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  • NLM标题： Aorta (Stamford)
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共284条结果
  • 1.

    【2hr】Crater-Like Ulceration of Aortic Arch

    包量

    机译 火山口般的主动脉弓溃疡
    摘要：We report the case of a 78-year-old female who presented to our hospital with signs of hemorrhagic shock and breathlessness. A transthoracic echocardiography demonstrated pericardial effusion. Computed tomography of the chest showed a penetrating atherosclerotic ulcer of the aortic arch with an intramural hematoma of the ascending and descending aorta. Endovascular repair with stent-grafting was urgently performed and a pericardial window placement was done to reduce mediastinal bleeding.
  • 2.

    【2hr】Post-Traumatic Aortic Arch Aneurysm Complicated by Aorto-Pulmonary Fistula

    包量

    机译 创伤后主动脉弓动脉瘤并发主动脉-肺瘘
    摘要：We report a rare case of presumed post-traumatic aortic arch aneurysm complicated by an aorto-pulmonary artery fistula. Contrast-enhanced computed tomographic pulmonary angiography completed by dynamic cardiac magnetic resonance imaging allowed adequate preoperative visualization of an 8-mm large fistula between the aneurysm and the left pulmonary artery. The patient underwent successful total aortic arch replacement and closure of the fistula using a patch.
  • 3.

    【2hr】A Bentall Is Not a Bentall Is Not a Bentall: The Evolution of Aortic Root Surgery

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    机译 Bentall不是Bentall不是Bentall：主动脉根部手术的演变
    摘要：Background: Aortic root pathology had been a known entity with a progressive and catastrophic course, long before the methods to surgically address them were first developed. Once reliable cardiopulmonary bypass was established, surgeons were able to pioneer new operative techniques, and in the half-century to follow, countless modifications and refinements have provided today's surgeons with the surgical approaches that are currently at their disposal. History: Denton Cooley and Michael De Bakey reported the first successful surgical intervention for aneurysms involving the ascending aorta in 1956. Nearly a decade later, Hugh Bentall described his modification, and provided a name that would leave a lasting mark on aneurysmal surgery. In the decades to follow, numerous innovative surgeons improved on these original procedures to allow for a more reliable and consistent operation. Further, Tirone David and Sir Magdi Yacoub each described their methods to repair the aortic root while preserving the valve, thus providing their patients with freedom from a prosthetic or mechanical valve and improved quality of life. Conclusions: The development of surgical techniques required to successfully care for patients with pathology of the aortic root has evolved considerably since Cooley and De Bakey's original report. Although it is common to hear aortic root replacement referred to as a “Bentall,” the methods currently employed have gone through considerable evolution, such that the techniques of today should not be referred to as a Bentall.
  • 4.

    【2hr】Differences in Elastin and Elastolytic Enzymes between Men and Women with Abdominal Aortic Aneurysm

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    机译 男女腹主动脉瘤中弹性蛋白和弹性蛋白酶的差异
    摘要：Background: Abdominal aortic aneurysms (AAAs) in women differ in some important aspects from those in men. The lower prevalence rate, higher rupture rate and potentially increased growth rate in women with AAA suggest gender to be of importance for aneurysm development and progression. The aim of the study was to analyze wall properties with respect to synthesis and destruction of elastin in men and women with AAA, with and without an intraluminal thrombus. Methods: Patient characteristics and aneurysm wall biopsies were collected from all women (n = 14) treated with open repair for AAA, 2008-2012, and men with similar aneurysm diameter and similar age (n = 23) treated during the same time period. The expressions of elastin, matrix metalloproteinase (MMP)-2 and -9, and cathepsin K were quantified by immunohistochemistry, Western blot, and gene expression analysis on the aneurysm wall. Results: The protein expression of elastin was less in women than in men in the non-thrombus-covered aneurysm wall. In addition, the protein and mRNA expressions of MMP-9 were higher in women (−0.83 versus 0.09, P = 0.041). There was no difference in elastin and elastolytic enzymes between men and women in the thrombus-covered aneurysm wall. Conclusion: Less elastin in the non-thrombus-covered aneurysm wall in women than that in men, and the simultaneous higher level of MMP-9, suggest differences in the elastolytic process in AAA between the sexes.
  • 5.

