1/13. Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/13. Ductal aneurysm of adult patients.A ductal aneurysm is very rarely diagnosed in adults. We experienced 2 cases of adult ductal aneurysm. Both cases developed hoarseness and computed tomographic scanning demonstrated a typical 'triple star sign' at the aortopulmonary window level. They underwent surgical repair with successful results. During the same period, we experienced 38 operations for true thoracic aneurysm. The ductus origin was found in 5.2% of these patients. The ductal aneurysm may no longer be considered a 'rare' vascular disease with more careful diagnostic procedure.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/13. Continuous milrinone infusion during preoperative anti-inflammatory therapy in inflammatory aortic aneurysm complicating severe congestive heart failure.We report a 48-year-old man with inflammatory aortic aneurysm in the ascending aorta complicating severe heart failure due to massive aortic regurgitation. Continuous intravenous milrinone infusion was highly effective in reducing pulmonary arterial pressure and improving subjective symptoms during preoperative anti-inflammatory corticosteroid therapy over 7 weeks without any adverse effects or tolerance. Bentall's operation with a valved conduit was successfully performed after complete stabilization of inflammatory markers, and then milrinone was tapered off uneventfully. We consider that continuous milrinone infusion may be suitable for patients with surgically correctable inflammatory cardiovascular diseases complicating severe heart failure in whom maintenance of optimal hemodynamics is necessary for several weeks during preoperative anti-inflammatory corticosteroid therapy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/13. Endovascular repair of descending thoracic aortic aneurysm via midsternotomy and without extracorporeal circulation.A 68-year-old man with peripheral vascular disease and associated risk factors, was diagnosed by CT-scan and aortography with an atherosclerotic descending thoracic aortic aneurysm. The patient was treated by successful endovascular grafting of the aneurysm using a midsternotomy incision and the insertion of a thoracic stent-graft through a T-Dacron tube sutured in the ascending aorta, without the aid of cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/13. Combined endovascular treatment of a descending thoracic aortic aneurysm and off-pump myocardial revascularization-a case report.Endovascular intervention is an alternative form of treatment for patients with thoracic aortic aneurysms. Coexistent cardiovascular diseases may adversely influence the postoperative course and affect the long-term prognosis. The case of a 76-year-old man with severe coronary artery disease and a thoracic aortic aneurysm is reported. A single-stage procedure of off-pump coronary artery revascularization and endoluminal exclusion of the descending thoracic aortic aneurysm was performed. The patient was treated first with off-pump coronary artery bypass graft (left internal mammary artery on the left anterior descending coronary artery and two single venous grafts from ascending aorta to obtuse marginal artery and posterior descending artery). After heart revascularization, two Thoracic Excluder endovascular grafts (34 x 100 and 37 x 100 mm) were implanted to treat the descending thoracic aortic aneurysm. Follow-up with computed tomography angiography showed successful exclusion of the thoracic aneurysm 12 months after the procedure. The patient is well and free of symptoms 18 months later.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/13. Thoracic endovascular stent graft placement: a case report.Endovascular stent grafting (EVSG) is a minimally invasive alternative to open repair of thoracic aortic aneurysms. It is useful in the treatment of thoracic aneurysms, dissections, and ruptures. Currently, the incidence of thoracic aortic aneurysms is 6:100,000 people. Comorbidities often include hypertension, coronary artery disease, chronic obstructive pulmonary disease, peripheral vascular disease, and cerebrovascular disease, and there often is a history of smoking. Without surgical intervention, a high risk of mortality exists, primarily due to aneurysm rupture. Due to the complexity of performing open surgical repair of the thoracic aorta and its associated morbidities such as paraplegia, renal failure, stroke, and prolonged ventilator support, new approaches to thoracic aneurysm repair are being investigated. When compared with open repair, stent grafting is a palliative rather than a curative treatment, and the risk of aneurysmal rupture still exists. This article describes a patient who underwent EVSG who had a history of abdominal aortic aneurysm repair and a known bovine arch.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
7/13. Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome.Cardiovocal syndrome (Ortner's syndrome) is characterized by left recurrent laryngeal nerve palsy due to cardiovascular disease, but in rare cases it can also be caused by aortic dissection. An 81-year-old man with hypertension was admitted to the hospital with aspiration pneumonia. He had been developing progressive dysphagia and hoarseness for several months before admission. A videofluoroscopic swallowing study showed supraglottic penetration with barium paste and liquid. laryngoscopy and electromyography revealed left vocal cord palsy caused by left recurrent laryngeal neuropathy, and a contrast-enhanced chest CT revealed dissection of the aortic arch.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/13. Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient.A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
9/13. Stent angioplasty for renovascular disease associated with acute aortic dissection.Aortic replacement was performed in a patient with acute type A aortic dissection originating from the descending thoracic aorta. Postoperatively, a persistent false lumen resulted in severe stenosis of the right renal artery. Percutaneous stent angioplasty improved renovascular hypertension and renal function. This procedure is useful for management of patients with branch complications of aortic dissection.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
10/13. Chest wall infarction following bilateral internal mammary to coronary arterial bypass in a patient with a thoracoabdominal aneurysm.A 69-year-old man with severe peripheral vascular disease and a known thoracoabdominal aortic aneurysm underwent bilateral internal mammary artery (BIMA) to coronary artery bypass grafting and aortic hemiarch replacement. He immediately thereafter developed massive chest wall ischemia and infarction with a severe metabolic acidosis, and subsequently died. Chest wall infarction following BIMA harvesting has not been previously described. Cautious use of internal mammary arterial grafting may be in order in the severe vasculopath with significant thrombo-occlusive thoracoabdominal aortic disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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