Showing papers on "Aortic arch published in 1981"
TL;DR: All aortic dissections are characterized by separation of their media in a course parallel to that of the flow of blood, and a continuous more or less transverse intimal and medial tear is identified in all but a few patients.
472 citations
TL;DR: A method of preclotting the Dacron graft with platelet-rich plasma and autoclaving has eliminated interstitial bleeding through fabric grafts and is believed to be preferred over the deeper levels of hypothermia.
127 citations
TL;DR: It is concluded that vasa vasorum are critical in nourishment of aortic media as well as in outer layers of the descending aorta, probably by collateral vessels or formation of new vessels.
Abstract: Vasa vasorum are present in the middle and outer layers of media in the thoracic aorta of dogs and humans. To examine the role of vasa vasorum in nourishment of the aorta, we ligated four contiguous pairs of intercostal arteries in anesthetized dogs. These arteries are the source of vasa to the descending aorta but not the aortic arch. Blood flow through vasa vasorum was measured with microspheres. Acute intercostal ligation did not reduce conductance in the aortic arch but reduced conductance in the middle third of the descending aorta from 7 +/- 1 to 3 +/- 0.7 (SE) ml.min-1.100 g-1.mmHg-1 (P less than 0.05). After intercostal ligation, infusion of adenosine (5 mumol.kg-1.min-1 iv) increased conductance in the aortic arch 3- to 4-fold but did not increase conductance in the descending aorta. Six to ten days after intercostal ligation, conductance in the middle third of the descending aorta remained low. Vasodilator capacity was partially restored in outer layers of the descending aorta, probably by collateral vessels or formation of new vessels. Morphological changes ranged from broad bands of necrosis to patchy areas of cell loss, primarily in middle layers of descending aorta. We conclude that vasa vasorum are critical in nourishment of aortic media.
122 citations
TL;DR: Forty-two patients with aortic arch anomalies resulting in tracheoesophageal compression were treated during the period 1948 through 1978 and all survivors were relieved of their symptoms late (median, 94 months) postoperatively.
79 citations
TL;DR: An analysis of the prevalence and location of rib fractures showed that there was little relation between the presence of fracture and existence of an aortic tear, and an acutely injured patient with an M/C ratio of greater than 0.25 should be considered highly likely to have an aortsic rupture.
Abstract: The plain radiographic findings on 20 patients with traumatic aortic rupture were analyzed. A mediastinal-width to chest-width (M/C) ratio was calculated at three thoracic levels and compared to two matched groups of patients without aortic tears. Defining an M/C ratio of 0.25 or larger at the level of the aortic arch as abnormal would identify 95% of cases with ruptured aortas, and result in 25% false-positive studies in traumatized patients. A ratio greater than 0.28 retains 85% sensitivity for aortic rupture while increasing specificity to 100%. An analysis of the prevalence and location of rib fractures showed that there was little relation between the presence of fracture and existence of an aortic tear. Therefore, an acutely injured patient with an M/C ratio of greater than 0.25 should be considered highly likely to have an aortic rupture.
72 citations
TL;DR: Three young patients manifested upper airway symptoms from vascular rings accessible only through a right thoracotomy, and a double aortic arch with atresia of the right posterior segment, an anomaly not previously documented, was found in one infant.
53 citations
TL;DR: The authors discuss the role of computed tomography in the evaluation of congenitally anomalous aortic arches and subclavian arteries in seven patients.
Abstract: Computed tomography can help in the evaluation of congenitally anomalous aortic arches and subclavian arteries. The authors discuss the role of computed tomography in the evaluation of such anomalies in seven patients.
52 citations
TL;DR: Conventional M-mode echocardiographic and clinical criteria do not have acceptable specificity or accuracy for detection of left-to-right shunting PDA in fluid-restricted premature infants.
50 citations
TL;DR: Its frequent association with intracardiac defects, usually the tetralogy of Fallot, makes its recognition clinically important.
