1/55. Tubular stenosis of the aorta with aortic fibromuscular dysplasia.The autopsy findings in a 2-year-old girl with severe hypertension resulting from stenosis of the lower part of the thoracic and the abdominal aorta were reviewed. The lower portion of the thoracic aorta and the abdominal aorta showed uniform narrowing down to the level of the bifurcation of iliac arteries. Histologically, the aortic wall of the stenotic site showed irregular proliferation of smooth muscle cells and collagen fibers. The elastic fibers had disappeared from outside the media. No intimal thickening and inflammatory cell infiltration were observed. These histologic changes of the aortic media in this case are apparently similar to fibromuscular dysplasia (medial hyperplasia).- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/55. Intramural hematoma of the thoracic aorta in octogenarians: is non operation justified?OBJECTIVE: The prognostic factors and treatment options for thoracic aortic intramural hematoma are controversial. The purpose of this study was to determine the most suitable treatment of this condition in very elderly patients. methods: In a review of the world literature, eight octogenarians with thoracic aortic intramural hematoma were found; to these the three cases reported here must be added. The descending thoracic aorta was involved in eight cases and the ascending/arch in three. RESULTS: In spite of patients' poor general conditions, the medical treatment group showed survival rates of 85.7% (descending) and 66.6% (ascending/arch), respectively. CONCLUSION: Extensive atherosclerotic changes of the aortic wall in the elderly, combined with control of hypertension, may probably prevent thoracic aortic intramural hematoma from progressing to dissection, with a favourable outcome. An earlier and more accurate preoperative diagnosis by modern diagnostic techniques, including spiral computed tomography (CT), as were performed in our own patients, will allow optimal treatment and increased patient survival.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
3/55. Acute heart failure due to local dehiscence of aortic wall at aortic valvular commissure.Spontaneous dehiscence of the aortic wall at the aortic commissure is not recognized as one of the usual pathological causes of aortic regurgitation. We describe the case of a 56-year-old man with hypertension, who experienced acutely progressive congestive heart failure due to massive aortic regurgitation. Local layer dehiscence around the commissure was noted with partial detachment of the commissure resulting in the loss of commissural support with secondary rupture of a non-coronary cusp, which led to massive aortic regurgitation.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
4/55. Aortic septal defect and coronary-systemic micro-fistulae.This report concerns a 32-year-old man, who at the age of 11, had an aortic septal defect with severe pulmonary hypertension. The defect was partially closed and the patient was left with a continuous murmur, an a-v shunt and marked diminution of pulmonary hypertension. Five years later he was asymptomatic, auscultation was normal and no shunt was found at cardiac catheterization. At 32 years of age, although asymptomatic he had abnormal "T" waves, and a selective coronary angiography demonstrated micro-fistulae involving the anterior descending coronary artery. It is suggested that these fistulae may be responsible for the abnormality of ventricular repolarization.- - - - - - - - - - ranking = 2keywords = hypertension (Clic here for more details about this article) |
5/55. Unsuspected embolic fungal endocarditis of an aortic conduit diagnosed by transesophageal echocardiography.A 66-year-old man with a history of hypertension and ascending aortic replacement because of a type A dissection had 3 successive embolic events (left lower limb, brain, and spleen). Two consecutive transesophageal echocardiography studies showed mobile masses in the ascending aorta. The patient was reoperated without a certain etiologic diagnosis, and an unsuspected fungal endocarditis caused by an unusual germ (trichoderma species) was found. Transesophageal echocardiography proved very useful in the management of this uncommon case of endocarditis.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
6/55. A case of penetrating aortic atherosclerotic ulcer with hemoptysis.A 69-year old Japanese woman with hypertension was admitted because of continuous back pain and recurrent hemoptysis. Radiographic findings showed an enhanced irregular mass, at the aortic arch fed by the tracheal artery, which implied both a penetrating aortic atherosclerotic ulcer and lung cancer. Diagnostic surgery revealed no evidence of cancer but did reveal a rupture of the intima at the distal part of the aortic arch. It is assumed that the transmural oozing occurred after development of the penetrating aortic ulcer, which formed an extra-aortic hematoma and caused surrounding inflammation, and led to tracheal artery feeding. The intramural hematoma might have weakened vascular wall tension from the aorta, and formed an oozing extra-aortic hematoma instead of an acute rupture.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
7/55. Anaesthetic management of a caesarean section in a patient with Marfan's syndrome and aortic dissection.This report describes a case of a Stanford Type B aortic dissection (originating distal to the left subclavian artery and extending to the aortic bifurcation and proximal left iliac artery) in a 31-year-old primigravid woman who was at 39 weeks gestation and had Marfan's syndrome. The dissection was managed conservatively. Caesarean section was performed under epidural anaesthesia with aggressive control of hypertension. Postoperatively, there was no extension of the dissection and no aneurysm formation. She was discharged from hospital two weeks after delivery and remained asymptomatic at six months. There are no plans for surgical intervention.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
8/55. Unusual case of refractory hypertension: late presentation of the mid-aortic syndrome.A 58 year old patient with refractory hypertension, chronic renal failure, and widespread arterial bruits is described. Investigations found hypoplasia of the major blood vessels, particularly the aorta, leading to low flow nephropathy.- - - - - - - - - - ranking = 5keywords = hypertension (Clic here for more details about this article) |
9/55. Middle aortic syndrome diagnosed at 54 years of age--a case report.A 54-year-old woman was admitted to our hospital because of heart failure, upper-limb hypertension, and lower-limb claudication. A loud systolic bruit was audible along the middle lower back. An arteriogram confirmed long-segment stenosis from the lower thoracic to the upper abdominal aorta with normal aortic arch. The patient was diagnosed as having middle aortic syndrome. This case was atypical because most cases of this disease are seen in children and young adults. After administration of diuretics and ACE-I, the heart failure and hypertension were both improved. However, the lower limb claudication was aggravated because of decreased blood pressure of the lower limb. In this patient, percutaneous angioplasty or surgical treatment will be required to prevent the recurrence of heart failure and to improve long-term quality of life by relief from intermittent claudication.- - - - - - - - - - ranking = 2keywords = hypertension (Clic here for more details about this article) |
10/55. Midaortic syndrome associated with fetal alcohol syndrome.Midaortic syndrome (MAS) is an uncommon condition characterized by progressive narrowing of the abdominal aorta and its branches and impressive formation of collateral circulation. It affects children and young adults and presents predominantly as untreatable hypertension. Fetal alcohol syndrome (FAS) refers to a constellation of physical, behavioral, and cognitive abnormalities secondary to alcohol exposure in utero. The authors present an unusual association between a hypoplastic abdominal aorta and fetal alcohol syndrome. The patient discussed in this article presented with severe hypertension that was successfully treated with renal angioplasty.- - - - - - - - - - ranking = 2keywords = hypertension (Clic here for more details about this article) |
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