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At least 19 recordsLinked to original sources
PubMed1999

Noninvasive Imaging of the Thoracic Aorta.

Thoracic aortic disease is a common problem affecting the geriatric population of the U.S. Thoracic aortic aneurysms and aortic dissection and its variants are the most common diseases of the thoracic aorta, often leading to death if not treated immediately. Contrast aortography is no longer considered to be the diagnostic gold standard for evaluating the thoracic aorta. This is a review of those abnormalities most commonly seen in the geriatric population: thoracic aortic aneurysms, aortic dissections, intramural hematomas, and penetrating ulcers. The roles of multiplanar transesophageal echocardiography (TEE), spiral computed tomography (CT), and magnetic resonance imaging (MRI) are discussed in the evaluation of each of these disease entities. Although each has been shown to have high sensitivities and specificities for the diagnosis of aneurysms and dissections and its variants, TEE and MRI are thought to be superior to spiral CT because of their ability to evaluate the aortic valve apparatus. However, spiral CT is perhaps the easiest and most cost effective modality to screen patients with known or suspected aortic dissection. (c)1999 by CVRR, Inc.

Journal Article↗
PubMed1997

Surgery of the thoracic aorta.

Thoracic aortic surgery has evolved from a high-risk, high-morbidity procedure to a safe procedure with predictable results. The frontiers left are adequate spinal cord protection and a less invasive approach to these procedures.

Aorta, Thoracic↗
PubMed1994

Positional dyspnoea due to aneurysm of the thoracic aorta.

Thoracic aortic aneurysms may produce breathlessness by compressing the tracheobronchial tree. We report a patient whose shortness of breath demonstrated a marked positional component, due to varying compression of her major airways by the lesion.

Aged↗
PubMed1993

[Long-term treatment of patients with dissection of the thoracic aorta].

Thoracic aortic dissection is an extremely serious vascular accident which must be treated immediately. While ascending aortic dissection requires surgery as soon as possible, descending aortic dissection is only treated surgically when complications such as aortic ectasia, hemorrhage or ischemia occur. Late complications most often lead either to the patient's death or to reoperation. Late death occurs in 4-6% patients/year and about 3% patients/year undergo late reoperation. In our own experience these figures amount to 2 and 0.8% respectively.

Aortic Dissection↗
PubMed1987

Factors in the propagation of aortic dissections in canine thoracic aortas.

Factors were examined which altered the propagation of aortic dissections in canine aortas. Thoracic aortas were removed from sacrificed dogs from the distal end of the arch to the diaphragm. An intimal tear was created at the proximal end of the aorta. The dissection was propagated using a pulsatile pressure system with no flow. The aorta was perfused with a dilute black paint solution, which allowed both video monitoring of the extension of the dissection and measurement of the dissection rate. The dependence of the dissection rate on the variables peak pressure, (dP/dt)max and intimal tear depth was examined. The dissection rate was found to be dependent on (dP/dt)max (p less than 0.005) and the intimal tear depth, expressed as a percentage of wall thickness (p less than 0.01), but not on the peak pressure or intimal tear length. The equation relating the significant variables was log (dissection rate) = (-0.034) X % tear depth +(1.89 +/- 0.56) X (dP/dt)max -(4.3 +/- 1.8); r = 78. Thus a higher (dP/dt)max was associated with a more rapid dissection rate and a deeper intimal tear was associated with a slower dissection rate.

Aortic Dissection↗
PubMedDate not supplied

Endografting of the thoracic aorta:.

