scholarly journals Late Diagnosis of Silent Thoracic Aortic Rupture Presented as a Right Pleural Effusion

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Meletios A. Kanakis ◽  
Vassilios G. Papavassiliou ◽  
Polivios Drosos ◽  
Elias A. Kaperonis ◽  
George Benakis ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Clinical Condition ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Rupture ◽  
Descending Thoracic Aorta ◽  
Open Thoracotomy ◽  
Endovascular Graft ◽  
Stable Clinical Condition

Patients with ruptured thoracic aortic aneurysm rarely present in a stable clinical condition. A man was referred to our hospital with the diagnosis of ruptured saccular aneurysm of the descending thoracic aorta. He successfully underwent both endovascular graft repair and open thoracotomy.

scholarly journals A New Methodology to Determine Apposition, Dilatation, and Position of Endografts in the Descending Thoracic Aorta After Thoracic Endovascular Aortic Repair

2019 ◽  
Vol 26 (5) ◽  
pp. 679-687 ◽  
Author(s):  
Kim van Noort ◽  
Richte C. L. Schuurmann ◽  
Gersom Post Hospers ◽  
Emma van der Weijde ◽  
Hans G. Smeenk ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Applied Software ◽  
Shortest Distance ◽  
The Mean

Purpose: To validate computed tomography angiography (CTA)–applied software to assess apposition, dilatation, and position of endografts in the proximal and distal landing zones after thoracic endovascular aortic repair (TEVAR) of thoracic aortic aneurysm. Materials and Methods: Twenty-two patients (median age 75.5 years; 11 men) with a degenerative descending thoracic aortic aneurysm treated with TEVAR with at least one postoperative CTA were selected from a single center’s database. New CTA-applied software was used to determine the available apposition surface in the proximal and distal landing zones, apposition of the endograft fabric with the aortic wall, shortest apposition length, endograft inflow and outflow diameters, shortest distance between the left subclavian artery and the proximal endograft fabric, and shortest distance between the celiac trunk and the distal endograft fabric on each CTA. Interobserver variability for these parameters was assessed with the repeatability coefficient and the intraclass correlation coefficient. Results: Excellent interobserver agreement was found for all measurements. Interobserver variability of surface and shortest apposition length calculations was larger for the distal site compared with the proximal site, with a mean difference of 10% vs 2% of the mean available apposition surface, 12% vs 5% of the endograft apposition surface, and 16% vs 8% of the shortest apposition length, respectively. Inflow and outflow diameters of the endograft showed low variability, with a mean difference of 0.1 mm with 95% of the interobserver difference within 1.8 mm. Mean interobserver differences of the proximal and distal shortest fabric distances were 1.0 and 0.9 mm (both 2% of the mean lengths). Conclusion: Assessment of apposition, dilatation, and position of the proximal and distal parts of an endograft in the descending thoracic aorta is feasible after TEVAR with the new software. Interobserver agreement for all measured parameters was excellent for the proximal and distal landing zones. The new method allows detection of subtle changes during follow-up. However, a larger study is needed to quantify how parameters change over time in complicated and uncomplicated TEVAR cases and to define the real added value of the new methodology.

Aortic aneurysm

2018 ◽  
Author(s):  
John Chambers
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Natural History ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Diameter ◽  
Descending Thoracic Aorta ◽  
Body Habitus ◽  
Abdominal Aortic ◽  
History Of

The epidemiology and natural history of thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) are different. The thoracic aortic diameter is dependent on age and body habitus as well as the level at which it is measured. Average diameters are 2.1 cm/m2 for the ascending thoracic aorta, and 1.6 cm/m2 for the descending thoracic aorta, giving approximate thresholds for the diagnosis of a TAA of 40 mm and 35 mm, respectively. AAAs are defined by a diameter >30 mm and are mainly infrarenal, with only 2%–5% in a suprarenal position.

Influence of the Descending Thoracic Aortic Cross Clamping on Bispectral Index Value and Plasma Propofol Concentration in Humans

2006 ◽  
Vol 104 (5) ◽  
pp. 939-943 ◽  
Author(s):  
Manabu Kakinohana ◽  
Seiya Nakamura ◽  
Tatsuya Fuchigami ◽  
Yuji Miyata ◽  
Kazuhiro Sugahara
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Radial Artery ◽  
Femoral Artery ◽  
Bispectral Index ◽  
Thoracic Aortic Aneurysm ◽  
Descending Thoracic Aorta ◽  
Blood Samples ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Background In this study, the authors investigated changes in Bispectral Index (BIS) values and plasma propofol concentrations (Cp) after aortic cross clamping in the descending thoracic aortic aneurysm repair surgery during propofol anesthesia. Methods Prospectively, in 10 patients undergoing thoracic aortic surgery during total intravenous anesthesia with propofol, BIS values were recorded during cross clamping of the descending thoracic aorta. In this study, the rate of propofol infusion was controlled to keep the BIS value between 30 and 60 throughout surgery. Simultaneously, Cp values in the blood samples taken from the right radial artery (area proximal to cross clamping) and the left femoral artery (area distal to cross clamping) were measured. Results Approximately 15 min after initiating aortic cross clamping, BIS values in all cases started to decrease abruptly. Cp values of samples taken from the radial artery after cross clamping of the aorta were significantly (P < 0.05) increased compared with pre-cross clamp values (1.8 +/- 0.4 microg/ml), and the mean Cp after aortic cross clamping varied between 3.0 and 5.3 microg/ml. In addition, there were significant differences in the Cp values between radial arterial and femoral arterial blood samples throughout aortic cross clamping. Cp values in samples from the radial artery were approximately two to seven times higher than those from the femoral artery. Conclusions This study showed that Cp values increased and BIS values decreased rapidly after aortic cross clamping in thoracic aortic aneurysm repair surgery during propofol anesthesia. These findings suggested that all anesthesiologists should control the infusion rate carefully, taking the abrupt changes in its pharmacokinetics into consideration, especially during cross clamping of the descending thoracic aorta.

