Showing papers on "Aortic arch published in 1989"
TL;DR: The independent determinants predictive of 30-day death were increasing age, severe aneurysm symptoms, diabetes, previous proximal aortic operation, need for cardiac support, postoperatively tracheostomy, postoperative heart dysfunction, and stroke.
329 citations
TL;DR: A possible role for compliance in the assessment of cardiovascular fitness and the detection of coronary artery disease is suggested and total arterial compliance also fell with age in those with coronary arteries disease although there was more variation.
Abstract: Arterial compliance was measured in 70 healthy volunteers, 13 athletes, and 17 patients with coronary artery disease. Magnetic resonance images were acquired at end diastole and end systole through the ascending aorta, the aortic arch, and the descending thoracic aorta. Regional compliance was derived from the change in luminal area in a slice of known thickness and from the pulse pressure. Total arterial compliance was also measured from the left ventricular stroke volume and the pulse pressure. In the volunteers, mean (SD) regional compliance (microliters/mm Hg) was greatest in the ascending aorta (37 (18], lower in the arch (31 (15], and lowest in the descending aorta (18 (8], and it decreased with age. Compliance in the athletes was significantly higher than in their age matched controls (41 (16) versus 22 (11) microliters/mm Hg). In the patients with coronary artery disease it was significantly lower (12 (4) v 18 (10] than in age matched controls. Total arterial compliance also fell with age in those with coronary artery disease although there was more variation. The results suggest a possible role for compliance in the assessment of cardiovascular fitness and the detection of coronary artery disease.
283 citations
TL;DR: It is demonstrated noninvasively that both the aortic arch diameter and the elastic modulus are increased in patients with sustained uncomplicated essential hypertension, and that both age and blood pressure act independently as factors that alter the arterial wall of subjects with sustained essential hypertension.
226 citations
TL;DR: Two hundred four infants and children (mean age 13 months) have undergone operation for the relief of tracheoesophageal obstruction resulting from vascular anomalies, with no operative deaths in patients with isolated vascular anomalies in the past 28 years.
211 citations
Patent•
04 Dec 1989
TL;DR: A rapidly exchangeable catheter for use in the coronary arteries includes an elongate relatively stiff proximal segment that defines inflation lumen, an intermediate, shorter segment formed from a more flexible plastic material and having two lumens, and a third, single lumen distal segment as discussed by the authors.
Abstract: A rapidly exchangeable catheter for use in the coronary arteries includes an elongate relatively stiff proximal segment that defines an inflation lumen, an intermediate, shorter segment formed from a more flexible plastic material and having two lumens, and a third, single lumen distal segment. A balloon or other instrumentality adapted to operate in a coronary artery is mounted to the distal region of the catheter. The intermediate and distal segments include a guidewire lumen by which the catheter may be advanced along a guidewire. The proximal segment may include an inflation lumen when the operating instrumentality at the distal end of the catheter is a balloon. The intermediate and distal segments of the catheter are of a length of between about 35 to 45 cm such that when the catheter is advanced into the most remote distal portions of the coronary anatomy, the flexible plastic intermediate and distal segments will extend over the aortic arch of the patient thereby containing the guidewire over the aortic arch and maintaining the juncture of the relatively stiff proximal segment and the more flexible intermediate segment proximally of the aortic arch. The relatively stiff proximal section thus extends generally along a straight line from the femoral artery into the descending aorta but not so far as into the aortic arch. Buckling of the catheter is avoided so that the catheter is more easily manipulated.
191 citations
TL;DR: A new theory is advanced that decreased myocardial perfusion leading to ischemic heart disease has two sources: insufficient blood flow into the coronary artery inlet due to abnormal aortic function and independent of coronary artery stenosis and (2) local coronary arteries stenosis.
151 citations
Journal Article•
TL;DR: The results of current techniques warrant a more aggressive approach to these problems to permit better long-term results, according to the authors.