    【2hr】Heterogeneity in the Segmental Development of the Aortic Tree: Impact on Management of Genetically Triggered Aortic Aneurysms

    包量

    机译 主动脉树节段发育中的异质性：对基因触发的主动脉瘤的管理的影响。
    摘要：An extensive search of the medical literature examining the development of the thoracic aortic tree reveals that the thoracic aorta does not develop as one unit or in one stage: the oldest part of the thoracic aorta is the descending aorta with the aortic arch being the second oldest, developing under influence from the neural crest cell. Following in chronological order are the proximal ascending aorta and aortic root, which develop from a conotruncal origin. Different areas of the thoracic aorta develop under the influence of different gene sets. These parts develop from different cell lineages: the aortic root (the conotruncus), developing from the mesoderm; the ascending aorta and aortic arch, developing from the neural crest cells; and the descending aorta from the mesoderm. Findings illustrate that the thoracic aorta is not a single entity, in developmental terms. It develops from three or four distinct areas, at different stages of embryonic life, and under different sets of genes and signaling pathways. Genetically triggered thoracic aortic aneurysms are not a monolithic group but rather share a multi-genetic origin. Identification of therapeutic targets should be based on the predilection of certain genes to cause aneurysmal disease in specific aortic segments.
  • 6.

    【2hr】Aspergillus Pseudoaneurysm Post Aortic Valve Replacement

    包量

    机译 曲霉菌假性动脉瘤主动脉瓣置换术后
    摘要：Thoracic aortic mycotic aneurysms caused by Aspergillus fumigatus postoperatively are rare and devastating complications. These cases are usually attributed to intraoperative contamination of surgical equipment. We present a patient who had an ascending aortic mycotic aneurysm 20 weeks post aortic valve replacement. A high index of suspicion allowed for diagnosis and prompt treatment, although the patient presented in an unusual manner. Treatment included both medical and surgical therapy to minimize morbidity and mortality. Despite treatment our patient suffered long-lasting consequences due to the aggressive nature of the disease. Cases presented in the literature and this experience show that a high index of suspicion must be maintained in such patients regardless of immune status and postoperative interval, in order to avoid long-lasting sequelae.
  • 7.

    【2hr】An Aortic Pseudoaneurysm following Bentall Procedure

    包量

    机译 Bentall手术后主动脉假性动脉瘤
    摘要：We describe a rare case of an ascending aortic pseudoaneurysm detected incidentally at coronary angiography in a 64-year-old man with a history of a Bentall procedure 8 years previously. The patient underwent reoperation, with longitudinal opening and cleaning of the aortic pseudoaneurysm and graft repair of the defect. This report highlights the insidious late onset of pseudoaneurysm and the importance of its detection and treatment.
  • 8.

    【2hr】Aortic Root Replacement for Pseudoaneurysm Arising from Freestyle Aortic Bioprosthesis

    包量

    机译 自由式主动脉生物假体引起的假性动脉瘤的主动脉根部置换术
    摘要：A 70-year-old female presented with a new systolic murmur and shortness of breath three years after undergoing aortic root replacement using a 27-mm Medtronic Freestyle® stentless full root bioprosthesis (Medtronic, Inc., Fridley, Minnesota, USA). A large complex aortic root pseudoaneurysm was identified on contrasted computed tomography of the chest and transesophageal echocardiogram. We describe the redo aortic root replacement using a customized Dacron tube/valve composite graft with a proximal “skirt” and a modified Cabrol technique.
  • 9.

    【2hr】Second Redo for Composite Graft Pseudoaneurysm with Transcutaneous Rupture

    包量

    机译 经皮破裂的复合移植物假性动脉瘤的第二次重做
    摘要：Six months after a composite graft redo operation repairing two pseudoaneurysms at the distal suture line and the right coronary artery, respectively, a patient returned asymptomatic and in good general condition but with new presternal bulges. Computed tomography and angiography diagnosed a new pseudoaneurysm of the left coronary artery, and on frank rupture, acute re-repair was undertaken with the aid of presternotomy hypothermic circulatory arrest. Temporary postoperative neurological dysfunction subsided and recovery was otherwise uneventful.
  • 10.

    【2hr】The History of Deep Hypothermic Circulatory Arrest in Thoracic Aortic Surgery

    包量

    机译 胸主动脉手术中深部低温循环性停搏的历史
    摘要：Depending on the extent of aortic disease and surgical repair required, thoracic aortic surgery often involves periods of reduced cerebral perfusion. Historically, this resulted in detrimental neurological dysfunction, and high risk of mortality and morbidity. Over the last half century, rapid improvements have revolutionized aortic surgery. Among these, deep hypothermic circulatory arrest (DHCA) has drastically reduced the risk of mortality and morbidity following surgery on the thoracic aorta. This progress was facilitated by experimental pioneers such as Bigelow, who studied reduced oxygen expenditure consequent on induction of hypothermia in dogs. These encouraging findings led to trials in human cardiac surgery by Lewis in 1952 and further made possible the first successful aortic arch replacement by Denton Cooley and Michael De Bakey. Modern day surgery has come a long way from the use of immersion of the patient in ice baths and other primitive techniques previously described. This paper explores the development of deep hypothermic circulatory arrest from its origins to the present.
  • 11.

