1/10. Redo Bentall operation for the aortitis syndrome.The aortitis syndrome is a chronic inflammatory arterial disease with an unknown etiology that may present as a variety of vascular lesions. The surgical treatment of aortitis syndrome is associated with many potential difficulties due to the inflammatory nature of the disease. A patient with the aortitis syndrome underwent the Bentall operation for annulo-aortic ectasia and aortic regurgitation 11 years prior to presentation. The operation was not performed during the active inflammatory phase. An anastomotic dehiscence required reoperation, which was performed with Piehler's method. In the aortitis syndrome, the exclusion technique, Carrel patch repair of the coronary arteries and pledgeted anastomoses should be performed for aortic root reconstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Aortobronchial fistula after aortic dissection type B.Although rare, aortobronchial fistula complicates thoracic aortic surgery. Correct diagnosis and the infectious nature of the lesion are the most important conditions to define, for the following best therapy. We presented a case of non-infectious postsurgical aortobronchial fistula, revealed by computed-tomographic scan and angiography procedure, treated with prosthetic graft replacement and broad spectrum antibiotic therapy. In the case of infection our policy is homograft replacement. Computed tomography, being able to make diagnosis, should be performed as the initial technique.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Aortic dissection and Turner's syndrome.Cardiovascular malformations, especially coarctation of the aorta and bicuspid aortic valve, are common in patients with Turner's syndrome. Only 46 patients with aortic dissection and/or rupture have been described. All patients had associated aortic dilation or aneurysm. In all cases except three, involvement of the ascending aorta was present, making surgery often imperative. We describe a rare case of a DeBakey type IIIb aortic dissection (without involvement of the proximal aorta) in a patient with Turner's syndrome mosaicism. The dissection occurred two weeks after a caesarean section because of eclampsia. No aortic dilation or other cardiovascular malformations were found. The distal extension and uncomplicated nature of the dissection indicated medical management. After fifteen months of follow-up, she is clinically doing well and repeated CT scan shows a stable dissection of the descending and abdominal aorta without dilation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Epidural cooling for spinal cord protection during thoracoabdominal aortic aneurysm repair (a case study).Aneurysms result from damage to artery walls as a result of underlying athrosclerotic and/or thromboembolic disorders. A thoracoabdominal aortic aneurysm involves vessel damage and wall weakening in the thoracic and abdominal segments of the aorta. Thoracoabdominal aortic aneurysm repair is considered to be high risk due to the nature of the intervention that requires an extensive incision with clamping of the thoracic aorta above the renal arteries. Clamping of the aorta renders all areas distal to the clamp at high risk for ischemic trauma especially to the spinal cord where the risk of neurological deficits postoperatively is 7-16% (Cambria, et al., 1997; Davison, et al., 1997). Several adjunct interventions have been tried to reduce the risk of spinal cord injury associated with the ischemia of cross clamping. Epidural cooling has been successful as an adjunct in reducing the neurological deficits. A preoperative nursing assessment indicating the appropriate nursing diagnoses and nursing care required for this patient, allowed for individualization of the plan needed to include this new procedure and plan for best patient outcomes and practices.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. giant cell arteritis presenting with annuloaortic ectasia.Four cases of giant cell arteritis causing severe aortic regurgitation secondary to an aneurysm of the ascending aorta are described. In two cases, the nature of the aortic pathology could be suspected considering the past clinical evidence of temporal arteritis and/or polymyalgia rheumatica. In the two other cases, the cardiothoracic manifestations represented the onset of Horton disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. bronchogenic cyst masquerading as a chronic post-traumatic pseudoaneurysm of the aortic isthmus.The serious nature of false aneurysms that develop in the aortic isthmus after blunt chest trauma is well known. The authors describe the case of a 33-year-old woman who presented with symptoms of chronic post-traumatic pseudoaneurysm of the aorta 3 months after blunt chest trauma. Radiologic investigations could not substantiate an aortic disruption. A bronchogenic cyst masquerading as a false aneurysm of the aorta was identified at thoracotomy. Bronchogenic cysts are one of the most common causes of primary mid-mediastinal masses and should be considered as potential causes of mid-mediastinal enlargement. However, this consideration should not delay urgent surgery if vascular damage cannot be ruled out.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Current status of branched stent-graft technology in treatment of thoracoabdominal aneurysms.Endovascular aortic aneurysm repair has been established as an alternative to open surgical reconstruction in appropriately selected patients. Until recently, this approach has been limited to aneurysms not involving critical aortic branches due to the complex nature of designing devices that would preserve important end-organ flow. This article reviews the current status of endovascular approaches to aneurysms involving the thoracoabdominal aorta. The evolution of fenestrated devices and further developments, including reinforced fenestrated branched grafts and directional branches for more complex aneurysms are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Chronic posttraumatic thoracic aortic aneurysm presenting with dysphagia.Chronic posttraumatic thoracic aortic aneurysms are rare. The natural history of these aneurysms is symptomatic enlargement. Herein is reported a chronic posttraumatic thoracic aortic aneurysm that became symptomatic by producing extrinsic compression of the esophagus. Despite the chronic nature of these aneurysms they should be repaired when found.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. Coexistence of fibromuscular dysplasia and cystic medial necrosis in a patient with Marfan's syndrome and bilateral carotid artery dissections.BACKGROUND: A primary arteriopathy is suspected in most patients with spontaneous dissections of the carotid artery, although the nature of this arteriopathy usually remains elusive. Angiographic changes of fibromuscular dysplasia (FMD), however, are found in 10% to 20% of patients with carotid dissections. CASE DESCRIPTION: A 26-year-old woman with Marfan's syndrome presented with bilateral amaurosis fugax after surgical repair of an aortic dissection. angiography revealed a dissection extending from the ascending aorta into the right internal carotid artery and, separate from the aortic dissection, a dissection of the left internal carotid artery. After surgery, microscopic examination of the right carotid artery revealed a medial dissection but no evidence of an underlying arteriopathy, while the left internal carotid artery displayed the typical features of FMD. Eighteen months later the patient died after resection of a large thoracoabdominal aortic dissecting aneurysm. Microscopic examination of the aorta revealed moderately extensive cystic medial necrosis. CONCLUSIONS: Carotid dissections associated with Marfan's syndrome may be the result of an extension of an aortic dissection or occur isolated from the aorta, even in the same patient. The occurrence of FMD in a patient with Marfan's syndrome in conjunction with previous reports of FMD in a variety of connective tissue disorders suggests that FMD, like cystic medial necrosis, may be a nonspecific disease entity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Dacron aorta.During the span of 6 years a 67-year-old woman underwent four consecutive major aortic operations, ultimately replacing her entire thoracoabdominal aorta with the exception of a tiny segment from which the left subclavian artery originated. The relatively uneventful postoperative course with each operation (one emergency and three elective procedures) and her current satisfactory condition at age 73 years have been attributed to her physical and mental fortitude, excellent anesthesia, superb postoperative care, and the chronic nature of her segmental aortic lesions caused by arteriosclerosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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