1/190. Rupture of aortic aneurysm with right-sided haemothorax.A 62-yr-old male with a history of high blood pressure was admitted for persistent dyspnoea and a right-sided pleural effusion, complicated by a recent episode of shock. There was no history of trauma and the patient denied any thoracic pain. A chest tube was inserted which released nonclotting bloody fluid. A thoracic computed tomographic scan of the chest revealed an aneurysm of the inferior third of the descending thoracic aorta. The patient underwent a successful prosthetic graft replacement. We emphasize that rupture of aortic aneurysms should be considered in the evaluation of spontaneous haemothorax even if it is right-sided and not associated with pain.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
2/190. Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans.A 73-year-old man with a ruptured distal aortic arch aneurysm into the pericardial space, mediastinum and right pleural space is described. The patient underwent a successful total aortic arch replacement using deep hypothermia, systemic circulatory arrest and selective cerebral perfusion. extracorporeal circulation was established with right axillar arterial perfusion due to arteriosclerosis obliterans (ASO). Presentation and management are discussed.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
3/190. Aorto--bronchial fistula resulting from an accidental fall one year earlier.A 75-year-old woman presented with massive haemoptysis 12 months after tripping over her shopping trolley. CT scanning and transoesophageal echocardiography demonstrated a traumatic false aneurysm which was confirmed at surgery to be partially ruptured. Aortobronchial fistula is an unusual cause of massive haemoptysis. It should be considered particularly in patients known to have abnormalities of the thoracic aorta.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
4/190. Chronic aneurysm of the descending thoracic aorta presenting with right pleural effusion and left phrenic paralysis.A 62-year-old man was admitted to the emergency department with chronic dysphagia and lower back pain. Chest radiography revealed a wide mediastinal shadow and an elevated left diaphragm, which proved to be secondary to left phrenic paralysis. The patient was diagnosed with an aneurysm of the descending thoracic aorta and was admitted to the hospital. After the patient was admitted, the aneurysm ruptured into the right chest. The patient underwent an emergency operation to replace the ruptured segment with a synthetic graft. Postoperative recovery and follow-up were uneventful. This report describes an unusual presentation of a thoracic aortic aneurysm. Hemidiaphragmatic paralysis caused by compression of the phrenic nerve is an unusual complication that, to our knowledge, has not been previously reported.- - - - - - - - - - ranking = 2keywords = rupture (Clic here for more details about this article) |
5/190. Acute traumatic dissection and blunt rupture of the thoracic descending aorta: A case report.Rupture of the thoracic aorta following blunt trauma is increasing in incidence and remains a highly lethal injury. Blunt traumatic rupture and acute dissection of the thoracic aorta is very rare. A 50-year-old man involved in a motor vehicle accident on March 3, 1998 was admitted to our hospital one and a half hours following the accident. On admission, he was alert and his hemodynamics were stable. Chest roentgenogram demonstrated a widened mediastinum and multiple left-sided rib fractures. Enhanced chest CT revealed a periaortic hematoma just distal to the isthmus, dissection of the descending thoracic aorta and mediastinal hematoma. With the diagnosis of thoracic aortic rupture and acute DeBakey type IIIB dissection, an emergency operation was performed. Intraoperative transesophageal echocardiogram showed a mobile intimal flap and diminished caliber of the proximal descending aorta. Disruption and dissection of the descending thoracic aorta were found. Prosthetic graft interposition was accomplished with the aid of left atrium-left femoral artery bypass using a centrifugal pump and heparin-coated circuits and a blood collection device for blood conservation. The weak dissected aortic wall was glued and reapproximated with Gelatine-Resorcine-Formol glue. The postoperative course was uneventful.- - - - - - - - - - ranking = 6keywords = rupture (Clic here for more details about this article) |
6/190. Endovascular stent-grafting via the aortic arch for distal arch aneurysm: An alternative of endovascular stent-grafting in a complicated case.A 67-year-old man with severe discomfort was diagnosed with a rupture of the thoraco-abdominal aneurysm, a distal arch aneurysm and triple coronary artery disease. After emergency surgery for a thoracoabdominal aneurysm, a scheduled surgery for coronary artery bypass grafting and endoluminal stent-grafting for the distal arch aneurysm was performed simultaneously. A stent-graft was introduced into the descending aorta via a small incision on the arch aorta. Open endovascular stent-grafting via the arch aorta is an alternative for repairing a distal arch aneurysm with coronary artery bypass grafting.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
7/190. The spectrum of aortic complications after heart transplantation.BACKGROUND: The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment. methods: Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8. RESULTS: Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 71/2 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period. CONCLUSIONS: Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
8/190. Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach.We report an unusual case of type IV Thoracoabdominal Aneurysm (TAA) with Superior Mesenteric Artery (SMA), celiac artery, and bilateral renal artery aneurysms in a patient who underwent an earlier repair of two infrarenal Abdominal aortic aneurysm (AAA) ruptures. Because of the presence of the visceral artery aneurysms and the earlier operation through the retroperitoneum, standard surgical treatment via a retroperitoneal approach with an inclusion grafting technique was considered difficult. A combined surgical approach achieving retrograde perfusion of all four visceral vessels and endovascular grafting allowing exclusion of the TAA was accomplished. Complete exclusion of the aneurysm and normal perfusion of the patient's viscera was documented by means of follow-up examinations at 3 and 6 months. The repair of a type IV TAA with a Combined Endovascular and Surgical Approach (CESA) allowed us to manage both the aortic and visceral aneurysms without thoracotomy or re-do retroperitoneal exposure and minimized visceral ischemia time. If the durability of this approach is confirmed, it may represent an attractive alternative in patients with aneurysmal involvement of the visceral segment of the aorta.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
9/190. A bidirectional closing aortic dissection from an atherosclerotic distal aortic arch aneurysm: report of a case.We experienced one rare case of a 76-year-old male with a Stanford type A bidirectional closing aortic dissection from a coexisting atherosclerotic distal arch aneurysm. He showed a cardiac tamponade, and effective pericardial drainage allowed us to conservatively manage the patient. Both an increase in the size of the aneurysm and a recrudescent dissection in the descending aorta were identified 2 months after the onset. A scheduled surgical repair was successful. The coexistence of an acute aortic dissection and an atherosclerotic aneurysm increases the risk of an aortic rupture, particularly at the confluence of the two lesions. Meanwhile, the management of a closing aortic dissection remains controversial because its characteristics still are not well known. We studied not only the pathogenesis but also the management of these two forms of aortic disease and their complex relationships.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
10/190. Successful surgical treatment of impending rupture of thoracoabdominal aortic aneurysm in an elderly patient with severe pulmonary emphysema.In a case of successful surgery for impending thoracoabdominal aortic aneurysmic rupture, an 83-year-old man with severe pulmonary emphysema was transferred to our hospital diagnosed with impending aneurysmic rupture. The aneurysm had been pointed out 2.5 years ago but surgical repair was not undertaken due to the patient's severe pulmonary emphysema. After admission, computed tomography showed an enlarging saccular thoracoabdominal aortic aneurysm. Emergency surgery was conducted because of severe pain below the left costal margin. We resected the wall of the saccular aortic aneurysm and reconstructed the aorta with an on-lay patch under femoro-femoral bypass and selective visceral organ perfusion. tracheostomy provided respiratory care on the day following surgery. The patient was weaned from respiratory support 6 days after surgery. Postoperative aortography showed that the reconstructed thoracoabdominal aorta functioned satisfactorily. The patient remains in good health 18 months after surgery.- - - - - - - - - - ranking = 6keywords = rupture (Clic here for more details about this article) |
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