scholarly journals A post mortem assessment of a 25-year-old man with ascending aortic dissection and a novel MYLK variant

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Katelyn Hodge ◽  
Katherine G. Spoonamore ◽  
Christopher B. Griffith ◽  
David D. Weaver ◽  
Patricia B.S. Celestino-Soper ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Rupture ◽  
Clinical Consequence ◽  
Post Mortem ◽  
Variant Of Uncertain Significance ◽  
Pathogenic Variants ◽  
Aortic Aneurysm And Dissection

We report on the process of <em>post mortem</em> evaluation and genetic testing following the death of a 25-year-old man due to ascending aortic dissection leading to aortic rupture. Following the negative clinical testing of a 12- gene thoracic aortic aneurysm and dissection panel, research testing revealed a novel c.5732A&gt;T (p.E1911V) variant in exon 34 of the MYLK gene (NM_053025). Two likely pathogenic variants in this gene have been reported previously in individuals with familial thoracic aortic aneurysm and dissection. Given the unclear clinical consequence of the variant found in our proband, we have classified this change as a variant of uncertain significance. In addition to discussing the complexity involved in variant interpretation, we recognize the need for additional research for more accurate <em>MYLK</em> interpretation. Finally, we comment on the unique challenges of <em>post mortem</em> genetic testing.

Vascular Disease

2016 ◽  
pp. 129-142
Author(s):  
Robert D. McBane
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Vascular Disease ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Ascending Aorta ◽  
Tobacco Exposure ◽  
Degree Relative ◽  
Men And Women ◽  
Medial Degeneration

Aneurysms of the ascending aorta are typically due to medial degeneration, whereas aneurysms of the descending thoracic aorta are primarily due to atherosclerosis. Men and women are equally affected, and the prevalence of thoracic aortic aneurysm (TAA) increases with advancing age. Overall, the incidence is approximately 1 per 10,000 individuals, and 20% of patients with TAA have at least 1 affected first-degree relative. Typical risk factors include tobacco exposure, hypertension, infection, and trauma.

scholarly journals Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

2013 ◽  
Vol 6 ◽  
pp. OJCS.S11446 ◽  
Author(s):  
Shigeki Masuda ◽  
Nobuhiro Takeuchi ◽  
Masanori Takada ◽  
Koichi Fujita ◽  
Yoshiharu Nishibori ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Rupture ◽  
Prosthetic Graft ◽  
Sigmoid Colon Cancer ◽  
Causative Organism ◽  
Protein Levels ◽  
Reactive Protein ◽  
History Of

A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes.

SUCCESFULL SURGICAL REPAIR OF AN ACCUTE TYPE A DISSECTING AORTIC ANEURYSM ASSOCIATED WITH A RIGHT-SIDED-AORTIC ARCH AND RIGHT SIDED DESCENDING THORACIC AORTA

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 416S ◽  
Author(s):  
Konstantinos E. Paziouros ◽  
Stavros Siminelakis ◽  
Sokrates Sismanidis ◽  
Leonidas Disnitsas ◽  
Miltiadis Matsagas ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Surgical Repair ◽  
Type A ◽  
Descending Thoracic Aorta ◽  
Dissecting Aortic Aneurysm

Open and endovascular treatment options in thoracic aortic surgery

2018 ◽  
pp. 111-134
Author(s):  
Ourania Preventza ◽  
Joseph S. Coselli
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Surgery ◽  
Treatment Options ◽  
Median Sternotomy ◽  
Aortic Disease ◽  
Transverse Arch ◽  
Abdominal Aortic ◽  
Thoracoabdominal Approach

Open endovascular and hybrid repairs have recently emerged as a method for treating the different segments of the thoracic aorta. A full or upper-mini median sternotomy is the usual approach for proximal aortic disease and proximal and transverse arch repairs. Other approaches, such as minimally invasive right thoracotomy, have also emerged. Until recently, a left thoracotomy and thoracoabdominal approach has been the sole approach for treating lesions of the descending and thoracoabdominal thoracic aorta. In the 1980s, the first aortic repair with a self-fixing endoprosthesis was performed. In subsequent years, the technique of using a stent graft to treat an abdominal aortic aneurysm, and subsequently thoracic aortic aneurysm, was popularized, followed by extensive development of this technology. The different techniques and modalities for treatment are discussed in this chapter.

Late manifestation of a pseudoaneurysm in the descending thoracic aorta

VASA ◽  
2006 ◽  
Vol 35 (2) ◽  
pp. 112-114 ◽  
Author(s):  
Gurkan ◽  
Sunar ◽  
Canbaz ◽  
Duran
Keyword(s):  
Surgical Treatment ◽  
Thoracic Aorta ◽  
Aortic Rupture ◽  
Descending Thoracic Aorta ◽  
Catastrophic Event ◽  
Descending Aorta ◽  
Car Accident ◽  
Injured Patients ◽  
Deceleration Trauma ◽  
Late Manifestation

Rupture of the descending aorta following deceleration trauma is a catastrophic event because it has a high mortality. Prompt surgical treatment is generally considered to be mandatory. However, a few injured patients may leave the hospital with an undiagnosed aortic rupture which may give rise to a chronic pseudoaneurysm. In this report, a 28-year-old man is presented in whom a pseudoaneurysm of the descending thoracic aortic was diagnosed six months after a car accident.

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