BACKGROUND: Thoracic aortic dissections, ruptures, fistulae, and aneurysms pose a unique surgical challenge. Traditional repair of thoracic aortic aneurysms involves thoracotomy with graft interposition. Despite advances in perioperative care and both total and partial cardiopulmonary bypass, conventional surgery carries a significant morbidity and mortality. Principal complications include bleeding, paraplegia, stroke, cardiac events, pulmonary insufficiency, and renal failure. Recent enthusiasm for innovative endovascular therapies to treat aortic disease has spurred many centers to investigate endoluminal grafting of the thoracic aorta. Early reports on endovascular repair using custom made "first generation devices" demonstrated the technique to be feasible with a mortality and morbidity comparable to open repair. METHODS AND RESULTS: From February 2000 to February 2001, endovascular stent graft repair of the thoracic aorta was performed in 46 patients (mean age 70; 29 male and 17 female) using the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, fourteen patients (30%) had dissections, three patients (7%) had aortobronochial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcomes, and complications were recorded. All patients were followed with chest CT scans at 1, 3, 6, and 12 months. Mean follow up was 9 months ranging from 1 to 15 months. All procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients left the hospital within 4 days (64%) after endoluminal grafting. Overall morbidity was 23%. Two patients (4%) had endoleaks that required a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 moths post procedure. Both were treated successfully with additional stent grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. The Gore Excluder device was voluntarily recalled on February 26, 2001. Therefore, from June 2000 to January 2001, 37 patients underwent endovascular stent graft repair of the thoracic aorta for various disease entities using our customized thoracic graft (Endomed). Twenty-seven patients (73%) had aneurysms, six (16%) had dissections, two (5%) had pseudoaneurysms, one (2%) had a traumatic transection, and one patient (2%) had an embolizing ulcer. Patients were followed with CT scans at 1, 3, 6, and 12 months. All procedures were technically successful. There were no conversions. The average age was 68 years.(17-87). And the male and female ratio was 24/13. One patient died in the operating room from iliac rupture and one died from embolization/stroke in the immediate postoperative period. Two patients died within 30 days from comorbid factors. The total 30-day mortality was 10%. Two patients had endoleaks. One returned to the operating room and needed an additional cuff. The other had a small leak in a proximal dissection that is being followed. There were no cases of paraplegia. CONCLUSION: Thoracic endoluminal grafting is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest that an endoluminal approach to these disease entities maybe favorable to open resection and graft replacement. Technical details of Endoluminal stent grafting of the thoracic aorta for different disease entities have been discussed at length.

Adult↗
PubMed1978

[Experimental investigation of thoracic aorta myocytes in mice. Contribution to the problem of the cause of arteriosclerosis].

The reactivity of myocytes has been ultrastructurally investigated. Pieces of aorta thoracic from mice were organ-cultured on the chorioallantoic membrane of chicken eggs incubated for 14 days. The outstanding finding were individual myocytes of the media--probably in a particular cytoenergetic stage--undergoing necrosis. They were enclosed from almost unaffected myocytes. Transferred to in vivo conditions, these findings may serve as a model for a participation of myocytes in the devleopment of disseminated multifocal arteriosclerotic plaques. The reactivity of the myocytes as to their ability of proteoglycan and lipid synthesis was opposed to Benditt's hypothesis of the genesis of an arteriosclerotic plaque caused by a monoclonal cell line originating from a mutated myocyte of the artery wall near the site of the plaque. The hypothesis of Kaunitz has been discussed, according to which the high serum cholesterin level with severe arteriosclerosis may be rather a consequence of cholesterin synthesis by the 'reparative' tissue of the arteriosclerotic lesion than its reason.

Animals↗
PubMed1994

Glycosaminoglycan content is increased in dissecting aneurysms of human thoracic aorta.

Ten thoracic aortas were obtained from cases of dissecting aneurysms and 10 from age-matched controls. Full wall thickness samples (1 cm diameter) were taken at 12 sites for both groups. Content, concentration and ratio to total glycosaminoglycan (GAG) were determined for chondroitin sulphate (CS), hyaluronate (HA), heparan sulphate (HS) and dermatan sulphate (DS). When compared with controls, content of CS and HS increased over the whole length of dissected aortas, whereas increased HA and DS were localised to dissected areas of affected aortas as were increased tissue mass and collagen and elastin content. Changes in concentration and ratios, significant for some GAGs and consequent upon these increases, may help to compromise the mechanical properties of the aortic wall. The localised increases in HA and DS content in areas where collagen and elastin were increased suggests that these GAGs are functionally related to these fibrous proteins in aorta, whereas CS and HS are not.

Aged↗
PubMed1996

Age-related changes in amounts and concentrations of collagen and elastin in normotensive human thoracic aorta.

Twenty thoracic aortas were obtained post-mortem from subjects between the ages of 14 and 90 years who had previously been recorded as normotensive. Full wall thickness samples of 1 cm diameter were taken at six sites between heart valve and diaphragm. Lipid-free dry weight (mg per sample) and amounts (mg per sample) and concentrations (mg/mg dry weight) of collagen and elastin were determined. Lipid-free dry weight and amount of collagen showed highly significant decreases with age (P < 0.0001), with the amount of elastin less so (P = 0.003), representing losses of 92%, 80% and 62%, respectively, between the ages of 14 and 90 years. In contrast, the concentrations of both collagen and elastin increased significantly with age (P < or = 0.0002) by 72% and 140%, respectively, over the age range studied. However, in both cases, the increase occurred substantially after the age of 45. Therefore, besides demonstrating loss of collagen and elastin from the aortic wall with age, these results suggest strongly that there is a parallel loss of other aortic components at a rate which outstrips that of either collagen or elastin in later life.

Adolescent↗
PubMed1980

Transabdominal exposure of the thoracic aorta.