Abstract: Eight patients with isolation of a subclavian artery are described. Isolation of subclavian artery is defined as a loss of continuity between the subclavian artery and aorta but with persistent connection to the homolateral pulmonary artery through a ductus arteriosus. The connecting ductus arteriosus may or may not be patent. As the pulmonary vascular resistance is usually lower than the systemic resistance, the isolated subclavian artery is perfused by subclavian steal, and if the connecting ductus arteriosus is patent, flow occurs from the subclavian artery into the pulmonary artery. In this material and in all reported cases, isolation of subclavian artery has always been associated with other anomalies of the aortic arch, such as right aortic arch or bilateral ductus. Its frequent association with intracardiac defects, usually the tetralogy of Fallot, makes its recognition clinically important. Thoracic aortography with delayed filming is the only procedure that allows consistent diagnosis of this ra...
46 citations
TL;DR: A staged treatment plan consisting of preliminary systemic--pulmonary artery shunting for symptomatic children under 4 to 5 years of age and total correction for older children is recommended.
41 citations
TL;DR: Clinically, an obstructive aortic arch lesion was suspected because of a systolic pressure gradient between the upper and lower extremities in one infant and unequal peripheral pulses with lower limb cyanosis in the other.
TL;DR: Primary definitive correction of type B IAA with VSD and PDA provides distinct advantages over palliative or other surgical procedures with excellent long-term results.
TL;DR: Computed tomographic studies of the thorax identified abnormalities including left superior vena cava, right aortic arch with aberrant left subclavian artery, L- and D-transposition of the great vessels, pulmonary valvular stenosis, and truncus arteriosus.
Abstract: Computed tomographic (CT) studies of the thorax were performed on 12 patients with congenital anomalies of the mediastinal great vessels. CT correctly identified 11 of 12 abnormalities including left superior vena cava, right aortic arch with aberrant left subclavian artery, L- and D-transposition of the great vessels, pulmonary valvular stenosis, and truncus arteriosus. CT obviated further invasive procedures in those anomalies not associated with intracardiac defects and supplemented the angiographic findings in some patients with intracardiac defects requiring catheterization.
TL;DR: Sixty-two hearts without a patent exit from the left atrium to the ventricular mass have been studied, and the aorta was larger in cases with discordant ventriculoarterial connection or in those with double outlet from the main ventricular chamber.
Abstract: Sixty-two hearts without a patent exit from the left atrium to the ventricular mass have been studied. All had situs solitus and laevocardia. The material consisted of 32 cases with coexistent aortic atresia and 30 cases with patent aortic root. Five hearts with aortic atresia were biventricular with atrioventricular concordance and imperforate left atrioventricular valves, and 27 hearts were univentricular of right ventricular type, with absent left atrioventricular connection. The anatomy of this group was uniform, with extreme hypoplasia of all the left cardiac segments. Among the cases with patent aortic root, five were biventricular, with atrioventricular concordance and imperforate left atrioventricular valves, and 24 had absent left atrioventricular connection, 15 with univentricular heart of right ventricular type and nine with univentricular heart of left ventricular type. The final heart had double inlet univentricular of left ventricular type with an imperforate left atrioventricular valve. In this second group the aorta was larger in cases with discordant ventriculoarterial connection or in those with double outlet from the main ventricular chamber. A normal sized aorta without aortic arch obstruction was observed in nine instances. These are of great interest in terms of surgical anatomy since definitive palliation may be feasible.
TL;DR: It is concluded that a central muscular ventricular septal defect is not an isolated malformation but is commonly part of a complex developmental anomaly that presumably may cause reduced aortic flow during morphogenesis, resulting in aortsic arch hypoplasia of various degrees of severity.
Abstract: Among 25 heart specimens with a central muscular ventricular septal defect (including 3 with the architecture of a spontaneously closed defect), only 6 (24 percent) had an aortic arch of normal size and configuration. Isthmus atresia was present in one case, isthmus hypoplasia in eight cases, local coarctation in six and a combination of isthmus hypoplasia and local coarctation in another four. A study of the left ventricular morphologic features of the 25 hearts revealed the presence of a spectrum of additional anomalies. The aortic valve was bicuspid in 16 and mitral valve anomalies were present in 13 specimens. Mitral valve deformities present in the 13 specimens included congenital stenosis (5), deficient chordae tendineae (4), parachute valve (2), adherent valve leaflets (1) and a hypoplastic posteromedial papillary muscle (1). Furthermore, there was a large incidence of abnormal left ventricular muscular structures that could be classified into three basic types: (1) the anteroseptal "twist": thickening and deviation of the anterobasal septum and anterior wall, resulting in a relatively posterior position of the aortic ostium (16 cases); (2) a prominent anterolateral muscle (9 cases); and (3) a posteromedial muscle (9 cases). It is concluded that a central muscular ventricular septal defect is not an isolated malformation but is commonly part of a complex developmental anomaly. This complex of associated inflow and outflow tract lesions presumably may cause reduced aortic flow during morphogenesis, resulting in aortic arch hypoplasia of various degrees of severity.
