Showing papers on "Aortic arch published in 1969"

Persistent fifth arterial arch in man: Congenital Double-Lumen aortic arch☆

Abstract: To our knowledge, this is the first reported case of persistence of the left fifth arterial arch in man. The persistent fifth arch forms a sizable subway beneath the fourth (aortic) arch, forming a congenital double-lumen aortic arch. The double lumen extends from the level of the innominate artery proximally to the level of the left subclavian artery and ductus arteriosus distally.

An open-loop analysis of the aortic arch barostatic reflex

Abstract: ALLISON,JAMES L., KIICHX SAGAWA, AND MAMORU KUMADA. Ati open-loop analysis of the aortic arch barustatic reflex. Am. J. Physiol. 217(6): 1576-1584. 1969.-The effects of stepwise pressure variations in the isolated aortic arch on cardiac pumping and systemic vascular resistance were studied in anesthetized open-chest dogs. The systemic arterial bed, except the aortic arch and brachiocephalic area, was perfused by a constant-flow pump. The mean left atria1 pressure was maintained by an overflow mechanism, and the ventricle ejected blood into a compliance chamber via a short segment of ascending aorta. The outflow pressure load was also maintained constant by a servomechanism. Multistep elevation of the isolated aortic arch pressure (AAP) from 0 to 300 mm Hg produced an average reduction of 34?$ in systemic arterial perfusion pressure (SAP). Heart rate (HR) decreased by 30% while cardiac output (CO) decreased by 15 %. The average maximum static gain of the reflex on the systemic vascular resistance (ASAP)/(AAAP) was -0.5 1 and occurred at a mean AAP of 144 mm Hg. The average threshold AAP for vascular effect was 90 mm Hg, whereas the threshoId for the HR response was 125 mm Hg. The HR response was most marked at a mean AAP of 17 1 mm Hg, whereas the CO response was greatest at 178 mm Hg. Besides the nonlinear static gain, both the vascular and cardiac responses to the step inputs contained nonlinear transient components. It was concluded that the experimental results confirmed the conventional concept that the aortic arch baroreceptor reflex is in many ways similar to the carotid sinus reflex though there are some quantitative differences between the two.

Management of occlusive lesions of the branches of the aortic arch.

Abstract: The clinical progress of 157 patients with atherosclerotic occlusive lesions of the major branches of the aortic arch is reviewed, with emphasis on the relation of the lesions to cerebral symptoms or stroke. Fifty per cent of these patients were free of significant symptoms from the onset or were made so by a prior carotid bifurcation endarterectomy. No operations were performed on the major arch branches in these patients. The subclavian artery was the prominent site of the proximal lesion. Follow-up examinations indicate that the lesions in these patients do not in themselves lead to stroke and that the indications for operation, therefore, are determined by the need for relief of symptoms. Revascularization operations were performed on eighty patients with genuine disabling symptoms. The innominate and common carotid lesions were more prone to cause disability than were the subclavian. Removal or bypass of the obstructing lesion was generally satisfactory in relieving symptoms.

Coarctation of the abdominal aorta in children: report of three cases and review of the literature.

Abstract: Three patients with coarctation of the abdominal aorta who were observed in an 8-year period illustrate some of the problems in diagnosis and management of this lesion. Coarctation was located at the level of the renal arteries in two instances, and above the renal vessels in the third. Bypass graft resulted in significant improvement in one patient. The second patient is presently asymptomatic with only mild systemic hypertension. A promotion thrombosis complicated the clinical course of the third infant and contributed to her early death. Histologic examination of the aortic wall revealed a unique pattern of fibromuscular dysplasia in this patient. Sixty-nine additional instances of this malformation have been reported in children. On the basis of this review, coarctation of the abdominal aorta may be classified into segmental and hypoplastic types. Renal arterial abnormalities are frequently associated. Physical examination reveals systolic murmurs and thrills in the epigastric and lumbar areas. Roentgenographic studies demonstrate a normal aortic arch and absence of rib notching. The atypical location of the coarctation is confirmed by abdominal aortography. The primary factor affecting ultimate prognosis is the presence of associated renal artery pathology. Operative procedures must include repair or bypass of significant renal arterial abnormalities.

Congenital aortic vascular ring.

Abstract: Compression of the trachea and esophagus by vascular anomalies of the aortic arch and its branches may be a threat to life in infancy. The significance of the so-called vascular ring, long recognized as a cause of obstruction of the trachea and esophagus in early life, assumed new importance in 1945 when the operation by Gross 1 placed this entity among the surgically correctable congenital lesions of the great vessels. Since that time, experience with the operative treatment of these anomalies has been accumulated. 2-4 In the normal 12-mm human embryo, the aortic trunk divides into a left and a right arch. These arches pass on either side of the trachea and esophagus and rejoin to form a single descending dorsal aorta. Normally, a process of absorption or resolution takes place in the right arch distal to the right subclavian, leaving the remaining portion of the right arch to become

Pseudocoarctation of the aorta: An unusual variant with coarctation

Abstract: A case of pseudocoarctation associated with probable coarctation, hypoplasia of the left vertebral artery, aneurysmal dilatation of the left subclavian artery and a previously undescribed anomaly of the descending thoracic aorta is reported Based on the concept of aortic arch derivatives, a hypothesis is advanced to explain the development of this additional anomaly

Transposition of the great arteries with ventricular septal defect. Palliation by atrial septostomy and pulmonary artery banding.