The thoracic aorta can be exposed from an abdominal approach by means of an incision in the diaphragm. This method has been used extensively by Crawford and colleagues but has not been described in detail. Patients with normal renal function before the operation suffered no permanent renal damage from periods of ischemia for up to 45 minutes under normothermic conditions. One patient with impaired renal function before the operation sustained permanent renal damage.

Abdomen↗
PubMed1988

Segmental volume distensibility of the canine thoracic aorta in vivo.

Segments of the canine ascending aorta, upper descending thoracic aorta, and middle descending thoracic aorta were instrumented with ultrasonic dimension gauges and a cathetertip manometer simultaneously to measure changes in segment diameter, length, and intravascular pressure. Volume distensibility (EV) was calculated as the sum of circumferential extensibility (EC), longitudinal extensibility (EL), and high order extensibilities (EK) for each segment. The EC and EL were linear expressions that represented percentage volume changes per mmHg pulse pressure due to circumferential and longitudinal dimensional changes. The high order extensibilities (second and third order) accounted for the percentage volume changes per mmHg pulse pressure due to the interactions between circumferential and longitudinal dimensional changes. Mean(SEM) EV values from six dogs were 1.62(0.31), 0.84(0.08), and 0.62(0.08)% delta V/mmHg delta P for the ascending aorta, upper descending thoracic aorta, and middle descending thoracic aorta segments respectively. The EV, EL, and EK of the ascending aorta segment were significantly greater than those of the upper descending thoracic aorta and middle descending thoracic aorta segments, whereas EC was significantly less in the ascending aorta than in both the upper descending thoracic aorta and middle descending thoracic aorta segments. It is concluded that there are regional differences in aortic distensibility and its components in vivo. Longitudinal wall motion is an important determinant of these aortic mechanical properties.

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↗
PubMed1979

Pitfalls in the plain film evaluation of the thoracic aorta: the mimicry of aneurysms and adjacent masses and the value of aortography. Part II. Descending thoracic aorta.

Distinguishing posterior mediastinal and pulmonary masses from aneurysms and tortuosity of the descending thoracic aorta may be difficult, as five such cases illustrate. Both the neoplasms and the aortic aneurysms or tortuosity can compress the same vital mediastinal structures; thus, they may give rise to the same symptoms. Because the plain film findings may also be similar, aortography is essential to their diagnosis.

Aged↗
PubMed2004

[A serious complication of sternal puncture: penetrating injury of the ascending thoracic aorta].

INTRODUCTION: Penetrating thoracic aorta wounds are rare but responsible for a high mortality when medical and surgical management is delayed. OBSERVATION: We report the case of a 71 year-old patient with malignant lymphoma who sustained an accidental penetrating injury of the ascending thoracic aorta while undergoing trephine biopsy of the sternum. He was successfully treated with emergency sternotomy and aortic suture-repair. CONCLUSION: This case report highlights the limits of sternal trephine biopsy, notably in patients whose bones are weakened by a malignant haematological process, and proposes preventive measures in order to avoid accidents.

Aged↗
PubMed2001

Characterization of alpha1-adrenoceptor-mediated contraction in the mouse thoracic aorta.

In the mouse thoracic aorta, noradrenaline, adrenaline, phenylephrine and methoxamine behaved as full agonists. The pA(2) values for 8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-8-azaspiro[4,5]decane-7,9-dione dihydrochloride (BMY 7378) against each agonist were in good agreement with the generally accepted affinity value of alpha(1D)-adrenoceptors. 5-Methylurapidil, 2-[2,6-dimethoxyphenoxyethyl]aminomethyl-1,4-benzodioxane hydrochloride (WB 4101) and prazosin inhibited the contraction in response to noradrenaline. A significant correlation was obtained between the antagonist affinities in mouse thoracic aorta and those of native alpha(1D)-adrenoceptors in rat thoracic aorta or with those of cloned alpha(1d)-adrenoceptors, but not with those for either alpha(1a)- or alpha(1b)-adrenoceptors. Buspirone behaved as a partial agonist in mouse thoracic aorta, the contraction of which was antagonized by BMY 7378 with a pA(2) value (8.49) consistent with that found against noradrenaline (8.43). Clonidine acted as a partial agonist (pD(2)=5.94). The pK(p) value for clonidine against noradrenaline was similar to the pD(2) value for clonidine. The apparent pK(B) value for BMY 7378 against clonidine was similar to the pA(2) value against other full agonists used in the present study. These results suggest that the alpha(1D)-adrenoceptor subtype exists, and that the full agonists and the partial agonists evoke the contraction mediated through the alpha(1D)-adrenoceptor in mouse thoracic aorta.

Adrenergic alpha-Agonists↗