    【2hr】Hepatopancreaticobiliary Values after Thoracoabdominal Aneurysm Repair

    包量

    机译 胸腹主动脉瘤修复后的肝胰胆管值
    摘要：Background: After thoracoabdominal aortic aneurysm (TAAA) repair, blood tests assessing hepatopancreaticobiliary (HPB) organs commonly have abnormal results. The clinical significance of such abnormalities is difficult to determine because the expected postoperative levels have not been characterized. Therefore, we sought to establish expected trends in HPB laboratory values after TAAA repair. Methods: This 5-year study comprised 155 patients undergoing elective Crawford extent II TAAA repair. In accordance with a prospective study protocol, all repairs involved left-sided heart bypass, selective visceral perfusion, and cold renal perfusion. Blood levels of aspartate transaminase (AST), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total bilirubin, amylase, and lipase were measured before TAAA repair and for 7 days afterward. Ratios between postoperative and baseline levels were compared for each time point with 95% confidence intervals. Results: Temporal patterns for the laboratory values varied greatly. Amylase, lipase, and AST underwent significant early increases before decreasing to preoperative levels. LDH increased immediately and remained significantly elevated, whereas ALT increased more gradually. GGT remained near baseline through postoperative day 4, and then increased to more than twice baseline. Total bilirubin never differed significantly from baseline. After adjusted analysis, the ischemic time predicted the maximum AST, lipase, GGT, and LDH values. Conclusions: Although most HPB laboratory values increase significantly after elective TAAA repair, the temporal trends for different values vary substantially. The ischemic time predicts the maximum AST, lipase, GGT, and LDH levels. These trends should be considered when laboratory values are assessed after TAAA repair.
  • 12.

    【2hr】Acute Type A Dissection Repair in an Achondroplastic Dwarf: Anesthetic, Perfusion, and Surgical Concerns

    包量

    机译 急性弹塑性矮化中的A型夹层修复：麻醉，灌注和手术问题
    摘要：In this report we present a 43-year-old male with achondroplastic dwarfism who presented with acute Type A aortic dissection with aortic insufficiency. The patient underwent successful Bentall and hemiarch repair. Anesthetic, perfusion-related, and surgical planning and execution are presented.
  • 13.

    【2hr】Development of Mega-Aorta Following Incompletely Treated Giant Cell Arteritis

    包量

    机译 未完全治疗的巨细胞动脉炎后大主动脉的发展
    摘要：An 82-year-old male presented with a 9.3 cm ascending aorta and arch aneurysm with additional aneurysms of the innominate, right subclavian, and left common carotid arteries. The patient had a history of temporal arteritis that was only briefly treated in 1989 and a 6 cm ascending aortic aneurysm that was repaired in 1993. Our operative strategy was to construct a temporary parallel cerebrovascular circuit for cerebral protection during the redo-sternotomy and aortic arch reconstruction, with the added benefit of permanently excluding the branch arch vessel aneurysms. Pathological analysis of the aortic specimen at the first operation may have identified giant cell arteritis, prompting medical therapy against further disease progression.
  • 14.

    【2hr】Establishment of Extracorporeal Circulation under Local Anesthesia in a Patient with an Acute Type A Aortic Dissection Complicated by Cardiac Tamponade

    包量

    机译 急性麻醉A型主动脉夹层并发心脏填塞的患者在局部麻醉下体外循环的建立
    摘要：We report the case of an 82-year-old female who presented in a hemodynamically unstable condition to the emergency department of our institution. Transthoracic echo showed a hemodynamically relevant pericardial effusion and the suspicion of an intimal flap in the ascending aorta. The subsequent computed tomography scan revealed a Type A dissection that was limited to the ascending aorta. To prevent hemodynamic deterioration the patient was prepped and draped awake and underwent femoral cannulation for extracorporeal circulation under local anesthesia. After commencing extracorporeal circulation the patient was anesthetized and intubated. During this whole time period no relevant drop in mean arterial pressure was observed. The patient underwent routine replacement of the ascending aorta and was extubated the day after surgery without any neurologic sequelae. Awake cannulation and inception of extracorporeal circulation can prevent the hemodynamic deterioration and cardiac arrest often seen during induction of anesthesia in patients with cardiac tamponade.
  • 15.

    【2hr】Hybrid Approach to Repair Type A Aortic Dissection: Combined Endovascular Superior Mesenteric Artery Stenting and Bentall Procedure

    包量

    机译 混合方法修复A型主动脉夹层：血管内肠系膜上动脉支架联合Bentall手术
    摘要：A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion.
  • 16.