TL;DR: Prostaglandin E1 (PGE1) has been used prior to operation in 28 neonates with congenital heart disease (CHD) and resulted in improvement of the pH to average of 7.37, improvement of congestive heart failure, and reappearance of femoral pulses.
TL;DR: A concept of disturbed interarterial septal growth, complemental to the long-established mechanism of obliteration, is introduced for interpretation of the formal genesis of malformations of the great arteries and their branches arising from the heart.
Abstract: The present paper reports our study of the developmental transformation of the aortic arch complex. A system of interarterial septa in the region of the embryonic aortic arch complex is demonstrated by means of microdissection and scanning electron microscopy. Local differences in growth of the dorsal and ventral free edges of these interarterial septa define, together with the commonly known obliteration of arterial segments, the arrangement of the origin of the great arteries. On the basis of this interarterial septal system a concept of disturbed interarterial septal growth, complemental to the long-established mechanism of obliteration, is introduced for interpretation of the formal genesis of malformations of the great arteries and their branches arising from the heart. The following pathogenetic mechanisms are suggested to contribute to the development of malformations in the aortic arch complex: 1. Increase or decrease of the number of interarterial septa 2. Excessive or reduced septal growth or deviating growth directions 3. Origin of septa in abnormal positions 4. Abnormal blending of the free edges of interarterial septa 5. Abnormal connection with the truncus septa 6. Abnormal processes of obliteration.
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TL;DR: The pathologic findings in two patients who died of nonspecific, granulomatous, coronary arteritis (Takayasu's disease) were studied and segmental involvement of the abdominal aorta produced an aneurysm.
Abstract: The pathologic findings in two patients who died of nonspecific, granulomatous, coronary arteritis (Takayasu's disease) were studied In one patient, the disease involved the aortic base, with extension into the aortic valve, coronary arteries, and interventricular septum, causing sudden death Segmental involvement of the abdominal aorta produced an aneurysm The other patient showed proximal coronary-artery involvement, with severe stenosis and resulting acute myocardial infarction Newly developed lesions were found in the splenic and renal arteries The aortic arch was not involved in either patient
TL;DR: A major advantage of this method of determining ventricular volume is that it does not require a blood sample.
Abstract: We have developed a simple method for measuring left ventricular volume based on semi-automated analysis of 40° left anterior oblique images obtained with a standard scintillation camera after equilibrium of an intravenous injection of 20 mCi of technetium-99m in vivo labeled red blood cells. The essence of the method is the use of the dimensions and radioactivity within a segment of aorta to convert observed left ventricular count rates to volume. Four assumptions were made: 1) the aortic arch is nearly parallel to the collimator face when a patient is in the proper left anterior oblique position; 2) a segment at the top of the aortic arch, approximately 1 cm wide, is a right cylinder, 3) the edges of the aorta can be delineated as the lines where the second derivative of a cross sectional profile equals zero; 4) left ventricular and aortic arch counts undergo the same attenuation because they are nearly the same distance from the chest wall in the proper left anterior oblique position. By measuring the counts and volumes of two regions of known shape, one in the middle, the other at the edge of the aortic arch, and calculating their differences a background-independent volume count ratio (Δv/ΔC) can be obtained. The left ventricular and diastolic volume (LVEDV) is calculated with the equation: LVEDV=(Δ/ΔC) LVEDC, where LVEDC represents left ventricular end diastolic counts. Twenty-six patients were evaluated by equilibrium radio- and contrast-ventriculography, the latter analyzed by planimetry. The radionuclide method yielded an end diastolic volume that correlated well with contrast ventriculography (r=0.96, Y=0.91 X+21 ml). In addition to its simplicity and objectivity, a major advantage of this method of determining ventricular volume is that it does not require a blood sample.