Abstract: This report is concerned with the surgical treatment of cardiovascular manifestations of Marfan syndrome in 151 patients by 280 operations, 70 before referral, 203 by the authors during a 16-year period, and seven by others in the follow-up interval. This therapy resulted in mitral valve replacement in 13, aortic valve replacement in 135, aortic segment replacement in 151 (including total aortic replacement in 10), nearly total aortic replacement in 26, entire thoracic aortic replacement in seven, and replacement of the entire descending and abdominal aorta in 20 patients. The early (30-day) survival was 94%, and the 5- and 10-year Kaplan-Meier survival was 75% and 56%, respectively. Fusiform aneurysms were present in the ascending aorta, aortic arch, or both in 135, the descending aorta in two, the thoracoabdominal aorta in four, and the abdominal aorta in seven. Aortic dissection occurred in 102 (67%) patients, and 34 (22%) patients with ascending aortic operations required reoperation. This study suggests that the results of current techniques warrant a more aggressive approach to these problems to permit better long-term results.
130 citations
TL;DR: Surgical manipulation of the aortic arch apparatus in the chick leads to distinct alterations in the arches of components and relationships which are important in development, which likely affects the development of the heart.
Abstract: A previous study has shown that, subsequent to ablation of cranial neural crest, heart morphology and pharyngeal arch vessels (aortic arches) are altered before septation of the outflow tract normally occurs. In the present study, we concentrated on very early development of the aortic arch apparatus in the chick (incubation days 3-5). The three-dimensional organization of the arch vessel apparatus was studied by scanning electron microscopy after intravascular injection of Mercox, and by serial sections of embryos embedded in plastic. Alterations in the arch vessel apparatus were already present by day three in embryos with neural crest ablation at stage 9-10. Bilateral symmetry frequently was lost. Arch vessels sometimes were enlarged and occupied most of the arch, with little surrounding mesenchyme. Some arch vessels were small or occluded. Mesenchyme was significantly reduced in quantity in the arches, and was not condensed and symmetrical as in controls. There was a significant increase in the proportion of direct apposition of vessel endothelium with epithelium, without the intervening mesenchyme typical of controls. The surgical manipulation used in this study leads to distinct alterations in the arches of components and relationships which are important in development. Altered blood flow likely affects the development of the heart.
114 citations
Journal Article•
TL;DR: It is concluded that chest CT has no screening role in the evaluation of blunt trauma patients with possible major vascular injury.
96 citations
TL;DR: This work reports a 9-year experience with a policy of emergency resection for all acute aortic dissections involving the aorti arch, with four hospital deaths between May 1979 and May 1988.
90 citations
TL;DR: Transesophageal Doppler echography provides a rapid and accurate method of diagnosing and evaluating dissecting aortic aneurysm and permits prompt initiation of appropriate treatment.
TL;DR: The powers of mimicry of this enigmatic structure may account for its apparent rarity and 3 of the cases were incorrectly interpreted when initially described.
TL;DR: In one patient with mediastinal squamous cell carcinoma, resection and reconstruction of the aortic arch and left subclavian artery were performed by application of a temporary bypass graft between the ascending and descending aorta, and this patient was alive and free of disease more than 17 months after the operation.
Journal Article•
TL;DR: Major changes in operative technique for aneurysms of the ascending aorta and aortic arch have been introduced during the last 5 years, especially use of a continuous suture-graft-inclusion technique in 99% of patients and more extensive use of circulatory arrest since that time.
Abstract: Results of surgery in 165 patients with aneurysms of the ascending aorta and aortic arch during 1978-1988 were analyzed retrospectively. Etiology included 29% dissection, 22% atherosclerosis, 22% cystic-medial necrosis, and 27% other causes. Concomitant procedures on the aortic valve were performed in 65% of patients (valvular replacement in 37%, valve-conduit in 23%, and valvular resuspension in 5%), and 13% underwent concomitant coronary artery bypass surgery. Major changes in our operative technique for such aneurysms have been introduced during the last 5 years, especially use of a continuous suture-graft-inclusion technique in 99% of patients, use of circulatory arrest in 59%, and use of an open hemiarch repair in 32%. Hospital mortality dropped from 17.9% during the first 5 years of the study period to 12.3% in the last 5 years despite increasing complexity of the cases encountered. Operative mortality was 7.6% for ascending aortic aneurysmal repair; 5.3% for valve-conduit procedure; 8.8% for open hemiarch repair; and 30.8% for repair of extensive aneurysms involving the aortic arch and significant portions of the descending aorta. Multivariate analysis showed that, of the variables examined, significant predictors of increased operative risk were age (p less than 0.05) and extension of an ascending aortic aneurysm to the descending aorta or involvement of the aortic arch (p less than 0.001). The incidence of stroke was 2.4%, with only one stroke since 1983 despite more extensive use of circulatory arrest since that time. Follow-up was 94% complete, with a mean (+/- SD) follow-up interval of 28 +/- 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Thirty patients with 33 vascular injuries from blunt trauma to the brachiocephalic branches of the aortic arch are reported, which is the largest series reported to date of blunt injuries to these vessels.
