1/35. Rupture of aortic aneurysm with right-sided haemothorax.A 62-yr-old male with a history of high blood pressure was admitted for persistent dyspnoea and a right-sided pleural effusion, complicated by a recent episode of shock. There was no history of trauma and the patient denied any thoracic pain. A chest tube was inserted which released nonclotting bloody fluid. A thoracic computed tomographic scan of the chest revealed an aneurysm of the inferior third of the descending thoracic aorta. The patient underwent a successful prosthetic graft replacement. We emphasize that rupture of aortic aneurysms should be considered in the evaluation of spontaneous haemothorax even if it is right-sided and not associated with pain.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/35. The spectrum of aortic complications after heart transplantation.BACKGROUND: The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment. methods: Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8. RESULTS: Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 71/2 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period. CONCLUSIONS: Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/35. Intraoperative rupture of an abdominal aortic aneurysm during an endovascular stent-graft procedure.PURPOSE: To highlight the risk of intraoperative rupture as a complication of endovascular aortic repair. CLINICAL FEATURES: An 81-yr-old man was admitted for endovascular aortic repair of a 6 cm infrarenal abdominal aortic aneurysm. After establishment of a conduction blockade using a combined spinal-epidural technique, a balloon-activated endovascular stent-graft was advanced to the proximal aneurysmal neck. Approximately four minutes after the stent-graft was deployed, the mean arterial pressure decreased to 30 mmHg and the heart rate increased to 135 bpm. While fluid and vasoactive medications were administered and the airway was secured, repeat aortography confirmed contrast extravasation into the retroperitoneal space at the junction of the proximal aortic neck and the aneurysm sac. The angioplasty deployment balloon was repositioned and inflated proximal to the presumed site of aortic rupture, thus providing aortic control until an open repair of the aorta was undertaken. CONCLUSION: Although endovascular stent-graft placement may be a less invasive method than conventional open aortic reconstruction, it must be recognized that the potential for devastating consequences such as aortic rupture is present.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/35. Successful completion of endoluminal repair of an abdominal aortic aneurysm after intraoperative iatrogenic rupture of the aneurysm.PURPOSE: A method of achieving successful completion of endoluminal repair of an abdominal aortic aneurysm (AAA) in the presence of intraoperative iatrogenic rupture of the aneurysm is reported. methods: An 83-year-old woman with an AAA that was 7 cm in diameter was treated electively by means of endoluminal repair with a Vanguard bifurcated prosthesis (boston Scientific, Natick, Mass). No difficulty was experienced with the introduction of the delivery catheter, despite extreme angulation in the aneurysm. An acute episode of hypotension prompted an aortogram to be performed. Extravasation of contrast outside the aneurysm sac was demonstrated. The balloon on the delivery catheter was immediately advanced to the suprarenal aorta and inflated. hypotension was reversed, and hemodynamic stability was restored, thus enabling deployment of the prosthesis to proceed and the repair to be completed by means of the endoluminal method. RESULTS: The patient's blood pressure remained stable after deflation of the balloon, allowing a postprocedure aortogram to be performed. Exclusion of the aneurysm sac was demonstrated. Exclusion of the aneurysm sac from the circulation and a large retroperitoneal hematoma were confirmed by means of a postoperative contrast computed tomography scan. convalescence was complicated by acute renal failure, pneumonia, and prolonged ileus. The patient remained well and active at the follow-up examination 6 months after operation. CONCLUSION: Iatrogenic perforation of an AAA during endoluminal repair may be treated by endovascular means and does not necessarily require conversion to open repair, although this may be the safest option.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/35. Abdominal aortic aneurysm rupture following endoluminal graft deployment: report of a predictable event.PURPOSE: To describe the predictability of an abdominal aortic aneurysm (AAA) rupture secondary to a type II endoleak following stent-graft exclusion. methods AND RESULTS: An 81-year-old man with an enlarging AAA underwent endovascular repair using an AneuRx aortic stent-graft, but a type II endoleak fed by an accessory renal artery was detected at postprocedural computed tomography (CT). Surveillance CT scans at 6 and 16 months showed an increase in the aneurysm diameter and endoleak volume, but the patient refused advised treatment to close the leak. He suffered a fatal aneurysm rupture 24 months after endografting. Retrospective analysis of CT data documented progressive aneurysm enlargement that correctly predicted the rupture. CONCLUSIONS: Type II endoleaks can lead to aneurysm rupture. Three-dimensional (3D) spiral CT angiography offers an opportunity to track endoleak volume and the effect of exposure to systemic pressure on the aneurysm sac.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/35. Successful surgical repair of a ruptured abdominal aortic aneurysm in a nonagenarian.mortality due to the surgical treatment of ruptured abdominal aortic aneurysms (RAAA) is high, more than 40%, especially in elderly patients. The literature concerning RAAA in very elderly patients is analyzed by internet research (medline). Only rare examples of emergency surgical management in nonagenarian patients are reported, and even fewer reports of successfully operated patients. A case report of a successful surgical repair of RAAA in a nonagenarian is presented. After ultrasound (US) and CT scans, the patient (in good condition as regards blood pressure, respiratory, cardiac and renal function) underwent uneventful aneurysmectomy and reconstruction of the aorta and common iliac arteries by means of a bifurcated prosthesis. The length of hospitalization was 30 days and the patient is still alive and in good condition four years and two months after the operation. The advisability of emergency surgical repair in these