TL;DR: A method to estimate an overall open-loop gain of the arterial pressure control system without surgically opening the reflex loop is developed, which can be estimated under the closed-loop condition in which the baroreceptor reflexes operate naturally around the existing range of systemic arterial Pressure.
Abstract: We developed a method to estimate an overall open-loop gain of the arterial pressure control system without surgically opening the reflex loop. Dogs anesthetized by intravenous injection of Nembutal (35 mg/kg body wt) were bled by 2 ml/kg body wt within 2-3 s through a catheter inserted into the abdominal aorta. Arterial pressure change after the quick hemorrhage was monitored via a catheter placed in the aortic arch for more than 2 min. The overall open-loop gain of the lumped arterial pressure control system was assessed as (delta API/delta APs)-1, where delta API is the immediate fall and delta APs the steady-state fall in mean arterial pressure obtained by a filter with a 2-s time constant. The advantage of this method is that the overall open-loop gain can be estimated under the closed-loop condition in which the baroreceptor reflexes operate naturally around the existing range of systemic arterial pressure. This enables one to study time-varying characteristics of the reflex gain. The disadvantage is that the substantial constituents of the lumped reflex system remain to be confirmed.
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TL;DR: A 30-year-old woman with rapidly progressive, fatal aortic insufficiency was studied and it was revealed that Takayasu's arteritis should be considered, even if most of its manifestations are absent.
Abstract: A 30-year-old woman with rapidly progressive, fatal aortic insufficiency was studied. Pathologic studies revealed that the aortic insufficiency was caused by dilation of the aortic root due to Takayasu's arteritis that, unusually, was confined to the ascending aorta and aortic arch. When other diseases that bring about aortic insufficiency can be excluded, Takayasu's arteritis should be considered, even if most of its manifestations are absent.
TL;DR: A case of pseudocoarctation of the thoracic aorta manifested by a mediastinal mass on a roentgenogram of the chest and subsequently evaluated with computed tomography (CT) is presented.
Abstract: A case of pseudocoarctation of the thoracic aorta manifested by a mediastinal mass on a roentgenogram of the chest and subsequently evaluated with computed tomography (CT) is presented. The following combination of CT findings is thought to be diagnostic of this rare congenital anomaly: (a) demonstration that the mass is part of the aorta, (b) the depiction of the unusual aortic arch high in the mediastinum, (c) visualization of the isthmus portion of the descending aorta not adjacent to the spine but rather located ventral to it and surrounding by aerated lung, and (d) more caudal origin of the subclavian artery resulting in a vascular shadow posterior to the kinked aortic arch.
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TL;DR: Although the technique is still under development, occlusions, stenoses, ulcerated plaques, and aneurysms have been visualized and a promising correlation with standard arteriography is indicated.
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TL;DR: It is recommended that a newborn with interrupted aortic arch complex be subjected to corrective surgery as the procedure of choice and excellent results may be expected when surgery is done prior to irreversible metabolic decompensation of the patient.
TL;DR: The cases of 62 patients with atherosclerotic occlusive disease at the origin of the aortic arch branches were reviewed and selective revascularization with priority given to the innominate-carotid flow was advocated.
Abstract: • The cases of 62 patients with atherosclerotic occlusive disease at the origin of the aortic arch branches were reviewed. Thirty-six were initially without neurologic symptoms and in four (11%) intermittent neurologic symptoms without stroke developed during an average follow-up of 27 months. No patient had limb-threatening ischemia. Twenty-six operations were performed for neurologic symptoms or disabling limb ischemia, with one death. Five-year graft patency by life-table analysis was 81%. Preoperative or late postoperative stroke in three patients with occluded common carotid artery suggests this to be a more dangerous subgroup. We advise surgery for patients with disabling arm symptoms or with ischemic neurologic symptoms associated with multiple-vessel disease or with major lesions in the innominate-carotid circulation. We advocate selective revascularization with priority given to the innominate-carotid flow. Isolated subclavian lesions first seen as a single lesion or as the only residual lesion after reconstruction for multiple-vessel disease can be safely left unreconstructed. (Arch Surg1981;116:1457-1460)
Journal Article•
TL;DR: Most patients presented with a combination of arm and hindbrain ischemia that was shown radiologically to be associated with a subclavian steal syndrome, but in some only isolated arm symptoms or severe vertigo alone was experienced.