Journal Article•
TL;DR: Deep-hypothermic cardiopulmonary bypass with selective cerebral perfusion was used in 34 consecutive patients with aneurysms involving the aortic arch or the adjacent part of theAorta, and with appropriate monitoring, this method can be performed in aorta or related surgeries with low morbidity results.
Abstract: Deep-hypothermic cardiopulmonary bypass with selective cerebral perfusion (SCP) was used in 34 consecutive patients with aneurysms involving the aortic arch or the adjacent part of the aorta. The ages ranged from 25 to 79 years (mean, 56 years). Atherosclerotic aneurysms were present in 14 patients, dissecting aortic aneurysms in 16, and other lesion types in four. Replacement of the ascending aorta was performed in 10 patients, replacement of the ascending aorta and arch in 12, replacement of the distal arch in two, and other procedures in 10. Perfusion techniques consisted of femoral artery perfusion and SCP to the brachiocephalic trunk and the left common carotid artery. The blood temperature was maintained at 16 degrees-20 degrees C. SCP time ranged from 25 to 214 minutes (mean, 123 minutes). Operative death occurred in three (9%) patients. Neurological sequelae occurred in one patient (cerebral infarction), but significant respiratory and hemorrhagic problems were not encountered. For the SCP protocols, we advise that perfusion pressures at bilateral superficial temporal arteries be kept at approximately 50 mm Hg and that venous oxygen saturation of the superior vena caval line or internal jugular vein be kept at above 90%. With appropriate monitoring, this method can be performed in aortic arch or related surgeries with low morbidity results.
Patent•
13 Nov 1989
TL;DR: In this paper, the tip portion of the catheter is moved down the wall of the ascending aorta until it reaches the ostium of the right coronary artery, with the distal end of the tip part touching the wall.
Abstract: An angiographic catheter includes a relatively soft, tip portion having a preformed curvature, and a resilient body portion extending therefrom having a preformed curvature in the opposite direction. A lumen extends through the catheter for the injection of angiographic dye therethrough to the right coronary artery. The part of the body portion of the catheter which it in the aortic arch of the patient during use has an amount of curvature which is less than the amount of curvature of the aortic arch, so that the body portion of the catheter is resiliently deformed where it passes through the aortic arch. The deformation results in the biassing of the tip portion of the catheter into the ostium of the right coronary artery. Upon insertion into the aorta the preformed catheter is oriented so that the curvature of the body portion of the catheter corresponds in direction to the curvature of the aortic arch, the tip portion of the catheter being disposed above the ostium of the right coronary artery with the distal end of the tip portion touching the wall of the ascending aorta. The tip portion of the catheter is moved down the wall of the ascending aorta until it reaches the ostium of the right coronary artery.
TL;DR: The results show that the pulmonary arch artery differs from the other arch arteries in that it is the most cranial vessel of a system of ventral splanchnic arteries, which connects the pulmonary plexus with the dorsal aortae at an early stage.
Abstract: A renewed study of the development of the branchial arch system was essential in view of the special morphologic characteristics of the ductus arteriosus, which derives from the pulmonary arch artery or sixth branchial arch artery. In congenital heart disease certain aorto-pulmonary collateral arteries have a marked histological similarity to the ductus arteriosus. To gain a better insight into the development of these vessels, 27 rat embryos, with the number of somites ranging between 19 and 41, were studied. Most embryos were collected after shortterm in vitro-culture, allowing precise staging of age and development. The vascular system of these embryos was injected with Indian ink, to enable easy recognition of even the smallest endotheliumlined vessels. The embryos were serially sectioned (3–5 μm) and reconstructed using a graphic method.
TL;DR: A case of an aortic arch with five primary branches arising in a sequence that has previously never been reported is described, and the embryology of this complex anomaly as well as its potential clinical significance are discussed.
