Left to Right Extracardial Shunt to Control Hemorrhage of Ascending Aorta and Left Ventricle: A Report of 3 Cases

Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.

Clinical Study of the Ascending Aorta Wall Motion by Velocity Vector Imaging in Patients with Primary Hypertension

We studied the wall motion characteristics of the ascending aorta by velocity vector imaging （VVI） in primary hypertension patients. The ascending aortas both in 30 patients with primary hypertension and 30 normal controls were examined by Acuson sequoia 512 equiped with VVI. The maximum velocity （Vs, Ve） of every point on the anterior wall of ascending aorta both in systole and diastole was measured. The aortic diameter was wider in the hypertension patients than that in the healthy subjects （P〈0.05）. The movement amplitude of the anterior wall of the ascending aorta in long axis view in the hypertension patients was lower than that in the healthy subjects （P〈0.05）. The motion and time to peak in systole of each point of the ascending aorta in the healthy subjects had no significant difference （P〉0.05）. The velocity curves of the anterior wall of ascending aorta both in the hypertension and healthy subjects were regular, and the curve in systole was named S wave and that in diastole named E wave. The velocity of S wave and E wave was slower in the hypertension patients than that in the healthy subjects （P〈0.05）. The time to peak of S wave on the anterior wall of ascending aorta in systole was shorter in the hypertension patients than in the healthy subjects （P〈0.05）. VVI could be used to accurately and directly observe the movement character of the ascending aorta walls, which would help us understand the elasticity of great arteries in patients with hypertension.

Calcific degeneration and rupture of the aortic valve and ascending aorta： from cardiac auscultation to multimodality imaging

A 76-year-old Caucasian woman was admitted to the emergency room and referred for cardiac evaluation for dyspnea and abrupt onset of cough three weeks ago. She had a history of well-controlled arterial hypertension and was on adequate oral anticoagulant therapy for permanent atrial fibrillation. Previous thoracic injuries, connective tis- sue disorders or recent infections were excluded. No chest pain or syncope was reported. mmHg in both arms, heart rate Blood pressure was 150/50 was 90 beats/min.

Association of dissected ascending aorta diameter with preoperative adverse events in patients with acute type A aortic dissection

BACKGROUND Acute type A aortic dissection(ATAAD)is a life-threatening disease associated with high morbidity and mortality.AIM To evaluate the diameter of dissected ascending aorta in patients diagnosed with ATAAD and whether the aortic diameter is associated with preoperative adverse events.METHODS A total of 108 patients diagnosed with ATAAD who underwent emergency operation under hypothermic circulatory arrest were enrolled in this study.Demographic characteristics and perioperative data were recorded.In all patients,preoperative chest and abdomen computed tomography(CT)scans were performed.RESULTS Median age of the patients was 61.5(52.5-70.5)years and median body mass index(BMI)was 28.2(25.1-32.6)cm^(2).The number of female patients was 37(25%).Median diameter of the ascending aorta was 5.0(4.5-6)cm and 53.8%of the patients had an aortic diameter<5.0 cm,while 32.3%of the patients had an aortic diameter of 4.5cm and 72.0%had an ascending aorta diameter<5.5 cm.The diameter of the ascending aorta did not differ in patients with vs without preoperative adverse events:Preoperative neurological dysfunction(P=0.53)and hemodynamic instability(P=0.43).Median age of patients with preoperative hemodynamic instability was 65(57.5-74)years,while it was 60(51-68)years in patients without(P=0.04)CONCLUSION Although current guidelines suggest replacing the ascending aorta with a diameter>5.5 cm,most of the patients with ATAAD had an aortic diameter of less than 5.5 cm.The diameter of the ascending aorta in patients diagnose with ATAAD is not associated with preoperative adverse events.

Case Report of a Pseudoaneurysm of Ascending Aorta Treated by Stent

Pseudoaneurysms of the ascending aorta are a rare complication of aortic and cardiac surgery. In this article, we present a clinical case of a 56-year-old patient with a fortuitous diagnosis of a pseudoaneurysm of ascending aorta that was treated by an endovascular stent-graft. We discuss in this article the diagnostic and therapeutic aspect of the case and the place of endovascular treatment for the ascending aorta.

Traumatic Break of the Ascending Aorta: About a Case

The traumatic break of the ascending aorta is rare. We bring report the case of a 40-year-old man, a victim of accident of the public highway having caused a break of the posterior face of the ascending aorta. The explorations scanno graphique and per operating highlighted this break. The treatment consisted of an edge-to-edge direct suture of the ascending aorta.

Adventitial Rupture of the Ascending Thoracic Aorta Extended to the Buttock by Thoracic Crushing between Two Tanks at the Thoracic and Cardiovascular Surgery Department at the Besançon CHRU

Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.

Aortic Root and Ascending Aortic Aneurysm Related to One Case. Reimplantation of the Right Coronary Artery by 8 mm Dacron Tube (Cabrol Hemi Mustache) and Review of the Literature

The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron® tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

A canine model of aortic arch aneurysm created with autologous pericardium

Background:To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.Materials and methods:Fifteen mongrel dogs underwent surgery.The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch.The animals were followed up for 3 months postoperatively.Computed tomography angiography was used to visualize and measure the aneurysm model.Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model.Changes in aneurysm diameter over time were analyzed using analysis of variance.Results:One dog died of hemorrhage during surgery.Fourteen dogs survived the surgical procedure.Two of them died on the first postoperative day because of ruptures at the suturing margin.The diameter of the aneurysm model was twice as large as that of the aortic arch.There was no significant change in the maximum diameter of the aneurysm model during the follow-up period.Conclusions:We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch.The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.

Successful Surgical Treatment of a Giant Mediastinal False Aneurysm 30 Years after Bentall Operation

False aneurysm occurring after replacement of ascending aorta by a vascular prosthesis is a rare, but life-threatening complication. In spite of advances in endovascular techniques, surgery remains the treatment of choice in the majority of cases. We report the case of a huge pseudoaneurysm caused by late dehiscence of the right coronary ostium-aortic tubular graft anastomosis, occurred 30 years after replacement of aortic valve and ascending aorta by classical Bentall operation. A fistula originating from the aneurysmal sac extended across the sternum into the thoracic subcutaneous soft tissues and gave rise to a pulsatile mass well appreciable on the anterior chest wall. The surgical treatment, consisting of partial resection of the aortic tubular graft and sternal reconstruction was effective and uneventful.

Very large aortic pseudoaneurysm repair using a septal occluder

A 63-year-old man,with previous coronary artery bypass surgery presented with infectious aortitis and a large ascending aorta pseudoaneurysm,causing compression of the left internal mammary graft.Percutaneous intervention with stenting of the graft followed by closure of the pseudoaneurysm using an atrial septal defect occluder was successfully carried out.