Abstract: Occlusive disease of the aortic arch vessels is relatively rare and often missed initially. Of 41 patients treated surgically for this condition over a 10-year period 38 had arteriosclerotic lesions, 2 had symptoms secondary to vasculitis (Takayasu9s arteritis) and 1 had a radiation injury to a subclavian artery. In 22 cases the left subclavian artery was involved; the right subclavian and innominate arteries were the next most commonly affected. Only four vertebral stenoses were treated. Most patients presented with a combination of arm and hindbrain ischemia that was shown radiologically to be associated with a subclavian steal syndrome, but in some only isolated arm symptoms or severe vertigo alone was experienced. There was a difference in blood pressure between the arms of at least 20 mm Hg in 88% of the patients. The treatment for 28 patients was creation of a carotid-subclavian bypass, for 6 the placement of a bypass graft from the ascending aorta to the subclavian or carotid artery or both, for a 3 a subclavian endarterectomy and for 4 vertebral angioplasty. There were no operative deaths, and 90% of the grafts were patent 1 to 72 months later. however, only 30 (73%) of the patients were asymptomatic and 9 (22%) had improved.
TL;DR: Embolic disease is often overlooked as a cause of digital ischemia, but unilateral symptoms, in particular, should suggest the possibility of emboli arising from the subclavian or more distal upper extremity vessels.
Abstract: Embolic disease is often overlooked as a cause of digital ischemia. Unilateral symptoms, in particular, should suggest the possibility of emboli arising from the subclavian or more distal upper extremity vessels. Emboli may originate in the subclavian artery as the result of atherosclerosis at its origin or arterial injury secondary to thoracic outlet compression. Arteriography can be useful in the identification of upper extremity emboli and their source, and should include studies of the aortic arch, proximal subclavian artery, and digital arteries. Retrograde subclavian injections may be required to adequately demonstrate the origin of the subclavian artery. Magnification technique is often essential in differentiating small digital artery emboli from primary arterial diseases, such as Buerger disease or scleroderma.
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TL;DR: The findings of this study support the use of arch aortography only in those patients who have surgical lesions demonstrated by the selective carotid examinations.
Abstract: The role of aortic arch angiography in the evaluation of cerebral ischemic disease is not well defined. In an attempt to develop guidelines for its optimal use, a prospective study of 100 patients with carotid distribution ischemic events was undertaken. Each patient underwent bilateral selective carotid angiography followed by arch aortography. In only two of the cases did the arch examination affect patient management. In the other individuals, the arch study either added no clinically useful information (69), or demonstrated abnormalities that did not affect patient care (29). The findings of this study support the use of arch aortography only in those patients who have surgical lesions demonstrated by the selective carotid examinations.
TL;DR: Doppler flow study showed a prolonged systolic flow phase with a double peak in the left common carotid, and the impression of dissecting aortic aneurysm involving the leftCarotid was confirmed at autopsy.
Abstract: • A 38-year-old man was hospitalized with severe neck pain. Aortic arch angiography failed to reveal an abnormality. Doppler flow study showed a prolonged systolic flow phase with a double peak in the left common carotid. The impression of dissecting aortic aneurysm involving the left carotid was confirmed at autopsy.
TL;DR: The morphogenesis of the aortic arch system was studied in rat embryos whose mothers had been treated with glycerol formal (GF) during pregnancy and India ink was injected into their vascular system while they were still alive.
Abstract: The morphogenesis of the aortic arch system was studied in rat embryos whose mothers had been treated with glycerol formal (GF) during pregnancy. The fetuses were removed from the uterus on days 13-17 of gestation and India ink was injected into their vascular system while they were still alive. The teratogenic effect of GF manifested itself by developmental retardation of the aortic arch system, vessel dilatation and persistence or anomalous regression of embryonic vessels. These conditions result in several aortic arch malformations: right aortic arch, double aortic arch and persistence of the 3rd aortic arch.