Abstract: We describe a case of an aortic arch with five primary branches arising in a sequence that has previously never been reported. From right to left, the brachiocephalic trunk and left common carotid, left vertebral, and subclavian arteries originated from the convexity of the aortic arch. The last branch was the right vertebral artery that arose from the dorsal aspect of the aortic arch opposite the ligamentum arteriosum. Presenting a dilatation at its commencement, the right vertebral ran to the right behind the esophagus and entered the foramen transversarium of the seventh cervical vertebra, whereas the left vertebral passed to the foramen transversarium of the fifth cervical vertebra. The left vertebral artery gave off the left thyroid artery; a thyrocervical trunk was absent on the left side. A thyroidea ima arose from the brachiocephalic trunk. The embryology of this complex anomaly as well as its potential clinical significance are discussed.
TL;DR: Although a rare occurrence, extracapsular parathyroid hemorrhage should be considered in the differential diagnosis of all rapidly evolving cervical and mediastinal masses, especially when hypercalcemia is present.
Abstract: • A 32-year-old man had a giant cervical mass, dysphagia, dyspnea, and severe hypercalcemia. A computed tomographic scan showed the mass to extend from the left mandible to the level of the aortic arch. Exploratory surgery of the neck revealed a ruptured parathyroid cyst complicated by massive hemorrhage into the cervical tissues and mediastinum. The postoperative course was uncomplicated with prompt resolution of the hypercalcemia. Although a rare occurrence, extracapsular parathyroid hemorrhage should be considered in the differential diagnosis of all rapidly evolving cervical and mediastinal masses, especially when hypercalcemia is present. (Arch Surg. 1989;124:1347-1350)
TL;DR: This study retrospectively reviewed the cineangiograms of other patients with and without DS to determine the frequency of its occurrence, after the fortuitous finding of aberrant origin of the left vertebral artery on an aortic arch cineANGiogram in a patient with DS.
Abstract: The Down Syndrome (DS), the most common chromosomal malformation syndrome in humans, occurs in 1 in 660 births. 1 The clinical manifestations of DS are variable, and may be difficult to recognize in the neonate. We performed this study after the fortuitous finding of aberrant origin of the left vertebral artery on an aortic arch cineangiogram in a patient with DS. We retrospectively reviewed the cineangiograms of other patients with and without DS to determine the frequency of its occurrence. Patients with DS (confirmed by karyotyping) who underwent cardiac catheterization and selective cineangiography for suspected congenital heart disease between January 1, 1977, and December 31, 1987, were included. Patients who did not have DS and who were shown to have similar congenital cardiac defects by cardiac catheterization and selective cineangiography served as controls. Only those cineangiograms that clearly showed the aortic arch and the branches arising from the aortic arch were included in the study.
Journal Article•
TL;DR: The present data suggests that both selective cerebral perfusion SCP and HCA are useful methods for cerebral protection during resection of aortic arch aneurysms, although the latter method has the limitation of restricted cerebral arrest time.
Abstract: Over the past four years, 21 patients have been operated for aneurysms of the thoracic aorta requiring aortic arch reconstruction. The causes of the aneurysms were dissecting aneurysms of the aorta (type A) in 16 patients and atherosclerosis in 5 patients. To prevent cerebral ischemia during operation, selective cerebral perfusion (SCP) (600 ml/min at 25 degrees C) was employed in 11 patients and hypothermic circulatory arrest (HCA) at 15 degrees C in 10 patients. There were three early deaths (14.3%) in the series. There were no serious neurologic complications in either group. The present data suggests that both selective cerebral perfusion SCP and HCA are useful methods for cerebral protection during resection of aortic arch aneurysms, although the latter method has the limitation of restricted cerebral arrest time.
TL;DR: The central shunt preserves pulmonary artery symmetry, which may be important in candidates for the Fontan operation in infancy, as well as in patients who had a late postoperative echocardiogram.
Journal Article•
TL;DR: The large field of view and high-quality images afforded by MR imaging make it a useful diagnostic tool that can supplement, confirm, and in some instances supplant the use of other conventional imaging techniques.
Journal Article•
TL;DR: Preliminary results indicate that surgical glue can be used safely and efficiently in type A aortic dissection as an alternative to aortsic replacement.