Abstract: Infants with transposed great arteries need atrioseptostomy for adequate intracardiac mixing of the systemic and pulmonic circulations. Those with ventricular septal defect and pulmonary artery hypertension, with or without other associated lesions, usually require further surgical palliation. Postseptostomy measurements of pulmonary artery pressures at systemic levels were obtained in ten infants with transposition of the great arteries and ventricular septal defects. Three had, in addition, patent ductus arteriosus, and two of these had aortic coarctation (one preductal with hypoplasia of the aortic arch). One had transposition of the great arteries, ventricular septal defect, and tricuspid atresia. Four of the patients had surgical septectomy; the remaining seven had balloon atrioseptostomy. All had pulmonary artery banding; the three ductus arteriosus lesions were ligated; and both coarctations were repaired (one with reconstruction of the aortic arch). The only operative death was in one of the patients with transposition of the great arteries and ventricular septal defect only. When the interatrial communication is adequate in patients with transposition, ventricular septal defect, and pulmonary artery hypertension, pulmonary vascular obstructive changes may be prevented by pulmonary artery banding and surgical correction of the associated lesions.

Right Cervical Aortic Arch With Left Descending Aorta: Case Report and Review of the Literature

Abstract: THE NORMAL aortic arch is an intrathoracic structure derived embryologically from the left fourth branchial arch. In rare individuals, the aortic arch appears to be derived from the right third branchial arch. In such instances, the aortic arch extends well into the neck and the pattern of the brachiocephalic arteries is altered. This unusual anomaly manifests certain characteristic clinical findings. Report of a Case A white female infant, delivered without incident after an uneventful, full-term gestation, appeared normal at birth and weighed 3,090 gm (6 lb 13 ounces). At 1 month of age, her weight was 3,508 gm (7 lb 11¾ ounces). The only abnormality found at that time, an inconstant systolic murmur heard along the left sternal border, was also heard at each monthly examination during the first year of life. At age 5 months, blood pressure was 116/60 mm Hg in the right arm and 122/84 mm Hg

Coarctation-like Physiology with Cerebral Arteriovenous Fistula

Abstract: Hemodynamic signs of coarctation of the aorta were present in a neonate dying in cardiac failure. A cerebral arteriovenous fistula was found at autopsy. No obstructive lesion of the aortic arch was present. Development of the aortic isthmus may be impaired if diminished flow through this segment is present. Reduced flow may be present if most of the systemic output is diverted to a fistula proximal to the isthmus, distal systemic flow being maintained by flow from right-to-left through the ductus arteriosus. Spontaneous duct closure after birth may then be followed by a reduction in distal systemic flow, resulting in signs suggestive of coarctation.

Bullet embolism from the aortic arch to the popliteal artery.

Abstract: Embolism of a bullet to a peripheral vessel following an aortic injury of a blood vessel may be due to thrombi, fat, air, organ tissue, or a projectile foreign body. In the present case, embolism of a bullet to the popliteal artery occurred after its entry into the aortic arch was demonstrated by femoral arteriography. Report of a Case A 19-year-old Negro boy was shot above the left clavicle by a.22 caliber pistol. He began running and subsequently felt pain in the left side of the chest. In the emergency room of St. Louis City Hospital, 45 minutes later, he complained of left chest pain at the level of the second thoracic vertebra on deep inspiration and steady pain in the left calf. A small wound was present in the left side of the chest just above the midportion of the clavicle. The left calf was tender, and the pulses

Hemodynamic Effects of Pulsatile and Nonpulsatile Blood Flow: II. Selective Depulsation of the Aortic Arch and Brachiocephalic Trunk

Abstract: There is mounting experimental evidence which indicates that the arterial pulse plays a significant physiologic role. Studies comparing pulsatile and nonpulsatile flow have indicated that pulsatile flow affects the capillary circulation, the maintenance and regulation of vascular tone and blood pressure, cellular metabolism, and the function of such organs as the kidney.1The specific role played by the pulse in the regulation of blood pressure has been well documented and indicates that it exercises its control by means of its effect on the stretch receptors within the arterial wall. Experiments have shown that arterial pressure does not act directly on the baroceptors of the aortic arch and carotid sinus, but indirectly by stretching the wall of the arteries where these receptors are located.2-4The state of contraction and thus resistance to stretch of the arterial wall where the baroceptors are located are the primary factors affecting these receptors.

Persistent truncus arteriosus. A radiographic and angiocardiographic study.

