Showing papers on "Aortic arch published in 1982"

Distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum, patent ductus arteriosus and hypoplasia of the aortic isthmus: a newly recognized syndrome.

Abstract: The association of distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum and interruption or coarctation of the aortic isthmus has not previously been reported as a syndrome. This combination of anomalies was encountered in five new patients and was previously reported in three. Two patients have undergone surgery with successful results. In contrast to the sagittally oriented conventional proximal aortopulmonary septal defect, the patients in this series had a more distal type of defect, possibly representing a partial persistence of the common arterial trunk. The pulmonary arterial bifurcation may malattach to this undivided truncal segment and, as a result, the right pulmonary artery may be partially or completely shifted into the aorta. This abnormal right pulmonary arterial origin may lead to "steal" from the aortic flow during embryogenesis and to hypoplasia of the aortic arch. This concept is supported by the angiographic observation that the greater the rightward displacement of the right pulmonary artery, the greater the hypoplasia of the arch. The diagnostic angiographic sign is a strikingly high origin of the right pulmonary artery together with aortic arch hypoplasia or atresia. Closure of the aortopulmonary septal defect with implantation of the right pulmonary artery in the pulmonary trunk and repair of the aortic arch anomaly is the recommended surgical treatment.

Open aortic anastomosis. Improved results in the treatment of aneurysms of the aortic arch.

Abstract: Over a 7-month period, 15 consecutive patients underwent resection and reconstruction of the transverse aortic arch for a variety of pathologic lesions using moderate systemic hypothermia (24 degrees C) and brief circulatory arrest. Simplified surgical techniques were developed to allow rapid repair. The "open" aortic technique facilitated repair of arch aneurysms, aortic dissections and obstructive lesions of the arch tributaries. The mean cerebral ischemic time was 11.2 +/- 1.5 minutes (mean +/- SEM). Moderate hypothermia afforded adequate cerebral and myocardial protection during circulatory arrest and shortened the duration of extracorporeal bypass necessary for the cooling and rewarming phases (87 +/- 8 minutes). Dacron grafts preclotted by a new method greatly reduced postoperative blood loss. Since these simplified techniques were adopted, 14 patients (93%) have survived aortic arch replacement, with minimal postoperative morbidity. One patients with severe preoperative left ventricular dysfunction died of cardiac failure after operation. These results suggest that aortic arch replacement can be performed safely and with low operative risk.

Method of and means for intraaortic assist

Abstract: A method and apparatus are described to provide improved cardiac assist by the use of a new form of intraaortic balloon. A single small balloon may be placed in the ascending aorta close to the aortic valve, such placement being effective to produce a substantially stronger augmentation of heart action than with the use of a longer balloon normally placed, for example, in the descending aorta. Multiple small balloons positioned in the aortic arch, with or without a large balloon in the descending aorta, can be used to provide even stronger coronary flows. The external diameter of the balloons in their inflated condition should in all events never be so great as to block the aorta, even when the latter may become contracted.

Measurement of instantaneous blood-flow velocity in the human aorta using pulsed Doppler ultrasound

Abstract: The reproducibility and ease of use of a pulsed Doppler system has been investigated in 27 normal subjects. Measurements were performed in the ascending aorta and the aortic arch in the sitting and supine position. Good quality recordings were obtained in over 90% of the subjects. Maximum velocities of 120 and 108 cm . s-1 were found in the supine position of the ascending aorta in males and females respectively, while the corresponding acceleration were 2254 and 2148 cm . s-2. When moving from the sitting to the supine position, changes in integral under the mean and maximum velocity curve, which is supposed to be proportioned to stroke volume, were approximately 30% both in the ascending aorta and in the aorta arch. Making certain assumptions about dimensions of the aorta, reasonable values for cardiac output could be calculated in all subjects. The reproducibility of the measurements was tested by making ten repeat measurements in five subjects. The mean variation coefficient was between 6 and 11% for all measured variables. It is concluded that blood-flow velocity can be measured in the ascending aorta and the aortic arch using pulsed ultrasound and that the method has a reproducibility which permits measurements of changes in the flow and flow velocity of over 10%.

Absent pulmonary artery. A hint to its embryogenesis.

Abstract: Cardiac catheterization was performed in nine patients with unilateral absence of a pulmonary artery. Aortography revealed a diverticulum of the innominate artery in five of six patients in whom the aortic arch and absent pulmonary artery were on opposite sides. It is suggested that the diverticulum indicates fetal systemic blood supply to the affected lung through the distal part of the sixth aortic arch, which--consisting of ductal tissue--obliterated after birth, leaving the diverticulum where the ductus joins the innominate artery.

Interruption of the aortic arch with aorticopulmonary septal defect. An anatomic review.

