Diseases of Blood vessels
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Gross examination of a dissection hematoma of the aorta reveals an intimal tear in the majority of cases. This is generally located in the ascending aorta 1 or 2 cm above the aortic valve ring (Fig. 13.45). The tear is usually horizontal and has irregular margins. This represents the site of entry of blood into the vessel wall. Dissection occurs generally between the layers of the media (Figs 13.48 and 13.46b) and may extend proximally towards the heart and distally into variable lengths of the aorta .At times, dissection may involve the entire length of the aorta including the iliac and femoral arteries. Dissection of the coronary arteries, vessels of the arch of aorta, renal and mesenteric is also described. Microscopically, the media shows disturbed architecture in that the elastic fibers are fragmented and degenerated and enclose pools of metachromatic material which are of variable size (Fig. 13.51). It is likely that disruption of the elastic tissue and presence of myxoid material in the media cause weakening of the vessel wall.
Coarctation of the aorta
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
The following situations may warrant consideration for intervention or reintervention:16All symptomatic patients with a gradient >30mmHg across the coarctation.Asymptomatic patients with a gradient >30mmHg across the coarctation and upper limb hypertension, pathologic blood pressure response during exercise, or significant left ventricular hypertrophy.Independent from the pressure gradient, some patients with ≥50% stenosis of the aorta (on MRI, CT or angiography).Significant aortic valve stenosis or regurgitation.Aneurysm of the ascending aorta.Aneurysm at the site of previous treatment.Symptomatic aneurysms of the circle of Willis.
Repair of Extensive Aortic Aneurysms: A Single-Center Experience Using the Elephant Trunk Technique over 20 Years
Juan Carlos Jimenez, Samuel Eric Wilson in 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
In conclusion, these results establish two things: (1) a standard against which endovascular procedures should be judged as new technologies are developed; (2) a rational guide to management for those who cannot be repaired by endovascular technique. As the commercially produced frozen elephant trunk devices become more available, it is likely that the traditional elephant trunk procedure will be replaced by this hybrid approach. In the United States, current endovascular options to address the ascending aorta and aortic arch are limited—and a significant proportion of these aneurysms may not be suitable for endovascular repair with any existing technology. Therefore, surgical options remain an essential element of the procedural armamentarium, and best practices for these complex problems need to be developed, refined, and disseminated.
Double right coronary artery: a plea for a standardized nomenclature
Published in Acta Chirurgica Belgica, 2022
Sotirios D. Moraitis, Apostolos C. Agrafiotis, Panagiotis Strempelas, Georgios Kagialaris, Pantelis Tsipas
A 42-year-old male patient was recently admitted to our department for surgical treatment of severe bicuspid aortic valve stenosis (AVA: 0,66 cm2, Vmax: 5,15 m/s). He had no significant medical history. Preoperative coronary angiography showed two RCA (Figure 1(a)). An aortic valve replacement was scheduled (Euroscore I: 1,51%, Euroscore II: 0,6%). Surgical access was gained through a median sternotomy. An arterial cannula was placed in the ascending aorta, a two-stage venous cannula in the right atrium and a retrograde cardioplegia catheter into the coronary sinus. After successful establishment of cardiopulmonary bypass, a left ventricular vent catheter was introduced through the right superior pulmonary vein, aorta was cross clamped and St. Thomas cardioplegic solution was administrated. A transverse aortotomy was performed in the ascending aorta. A double ostium of the RCA was encountered (Figure 1(b)). The calcified aortic cusps were removed and decalcification of the annulus was performed. A SJM RegentTM mechanical valve prosthesis of 23 mm replaced the calcified bicuspid valve, according to patient’s BSA. A Nicks’ operation was performed for enlargement of the small aortic root. Weaning from cardiopulmonary bypass was uneventful. There was no complication during the postoperative course and the patient was discharged on postoperative day 7, after a satisfactory cardiac ultrasound control.
Aortic stiffness in families with inherited non-syndromic thoracic aortic disease
Published in Scandinavian Cardiovascular Journal, 2018
Matias Hannuksela, Bengt Johansson, Bo Carlberg
There is an ongoing discussion about which imaging modality should be used for screening and if the measurements from different modalities are comparable [5]. Computed tomography is widely available and fast to perform, but exposes the patient to ionizing radiation and intravenous contrast agent. Magnetic resonance imaging (MRI) does not expose the patient to radiation but takes longer to perform and it is not as available as computed tomography or transthoracic echocardiography (TTE). Furthermore, approximately 5% of patients cannot undergo MRI due to claustrophobia. The TTE is widely available, easy to perform, and does not expose the patient to radiation or contrast agents. The descending thoracic aorta is difficult to investigate with ultrasound, but in the vast majority of the patients the disease is localized to the ascending aorta (AoA).
Bicuspid aortic valve aortopathies: An hemodynamics characterization in dilated aortas
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Diana Oliveira, Sílvia Aguiar Rosa, Jorge Tiago, Rui Cruz Ferreira, Ana Figueiredo Agapito, Adélia Sequeira
According to this, research studies have tried to underline mechanisms associated with dilation onset and progression in the presence of a BAV. Computational works have provided further insight on the hemodynamic aspects of ascending aortic blood flow in this disease: flow eccentricity, skewness, helical patterns and abnormally elevated wall shear stress (WSS) have been reported by computational (Cao et al. 2017; Bonomi et al. 2015; Kimura et al. 2017) and in vivo studies (Mahadevia et al. 2014; Rodriguez-Palomares et al. 2018). Nonetheless, further hemodynamics characterization of blood patterns in the ascending aorta in cases of dilation is necessary. 4 D flow MRI studies are extensively used to assess aortic hemodynamics in BAV patients (Mahadevia et al. 2014; Rodriguez-Palomares et al. 2018; Hope et al. 2010). However, this imaging modality is unable to evaluate accurately and noninvasively relevant hemodynamic predictors such as WSS, due to low temporal and spatial resolutions (Markl et al. 2011). Thus, computational modelling becomes advantageous in this matter, providing with several hemodynamic indexes that can further describe the abnormal aortic hemodynamics present in BAV patients.
Related Knowledge Centers
- Aorta
- Aortic Arch
- Aortic Sinus
- Aortic Valve
- Thoracic Aorta
- Sternum
- Ventricle
- Costal Cartilage
- Thoracic Aortic Aneurysm
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