    【2hr】A Novel Tool to Facilitate Crimping Suture Placement for a Modified David V/Miller Aortic Root Replacement

    包量

    机译 一种新颖的工具，以简化变形的David V /米勒主动脉根置换术的压接缝线放置
    摘要：Surgical treatment of aortic root and ascending aorta aneurysms with aortic insufficiency is still controversial. A valve-sparing operation is the procedure of choice for such patients, and the reimplantation technique is preferable. We describe a simple technique for aortic root reconstruction that has been successfully performed for patients with aneurysms of aortic root and ascending aorta with aortic insufficiency.
  • 17.

    【2hr】Acute Conditions Caused by Infectious Aortitis

    包量

    机译 传染性主动脉炎引起的急性病
    摘要：Infection of the aorta is rare but potentially very dangerous. Under normal circumstances the aorta is very resistant to infections. Following some afflictions, the infection can pass to the aorta from blood or the surrounding tissues. The authors present their 5-year experience with therapy of various types of infections of the abdominal aorta. Methods: In the 5-year period between January 2008 and December 2012, the Surgical Clinic of the University Hospital in Pilsen treated 17 patients with acute infection of the abdominal aorta. They included 9 males and 8 females. The mean age was 73.05 years (58-90). The most common pathogens were Salmonella (7), Staphylococcus aureus (2), Klebsiella pneumoniae (1), Listeria monocytogenes (1), and Candida albicans (1). Two cases included mixed bacteria and no infectious agent was cultured in three cases. In 14 cases (82.6%) we decided on an open surgical solution, i.e., resection of the affected abdominal aorta, extensive debridement, and vascular reconstruction. In all of these 14 cases we decided on in situ reconstruction. Twelve cases were treated using silver-impregnated prostheses. An antibiotic impregnated graft was used in one case and fresh aortic allograft in one case. In one case (5.9%) we decided on an endovascular solution, i.e., insertion of a bifurcation stent graft and prolonged antibiotic therapy. In two cases (11.8%) we decided on conservative treatment, as both patients refused any surgical therapy. Results: Morbidity was 47.2% (8 patients). In one case we had to perform reoperation of a patient on the 15th postoperative day to evacuate the postoperative hematoma. The 30-day mortality was 5.9% (1 patient). The hospital mortality was 11.8% (2 patients). One patient died on the 42nd postoperative day due to multiorgan failure following resection of perforated aortitis. During follow-up (average 3.5 years), we had no case of infection or thrombosis of the vascular prosthesis. Conclusion: Patients with mycotic aneurysms or acute aortitides face a high risk of death. One can legitimately expect an increase of “aortic infections” to parallel the increase of immunocompromised individuals. Surgical procedures for infectious aortitis are always demanding and require excellent interdisciplinary cooperation, but, as this experience shows, can lead to midterm survival.
  • 18.

    【2hr】Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery

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    机译 利物浦主动脉外科手术研讨会V：主动脉疾病和外科手术的新领域
    摘要：Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium.
  • 19.

    【2hr】A Pregnant Patient with Native Aortic Coarctation and Aneurysm

    包量

    机译 一名患有主动脉缩窄和动脉瘤的孕妇
    摘要：Uncorrected coarctation is rare and is known to cause hypertension in adult patients. Retrospective observational studies showed hypertension and occasionally aortic dissection to be the principal risks during pregnancy after correction of aortic coarctation. We present a case of a patient with known hypertension, who presented at 32 weeks of gestation. A saccular aortic aneurysm of 4.5 × 8.8 cm was found by echocardiogram and confirmed with a chest X-ray. She delivered a healthy girl by caesarean section. After delivery a CT-angiography was performed showing a stable situation. Two months postpartum she was successfully operated. We present images of echocardiography, X-ray, CT and the surgical procedure. We discus the literature on native coarctation and the management choices in this difficult case.
  • 20.

    【2hr】Type A Aortic Dissection in Pregnancy: Two Operations Yielding Five Healthy Patients

    包量

    机译 妊娠中的A型主动脉夹层：两次手术使五名健康患者受益
    摘要：Type A aortic dissection in pregnancy is a rare, life-threatening condition with a higher incidence in patients with connective tissue diseases. Mortality is high, reflecting the challenges of protecting both maternal and fetal well-being. We discuss two pregnancies complicated by aortic dissection, including one twin pregnancy, and describe the successful aortic repair immediately following Caesarean section. A total of three healthy neonates were delivered. The challenging management and implications of this precarious condition are explored in the context of these cases.
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