Abstract: Interruption of the aortic arch may occur with aorticopulmonary septal defect (APSD) as part of a developmental complex. The anatomic details of 46 cases of interruption of the aortic arch with APSD revealed the following characteristics: (1) type A interruption of the aortic arch occurred nearly six times more commonly than type B interruption; (2) the APSD was variable in size and position, conforming to the types previously described; (3) the ventricular septum was usually intact, but a ventricular septal defect was present in six cases and occurred more frequently with type B interruption of the aortic arch; (4) subaortic stenosis was not present in any of the 16 cases in which adequate details were available to make a judgment. The association of APSD with interruption of the aortic arch in infancy is not uncommon. Evaluation of infants with APSD should thus include evaluation of the aortic arch. The occurrence of interruption of the aortic arch with an intact ventricular septum is distinctly unusual. In such cases an APSD should be suspected and sought.

Takayasu's disease with aneurysm of right common iliac artery and iliocaval fistula in a young infant: case report and review of the literature.

Abstract: Takayasu9s arteritis or nonspecific arteritis is a term used to designate a primary arteritis of unknown etiology involving the aorta and its major branches at any level. Generally, the lesions are obliterative; however, aneurysms and saccular dilations have also been described. The arteritis was originally believed to be limited to the aortic arch; however, involvement of the descending thoracic and abdominal aorta has been reported. In fact, the majority of cases of Takayasu9s disease in children involve the descending thoracic and abdominal aorta. A case of Takayasu9s disease in a 7-month-old black male infant involving the right common iliac artery with development of a large aneurysm and an iliocaval fistula is reported. This child is the youngest to be affected by the disease as reported in the literature. Although Takayasu9s disease is rare, it should be considered in the differential diagnosis of children with an abdominal mass.

Complete transposition of great arteries with coarctation of aorta.

Abstract: Complete transposition of the great arteries with ventricular septal defect and coarctation or atresia of the aortic arch is a relatively rare anatomoclinical entity and in general not well understood. This association accounted for six out of 50 cases (12%) of our clinical experience and six out of 64 cases (9%) of the post-mortem series of complete transposition. Relevant clinical manifestations were cyanosis, early and pronounced congestive heart failure, with a decrease in amplitude of femoral pulses and, in the most severe cases, isolated left ventricular hypertrophy on the electrocardiogram. Inlet or outlet right ventricular obstruction and pulmonary artery dextroposition are the pathological substrates of unequal partitioning of the blood stream in favour of the pulmonary artery and ductus arteriosus, probably accounting for fetal underdevelopment of the aortic arch. The medical and surgical prognosis of these cases is definitely poor.

Cross-sectional echocardiographic recognition of interruption of aortic arch between left carotid and subclavian arteries.

Abstract: Interrupted aortic arch is a rare condition, usually lethal in early infancy without treatment. The only characteristic feature on conventional non-invasive investigation is peripheral pulse inequality, which indicates ductal construction, and therefore may be absent or transient and preterminal. We report the cross-sectional echocardiographic findings in seven patients with aortic arch interruption between the left carotid and subclavian arteries. Their ages were 1 day to 7 months (median 7.5 days). The arterial connection was concordant in four, double outlet right ventricle in two, and truncus arteriosus in one. In each case the ascending aorta was small in comparison to the pulmonary trunk. From the suprasternal approach the ascending aorta could be seen to terminate in the left carotid artery, and the ductus to continue smoothly into the descending aorta, with no vestige of an aortic arch linking its ascending and descending portions. The left subclavian artery was seen to arise distal to the ductus in all but one patient. All four patients with ventriculoarterial concordance had pronounced subaortic stenosis caused by posterior displacement of the infundibular septum. Cross-sectional echocardiography therefore provides the only accurate method of non-invasive diagnosis of this condition. It permits early treatment with prostaglandins to prevent ductal closure, a planned approach to cardiac catheterisation, and a further means of investigating the nature of subaortic stenosis in this condition.

The ductus arteriosus and associated cardiac anomalies in interruption of the aortic arch

Abstract: Seventeen heart specimens with aortic arch interruption, a ductus-dependent anomaly, were investigated. In all specimens the cardiac anatomy favoured a preferential flow into the pulmonary artery (from which the blood could reach the descending aorta through the ductus). Ten specimens had the interruption proximal to the left subclavian artery (type B) and nine of these presented solely with an outflow tract septal defect. On the other hand, six of seven specimens with the interruption distal to the left subclavian artery (type A) were associated with more complex heart malformations.