patients, questionable because of the excessive surgical risk and poor survival benefit, is discussed. However many other factors affect the outcome of emergency repair (mainly cardiac, respiratory and renal function), independently of age. The authors conclude that age per se does not limit the indication for or success of surgery in very elderly patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/35. Aortic dissection and rupture presenting as suprasternal bruising and neck swelling.BACKGROUND: a 76-year-old man presented with transient loss of consciousness associated with swelling of the neck, bruising in the suprasternal notch and an absent left carotid pulse. blood pressure was equal in both arms and chest x-ray was normal, but computed tomography of the neck and thorax showed dissection and rupture of the thoracic aorta with extensive intra-mediastinal bleeding. OUTCOME: surgical intervention was inappropriate in this situation and the patient died within 4 hours of presentation. CONCLUSION: syncope is a common presentation to hospital in older people and its cause may be difficult to elucidate, particularly if the patient is unable to provide a reliable history. syncope without pain is a rare presentation of aortic dissection and the occurrence of anterior chest wall bruising has not been described previously. pulse deficits and abnormal chest x-ray findings are often cited as indicative of aortic dissection but are rare manifestations and their absence should not be used to exclude this diagnosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/35. Prehospital rounds. The quick stop.The coroner's post-mortem examination revealed a tom aorta. This case illustrates that although a patient may appear stable, a major catastrophic event may nonetheless be taking place. How many times have we responded to MVAs similar to the one described here and seen those involved deny injuries? We carry a higher suspicion of aortic injury after someone has been ejected from a vehicle or involved in a high-speed crash. That's not always the case, however, and understanding how internal organs respond to high-speed impacts is crucial. Damage to the aorta may result after a sudden deceleration injury of any type: a fall, vehicle crash or violence. The most common forms of traumatic aortic injury occur where the aorta is "tethered" in place: at its intersection with the heart and at its distal portion just beneath the left subclavian artery near the ligamenta arteriosum. Approximately 80% of patients with aortic injury die at the scene. The injury may be hidden in the other 20%, but they have the potential to rapidly deteriorate and die. Those who survive typically are at a trauma center and are cared for by providers who have a suspicion of the injury. A high index of suspicion should be maintained on all rapid-deceleration injuries and with patients who experience chest pain, dyspnea, a difference in pressure between the upper and lower extremities, and paralysis. paralysis can occur when aortic injury cuts off blood supply [table: see text] to the spinal cord. The spinal cord obtains its blood supply from arteries coming directly off the aorta, and a torn aorta can shear off these vessels, leaving the spinal cord to infarct and the patient to lose all distal function. When a victim sustains a sudden-deceleration injury to the chest, signs of aortic injury should be sought. It is imperative to maintain a high index of suspicion throughout patient care and be aware that although a patient may appear to be quite stable, the reality might be otherwise, and rapid transport to a trauma center will be necessary to save their life.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/35. Salvage of an acutely ruptured thoracic aortic aneurysm during CPR.PURPOSE: To report the successful endovascular treatment of a ruptured thoracic aortic aneurysm during cardiopulmonary resuscitation. CASE REPORT: A 72-year-old woman with a type B aortic dissection treated conservatively for 8 years was referred for rupture of a 16-cm aneurysm of the descending thoracic aorta. During transfer to the operating room, the patient suffered cardiac arrest; cardiopulmonary resuscitation (CPR) was initiated. A few minutes later during CPR, the surgical procedure began with a cutdown of the right femoral artery and insertion of a guidewire and an aortic occlusion balloon, which was inflated at the origin of the left subclavian artery (LSA). blood pressure was immediately measurable. By only partially deflating the occluding balloon, a thoracic stent-graft was advanced above it and deployed at the origin of the LSA while rapidly deflating and retracting the occluding balloon. Three stent-grafts were required to cover 27 cm of the descending aorta. The patient was partly ventilator dependent for 3 months due to a massive pleural hematoma that was not evacuated. At the 10-month follow-up, the patient is fully recovered without any sign of respiratory dysfunction or any other sequela. CT scans reveal that the massive hematoma is almost completely resolved. CONCLUSIONS: This case illustrates that optimal collaboration between anesthesiologists, interventional radiologists, and vascular surgeons with appropriate resources can significantly expand the possibilities of emergent treatment in the face of aortic rupture.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/35. myocardial infarction in a young woman secondary to a rupture of a noncoronary sinus of valsalva aneurysm without coronary artery disease.A 22-year-old woman presented with sudden onset of chest pain. echocardiography showed a ruptured aneurysm of the noncoronary sinus of valsalva in the right atrium. Slight ST segment depression was observed on initial electrocardiography (ECG). The patient was transferred to a tertiary care centre 10 h after the onset of symptoms. Surgery consisted of patch closure of the noncoronary sinus and tricuspid valve resuspension through the right atrium. Postoperatively, myocardial infarction (MI) was diagnosed based on a significant increase in cardiac enzymes and a new septal and apical akinesia on echocardiography. The etiology of MI in such a setting is multifactorial. Decreased coronary perfusion secondary to the severe aortic valve regurgitation and increased left ventricular end diastolic pressure, coupled with increased myocardial workload and delay before surgery may be implicated in the genesis of MI.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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