 patients who had none of the four preoperative factors, 308 (97%) survived. Survival decreased to 74% in those with two or more factors. After a total of 1193 operations, the entire aorta was replaced in 53, near total in 35, total thoracic replacement in 78, and total aorta except arch in 27. Late survival rates (Kaplan-Meier) were 66% and 57% at 5 and 7 years. Independent predictors of death were severe aneurysm symptoms, preoperative angina, extent of proximal replacement, associated residual distal aneurysm, balloon pump, renal dysfunction, cardiac dysfunction, and stroke. Five-year survival rates varied with the incidence of the four preoperative variables and age in a single patient: 78% in 413 patients with up to one variables, 57% in 193 patients with two or three, and 39% in 111 patients with three or four (p less than 0.0001).

Aortic Dissection↗