Two-dimensional echocardiographic features of interruption of the aortic arch

Abstract: The 2-dimensional echocardiographic features of interruption of the aortic arch are presented based on analysis of the echocardiograms and angiograms from 8 infants: 2 with type A and 6 with type B interruption. Each infant had a patent ductus arteriosus, 6 had a conoventricular septal defect with leftward deviation of the conal septum, 1 had truncus arteriosus with truncal valve stenosis, and 1 had a distal aortopulmonary septal defect with an intact ventricular septum. Echocardiographic images obtained from the suprasternal notch or from a high parasternal approach demonstrated the interruption of the aortic arch and continuation of the patent ductus arteriosus into the descending aorta. These findings were compared with those in infants with aortic atresia and a hypoplastic ascending aorta or discrete coarctation of the aorta with tubular hypoplasia of the aortic arch. Types A and B interruption of the aortic arch were easily differentiated and the caliber of the patent ductus arteriosus was assessed. The characteristic conoventricular septal defect was readily visualized from an apex 2-chamber view or from a subcostal sagittal plane view. With this information subsequent angiography can be more expeditiously performed in this group of critically ill infants.

Measurements of the descending aorta in infants and children: comparison with other aortic dimensions.

Abstract: In paediatric cardiovascular surgery, knowledge of internal diameters along the first part of the aorta is essential. This paper presents reference data on the internal diameters of aortic ostium, ascending aorta, aortic isthmus and descending aorta, 1 cm distal to the ductus arteriosus. Measurements were made with the aid of calibrated probes in 126 post mortem specimens of normal hearts with great vessels. The age range was from 25 weeks of gestation up to 10 years after birth. The data revealed linear correlations between the internal diameters of the different parts of the aortic arch and body length. At variance with the literature, we found that, with few exceptions, the internal diameter of the ascending aorta was greater than that of the descending aorta.

Aortic valvular atresia. Associated cardiovascular anomalies.

Abstract: The pathological anatomy of 109 specimens of aortic valvular atresia was reviewed for the purpose of identifying the cardiovascular anomalies associated with that condition. We found the most commonly associated anomaly to be coarctation of the aorta, which was present in 71 percent of our cases and judged to be hemodynamic significance in one-third of the involved cases. Other associated anomalies, in order of decreasing frequency, were mitral atresia, anomalous systemic and pulmonary venous connections, abnormalities of branching of the aortic arch, and ventricular septal defect. The study demonstrated that aortic atresia is associated with a significant incidence of other cardiovascular anomalies. Additional anomalies, when present, may complicate emerging attempts at surgical correction of this condition.

Isolated atresia of the aortic arch in a 65-year-old man. Surgical treatment and review of published reports.

Abstract: Isolated atresia of the aortic arch is rare. In aortic arch atresia the arch is continuous, yet a segment of it is atretic so that apart from a collateral circulation, communication with the lower aortic segment is absent. Haemodynamically, the condition is similar to complete interruption of the aortic arch. To our knowledge only 10 cases of isolated aortic arch atresia or interruption have been reported. '9 In eight cases, the diagnosis was confirmed at operation, one case was diagnosed but untreated,8 and in one patient, the diagnosis was made at necropsy.I In this report we present a 65-year-old man with isolated atresia of the aortic arch which was subsequently corrected by operation. The anatomical aspects, diagnostic problems, and surgical approach are discussed, with a review of the previously published cases.

Interruption of the aortic arch with right descending aorta. A rare condition and a cause of bronchial compression.

Abstract: Four cases of interruption of the aortic arch with the rare association of right ductus arteriosus and right descending aorta are described. Three different variations in subclavian arterial origin are described. Each represents a mirror image of anatomic arrangements previously reported for interruption of the aortic arch with left descending aorta.

Method for cardiac transplantation in corrected transposition of the great arteries.

Abstract: A patient with corrected transposition of the great vessels (L-transposition) required cardiac transplantation because of severe myopathy of th systemic ventricle of right ventricular morphology. Because of the L-transposition of the great vessels, a modification of the transplantation procedure was necessary in order to make the great vessel anastomoses. This was accomplished without the need for prosthetic material primarily by extensive removal of donor pulmonary artery and aorta together with the heart. Anastomosis of the recipient ascending aorta was accomplished to the superior aspect of the transverse aortic arch of the donor, and the recipient pulmonary artery to the superior portion of the right pulmonary artery of the donor. The postoperative hemodynamics were normal and a thoracic aortogram one year post-transplant demonstrated the unusual anatomy.

The concurrence of dimensional aortic arch anomalies and abnormal left ventricular muscle bundles

Abstract: This anatomical study was designed to evaluate the concept that reduced blood flow through the embryonic preductal aorta contributes to the pathogenesis of dimensional aortic arch anomalies. For that purpose the intracardiac anatomy of 151 specimens was examined, of which 22 had an interruption, five atresia, 76 tubular hypoplasia, and 48 local coarctation of the aortic arch. Associated malformations were found in 148 specimens (98%); the remaining three (2%) had isolated local coarctation. Anomalies predisposing to reduced aortic blood flow were present in 128 specimens (85%). Among the potential obstructive factors affecting early morphogenesis, three left ventricular muscular structures seem to be particularly important: (1) the anterolateral muscle bundle, (2) the posteromedial muscle, and (3) leftward deviation of the anterior part of the ventricular septum. Obstructing combinations with these types of anomaly were identified in 77 cases (51%). The embryologic aspects of these muscular structures are discussed.