Abstract: Between 1984 and 1988, 15 patients with type A aortic dissection were treated by direct suturing of the intimal tear and extensive sticking of the dissected aortic layers with surgical (gelatin-resorcin-formaldehyde) glue without prosthetic graft replacement. Aortic incompetence was present in 10 patients, a situation that required valvular replacement in five and valvular repair in five. In 10 patients, the dissection extended to the transverse aortic arch, requiring profound hypothermia and circulatory arrest. All patients survived the operation. Follow-up ranged from 6 to 44 months. All patients were monitored by Doppler echocardiographic studies. In addition, 10 underwent angiography; six, a computed tomographic scan; and five, magnetic resonance imaging. In all patients but two, the ascending aorta and transverse arch had a normal appearance. In three patients, a limited dissection persisted that did not require reoperation. Dissection of the descending aorta was present in 10 patients. One patient required a valvular replacement 18 months after surgery, and one underwent heart transplantation for an associated cardiomyopathy 14 months after surgery. These preliminary results indicate that surgical glue can be used safely and efficiently in type A aortic dissection as an alternative to aortic replacement.
TL;DR: A magnetic resonance imaging scan confirmed the presence of severe tracheal narrowing caused byHer symptoms were very suggestive of exercise-induced bronchospasm and her flow-volume curves showed evidence of variable intrathoracic large airways obstruction.
Abstract: We present the case of a young woman with a right aortic arch who first became symptomatic when she began a vigorous exercise program. Her symptoms were very suggestive of exercise-induced bronchospasm. Her flow-volume curves, however, showed evidence of variable intrathoracic large airways obstruction. A magnetic resonance imaging scan confirmed the presence of severe tracheal narrowing caused by her right aortic arch.
TL;DR: A biological limit of the plasticity of the neural ectoderm is established and a probable cellular basis for a lethal congenital septal defect is given.
Abstract: Cells from the cardiac neural crest are essential for the normal development of both the heart and the great vessels. If cardiac neural crest is ablated surgically from Hamburger-Hamilton stage 9 chicken embryos, they will develop anomalies of both the heart and great vessels that are similar to anomalies that occur in humans. In the absence of cardiac neural crest, another area of neural ectoderm (nodose placode) provides replacement cells that are less competent than those of the neural crest. In this study, both the cardiac neural crest and the nodose placodes have been surgically ablated. A syndrome of unusual prevalence (47%) and severity was found among the survivors of this surgery, which was characterized by a large undivided aorta that arched dorsally without right or left deviation to become the dorsal aorta. There was no other tributary to the formation of the dorsal aorta. There were no ducti arteriosi, and the pulmonary arteries were both ectopic and hypoplastic. The brachiocephalic arteries were asymmetric and hypoplastic. The association of the aorta with the anlagen of the thyroid and thymus glands, as well as with the inferior ganglion of the vagus nerve, indicated that the solitary surviving aortic arch artery is that of arch III in this syndrome. These results establish a biological limit of the plasticity of the neural ectoderm and give a probable cellular basis for a lethal congenital septal defect.
TL;DR: In this paper, the authors test the effectiveness, in patients with known aortic or brachiocephalic arterial injury, of five previously published radiographic criteria for excluding aortography.
TL;DR: Electrocardiographically gated magnetic resonance imaging produced high quality images that showed the anatomy better than other non-invasive methods and provided all the anatomical information required for surgical correction.
Abstract: Nineteen infants with suspected coarctation of the aorta were studied with electrocardiographically gated magnetic resonance imaging on a 1.5 T whole body imaging system. In all cases imaging was successful and produced diagnostic images of high resolution. Coarctation was shown in 12 cases. The position and shape of the coarctation were well displayed by the magnetic resonance images. In addition, they clearly showed the relation of the coarctation to arteries arising from the aortic arch and to the length and diameter of the aortic isthmus and the distal aortic arch. The anatomy was confirmed at operation in all 12 patients, except for two with a small ductus arteriosus (arterial duct), which was not seen in the magnetic resonance images. In the seven remaining patients, coarctation was excluded. Magnetic resonance imaging produced high quality images that showed the anatomy better than other non-invasive methods. It provided all the anatomical information required for surgical correction.