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Diseases of the Aorta
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The aorta arises from the aortic sinuses which contain the aortic valve and then continues up and over to the left as the ascending aorta. The aortic arch passes over the hilum of the left lung and becomes the descending thoracic and abdominal aorta. Just distal to the left subclavian artery, there is often a puckered or depressed area visible on the intima which is the site of the closed ductus.
Aortic Regurgitation
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Such a pulse is a reflection of a rapid aortic run-off and has the eponymous name of 'water hammer' or Corrigan's pulse. It may also be found in patients with: A large patent ductus arteriosus.An aortopulmonary window.A ruptured aneurysm of the aortic sinus.High fever, due to the marked peripheral vasodilatation.Widespread active Paget's disease.Pregnancy.Severe anaemia.
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The left and right coronary arteries, which are end arteries, arise from the aortic root behind the cusps of the aortic valve. The aortic root has three dilatations (aortic sinuses) just above the aortic valve. The right coronary artery arises from the anterior aortic sinus and supplies blood to the right ventricle, the right atrium, the SA node in 60% of people and the AV node in 85% of people. It passes between the right atrium and pulmonary trunk and descends along the atrioventricular groove to the inferior border of the heart. The right coronary artery divides into smaller branches, including the right posterior descending (posterior interventricular) artery and the acute marginal artery. Together with the left anterior descending artery, the right coronary artery helps supply blood to the septum of the heart (Figure 23.4).
Sinus of Valsalva aneurysm presenting with chest pain
Published in Baylor University Medical Center Proceedings, 2021
Mostafa Abohelwa, Mohamed Elmassry, Ty Whisenant, Thanita Thongtan, Pooja Sethi
The aneurysm of the aortic sinus, also known as sinus of Valsalva aneurysm (SOVA), is a rare aortic root defect that can be dangerous. The aorta normally has three small pouches that sit directly above the aortic valve (Valsalva’s sinuses), and an aneurysm of one of these sinuses results in a thin-walled swelling. An aneurysm may affect the right (65%–85%), noncoronary (the posterior sinus) (10%–30%), or rarely the left (<5%) coronary sinus.1 It usually occurs due to the elastic lamina’s weakness at the media’s junction and the annulus fibrosis. It functions to prevent coronary artery ostia occlusion during systole when the aortic valve opens. Here, we present a case of a young man who had atypical chest pain and was found to have an unruptured SOVA of the noncoronary sinus.2,3
Management of valvular heart disease in the pregnant patient
Published in Expert Review of Cardiovascular Therapy, 2020
Aortic regurgitation (AR) can be encountered during pregnancy as a result of bicuspid aortic valve, annular dilation, rheumatic valve disease, or endocarditis. As with MR, the reduction of systemic vascular resistance that occurs with pregnancy allows AR to be well tolerated in this setting. Additionally, the rise in heart rate with pregnancy particularly favors this lesion [6,11]. Thus, the management of AR is similar to that for MR. In asymptomatic patients, valve replacement or repair is not recommended. However, prior to pregnancy, in cases of mild to moderate AR, exercise testing is recommended for the evaluation of symptoms. In addition, detailed aortic sinus measurement is recommended with echocardiogram prior to conception, especially in the presence of a bicuspid aortic valve [6]. Table 3 summarizes the management of AR in the pre and postconception settings.
A review of pulmonary autograft external support in the Ross procedure
Published in Expert Review of Medical Devices, 2019
Vincent Chauvette, Marie-Ève Chamberland, Ismail El-Hamamsy
Dacron has also been associated with increased inflammatory reaction around the pulmonary autograft which might cause early dysfunction and limit the long-term benefits of the Ross procedure [31]. Other types of synthetic material might provide different results. Kollar et al have reported the case of a 44 years old patient in whom GoreTex was used to wrap the pulmonary autograft. Unfortunately, the long-term measurements of the neo-aortic sinuses were not available [32]. Finally, as it is the case for other cardiac procedures, the use of prosthetic material has to be balanced with the risk of future endocarditis. Currently, we see more limitations than advantages in using this technique for all patients. However, it might provide benefits in selected patients at risk of pulmonary autograft dilatation (preoperative aortic regurgitation, dilated aortic annulus, etc). It may also open the possibility of considering the Ross procedure in groups of patients previously deemed absolute contra-indications, such as young female patients contemplating pregnancy with a connective tissue disorder and non-sparable valve [33].