CT demonstration of mediastinal aortic arch anomalies.

Abstract: Computed tomography (CT) can be helpful in the detection and diagnosis of aortic arch malformations, including anomalous right subclavian artery, left sided aortic arch with right descending aorta, right sided, aorta with anomalous left subclavian artery or mirror image branching, and double aortic arch. This paper reviews the CT findings in 10 such patients. Computed tomography can confirm the presence of an aortic anomaly suspected from plain radiographs or can detect a vascular anomaly when the plain radiograph suggests the presence of a mediastinal mass.

Right aortic arch and isolation of the left innominate artery from the aorta

Abstract: The clinical and angiographic features of a patient with right aortic arch and isolation of the left innominate artery from the aorta who presented with left subclavian steal syndrome are described.

Two-dimensional echocardiographic visualization of the aortic arch by right parasternal scanning in neonates and infants.

Abstract: Echocardiography has previously been of limited use in visualizing the aorta in neonates and infants. Using a new technique—right parasternal scanning—the aortic arch and brachiocephalic vessels were studied in 50 children under 18 months of age. Complete visualization was accomplished in 47 patients including those 1) under 1,000 grams, 2) with indwelling endotracheal tubes, 3) who had D- or L-transposition, or 4) with right or double aortic arch. Inadequate studies were related to bilateral pneumothorax (2 neonates) and lack of cooperation (1 infant). Close correlation was obtained between images of the aorta by echocardiography and by angiography.

Prostaglandin E1 as an Adjunct to Emergency Cardiac Operation in Neonates

Abstract: Prostaglandin E1 (PGE1) has been used prior to operation in 28 neonates (0 to 30 days) with congenital heart disease (CHD). The patients were divided into two groups. Group I consisted of 19 neonates with CHD resulting in marked cyanosis. Thirteen patients had pulmonary atresia, three had tetralogy of Fallot, and three had complex defects with pulmonary stenosis. All patients were markedly hypoxemic. The average oxygen saturation was 41%. PGE, infusion, 0.1 mcglkglmin, was successful in 17 of 19 patients, as it resulted in an increase in oxygen saturation from 41% to 79%, average increase 38%. Two patients did not respond to PGE1 infusion. One was 30 days of age and the other had no patent ductus arteriosus. All of the patients underwent a palliative shunt procedure. There were three hospital deaths in this group. No patient died of hypoxemia. Group II consisted of nine patients whose CHD was predominately that of aortic obstructive disease with clinical manifestations of cardiac failure, hypoperfusion, and acidemia. Six of these patients had complicated coarctation of the aorta. Three patients had interruption of the aortic arch. The pH of these patients averaged 7.19. PGE1 infusion resulted in improvement of the pH to average of 7.37, improvement of congestive heart failure, and reappearance of femoral pulses. One patient failed to respond. All patients in Group II underwent operation. There were three hospital deaths in this group. No patient died intraoperatively. PGE1 infusion is a valuable aid to surgical treatment of desperately ill neonates with both cyanotic and acyanotic forms of CHD.

Anatomy of the Arterial System of the Upper Extremities

Abstract: This chapter reviews the normal roentgenological anatomy and common congenital anomalies of the major branches of the aortic arch and the arteries of the upper extremities

Two-Dimensional Echocardiographic Prospective Diagnosis Of Common Truncus Arteriosus in Infants

Abstract: Two-dimensional echocardiographic prospective diagnosis of truncus arteriosus was made in 7 infants. Two infants had truncus arteriosus type I, 3 patients had truncus arteriosus type II, 1 infant had truncal valve stenosis with an interrupted aortic arch, and 1 had type IV truncus arteriosus with pulmonary hypertension. Multiple imaging views were utilized to confirm the diagnosis. The parasternal long-axis view demonstrated the great vessel-ventricular septal override and the origin of the pulmonary arteries from the posterior aspect of the ascending truncus. The suprasternal notch image facilitated identification of the left- or right-side aortic arch and the origin of the pulmonary arteries from the truncus. Transverse imaging sections at the base of the heart facilitated identification of the pulmonary artery origin of truncus arteriosus type I. Subcostal coronal and sagittal views imaged the common truncus and the ventricular septal defect. These echocardiographic images were contrasted with and discriminated from those of an infant with aorticopulmonary window with intact ventricular septum. Although cardiac catheterization and angiography may be required to assess pulmonary arterial pressure, pulmonary vascular resistance, and the distal pulmonary arterial anatomy in truncus arteriosus, 2-dimensional echocardiography can be used to correctly establish the morphologic diagnosis of truncus arteriosus in infants.