Abstract: Review of the plain chest roentgenograms and angiocardiograms of 30 patients with Type 1 or Type 2 truncus arteriosus indicated that the diagnosis is suggested by cardiac enlargement, levocardia with right aortic arch, and increased pulmonary vasculature on the chest roentgenogram. Elevation of the left pulmonary artery and left atrial enlargement frequently are present and, when found, tend to substantiate the diagnosis. Exact preoperative diagnosis requires high-quality angiocardiograms. Even so, differentiation of Types 1 and 2 may be difficult. The truncal valve frequently is insufficient and often there is preferential regurgitation of blood into the right ventricle.

Chemodectoma in relation to the aortic arch (aortic body tumour): A clinical report

Abstract: Tumours of the aortic body in man are relatively rare and were first described in 1950. Aortic bodies are found in the region of the base of the heart and great vessels, are thought to be of neuroepithelial origin, and have a role in maintenance of circulatory homoeostasis. A clinical report is presented of a benign aortic body tumour which was removed surgically from a 61-year-old woman.

Collateral circulation in subclavian atresia. Report of a case with right aortic arch and tetralogy of Fallot.

Abstract: A case of atresia of the left subclavian artery, right-sided aorta and tetralogy of Fallot is described. There was angiographic evidence of “subclavian steal” blood flow pattern, but other collaterals seemed more important. Accordingly, there were no symptoms of basilar artery insufficiency. The clinical diagnosis depends on the pulse and blood pressure recordings in both upper extremities. In cyanotic patients, a correct diagnosis might have important therapeutic consequences, as a Blalock-Taussig shunt operation cannot be performed on the side with the atretic subclavian artery.

Coarctation of the aorta with multiple artery anomalies in idiopathic hypercalcemia of infancy.

Abstract: Summary A case of idiopathic hypercalcemia of infancy with multiple anomalies of the arteries is described. This patient demonstrated a combination of supravalvular pulmonary artery stenosis, supravalvular aortic stenosis, hypoplasia of the aortic arch, coarctation of the aorta and multiple stenoses of the branches of the abdominal aorta. The pathogenesis of arterial hypertension in this syndrome is discussed.

Aortic Arch Syndrome

Abstract: Arteriosclerotic occlusion of the great vessels arising from the aortic arch was initially described by Savory1in 1856. Hunt,2in 1914, pointed out that extracranial obstruction of the carotid arteries could cause stroke. Introduction of arteriographic techniques by Egas-Moniz et al3in 1937 made accurate diagnosis of these lesions possible. Davis et al4are given credit for first surgically correcting occlusive disease in arteries at their origin from the aortic arch. In 1960, Contorni5demonstrated angiographically reversal of blood-flow in the ipsilateral vertebral artery in an asymptomatic patient with occlusion of the first portion of the subclavian and an absent pulse. Reivich et al,6in 1961, observed a similar phenomenon in two patients who were operated on because of symptoms related to basilar artery insufficiency. In a series of animal experiments, they were able to duplicate and quantitate such reversal of cerebral blood flow.

Problem of aortic vascular rings and other anomalies of the aortic arch

Abstract: SUMMARY Anomalies of the aortic arch are not rare. Usually the lesions are asymptomatic and require no therapy. When symptoms such as tracheal obstruction or dysphagia are present in infants, roentgenographic studies will establish the diagnosis. Surgery is directed at the relief of the compression of the trachea and/or oesophagus. Some of the problems involved in infants with anomalous vascular rings are illustrated in a case report. A combination of surgical mediastinal dissection, endotracheal anaesthesia, and previous long-standing compression of the trachea and/or bronchi with possible pressure atrophy, all combined to invite the postoperative respiratory difficulties noted.

Failure of selective aortic angiography to demonstrate persistence of the ductus arteriosus

Abstract: Retrograde thoracic aortography is a valuable method for the angiographic demonstration of a persistent ductus arteriosus. The present brief report records the failure to demonstrate persistence of the ductus by high pressure injection of contrast into the aortic root and into the aortic arch. Such an occurrence has not, as far as can be determined, been reported previously. V.S., an African child, presented at the age of five months with a history of frequent respiratory tract infections since birth. There was a continuous basal murmur and the pulse was collapsing in type. The clinical diagnosis was persistence of the ductus arteriosus.

Multiple-curve guide wire for aortic catheterization.

Abstract: Frequently the angiographer finds it desirable to catheterize the abdominal aorta by percutaneous entry through the left subclavian artery. This is most often done when there is block or severe obstruction to the distal aorta or the iliac or femoral arteries. Some angiographers prefer this approach routinely (5, 7). The Problem Unfortunately, in many patients who have distal blocking of the aorta or iliacs or femorals or various combinations, there is also a gross extensive atherosclerosis in the ascending aorta and aortic arch; the aortic arch becomes elongated and tortuous, and the left subclavian artery shifts to the right so that the guide wire enters the ascending aorta (Fig. 1). Hanafee reports that 50 per cent of the time the guide wire will enter the ascending aorta (2). Using a straight wire, a regular curved guide wire, or the usual J-shape wire to make a U turn in the arch or ascending limb of the aorta often does not succeed. This difficulty arises because the tip of the straight or large curv...