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Heart (British Cardiac Society) Dec 2008
Topics: Aortic Aneurysm, Thoracic; Aortic Rupture; Echocardiography; Hematoma; Humans; Prognosis; Stents; Tomography, X-Ray Computed
PubMed: 19011143
DOI: 10.1136/hrt.2007.132811 -
Journal of Vascular Surgery Dec 2022
Topics: Humans; Aortic Rupture; Selection Bias; Patient Transfer; Risk Factors
PubMed: 36410844
DOI: 10.1016/j.jvs.2022.06.095 -
The Annals of Thoracic Surgery Sep 1996Traumatic thoracic aortic rupture is a rare injury in the pediatric patient. Experiences with thoracic aortic rupture in patients less than 17 years of age are needed to...
BACKGROUND
Traumatic thoracic aortic rupture is a rare injury in the pediatric patient. Experiences with thoracic aortic rupture in patients less than 17 years of age are needed to help identify factors that can influence injury occurrence, diagnosis, management, and outcome.
METHODS
Between July 1989 and December 1995, 6 children were treated operatively for thoracic aortic rupture from blunt trauma at a level I pediatric trauma center. The average age was 13.2 years (range, 8 to 16 years). There were 4 females and 2 males. There were 5 motor vehicle accidents and 1 bicycle accident. Aortic injury was suspected based on the mechanism of injury and abnormal chest roentgenogram results, and was confirmed by aortography (3 cases) or chest computed tomography (2) and transesophageal echocardiography (3). Life-threatening central nervous system or gastrointestinal injuries were evaluated or treated first. Operative repair of the thoracic aorta was performed by cardiopulmonary bypass (2 patients) and clamp and sew technique (4).
RESULTS
Aortic ruptures were complete transections at the ligamentum arteriosum in 5 of 6 (83%); the other case was a cervical arch pseudoaneurysm. Associated injuries included pulmonary contusion (100%), pelvic/long bone fractures (50%), visceral laceration/perforation (50%), central nervous system (33%), paraplegia (17%), and myocardial contusion (17%). There were no rib fractures. Four of 5 patients (80%) were not wearing seat belts, and 2 of these were ejected. The average time from injury to the operating room was 17.6 hours (range, 5 to 48 hours); the time from diagnosis to the operating room exceeded 5 hours with aortography and was less than 3 hours with chest computed tomography and transesophageal echocardiography. Each diagnostic modality accurately identified an aortic injury. The average time for cardiopulmonary bypass and for clamp and sew was 52 minutes (range, 49 to 55 minutes) and 34 minutes (range, 16 to 45 minutes), respectively. One patient with preoperative paraplegia regained partial function; there were no other patients with paraplegia. There were no deaths. All patients are alive 2 months to 7 years after repair.
CONCLUSIONS
The multiply injured child with severe blunt trauma and an abnormal chest roentgenogram requires a search for aortic injury. We believe the most effective algorithm to follow for the diagnosis of traumatic thoracic aortic rupture in the child involves selective performance of chest computed tomography and transesophageal echocardiography. Our experience suggests that the mechanism of injury, the duration to diagnosis of an aortic injury, and failure to use seat belts may contribute to morbidity. A high index of suspicion and a systematic approach to the diagnosis and to the management strategy for injuries to the thoracic aorta can contribute to a good outcome in those few children who survive the injury.
Topics: Adolescent; Aorta, Thoracic; Aortic Rupture; Child; Female; Humans; Intraoperative Complications; Male; Multiple Trauma; Postoperative Complications; Wounds, Nonpenetrating
PubMed: 8783999
DOI: 10.1016/s0003-4975(96)00355-4 -
European Journal of Vascular and... 2022
Topics: Humans; Aortic Aneurysm, Abdominal; Aortic Rupture; Risk Factors
PubMed: 35716993
DOI: 10.1016/j.ejvs.2022.06.005 -
Journal of Vascular Surgery Mar 1990Sealed rupture of abdominal aortic aneurysms, even if uncommon, deserves particular attention for the possibility of misdiagnosis and for the deleterious effects of such...
Sealed rupture of abdominal aortic aneurysms, even if uncommon, deserves particular attention for the possibility of misdiagnosis and for the deleterious effects of such a misdiagnosis. Sixteen patients (mean age 72 years; range 65 to 84 years) with chronic sealed rupture of abdominal aortic aneurysms are reported. Two patients had acute rupture of the aneurysm, and at operation chronic contained rupture was found along with the recent hemorrhage. One patient died after surgery. The remaining patients underwent successful resection with long-term survival and regression of symptoms. Consideration of sealed abdominal aortic aneurysm rupture should be included when examining elderly patients with history of unexplained back pain or femoral neuropathy. Computed tomography is a useful aid in the diagnosis of sealed rupture. Ultrasonography is less accurate; in three patients ultrasonography failed to diagnose the presence of the rupture.
Topics: Aged; Aged, 80 and over; Aorta, Abdominal; Aortic Rupture; Back Pain; Female; Hematoma; Humans; Male
PubMed: 2138232
DOI: 10.1067/mva.1990.17240 -
Pathologia Veterinaria 1967
Topics: Animals; Aortic Rupture; Horse Diseases; Horses; Male
PubMed: 5624872
DOI: 10.1177/030098586700400306 -
AJR. American Journal of Roentgenology Nov 1981The plain radiographic findings on 20 patients with traumatic aortic rupture were analyzed. A mediastinal-width to chest-width (M/C) ratio was calculated at three...
The plain radiographic findings on 20 patients with traumatic aortic rupture were analyzed. A mediastinal-width to chest-width (M/C) ratio was calculated at three thoracic levels and compared to two matched groups of patients without aortic tears. Defining an M/C ratio of 0.25 or larger at the level of the aortic arch as abnormal would identify 95% of cases with ruptured aortas, and result in 25% false-positive studies in traumatized patients. A ratio greater than 0.28 retains 85% sensitivity for aortic rupture while increasing specificity to 100%. An analysis of the prevalence and location of rib fractures showed that there was little relation between the presence of fracture and existence of an aortic tear. Therefore, an acutely injured patient with an M/C ratio of greater than 0.25 should be considered highly likely to have an aortic rupture.
Topics: Adolescent; Adult; Aorta, Thoracic; Aortic Rupture; Female; Humans; Male; Mediastinum; Middle Aged; Radiography; Rib Fractures
PubMed: 6974993
DOI: 10.2214/ajr.137.5.1011 -
The Thoracic and Cardiovascular Surgeon Mar 2024Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the...
BACKGROUND
Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the site of rupture in distal stent graft-induced new entry (dSINE) after frozen elephant trunk with a clinically time efficient steady-flow simulation versus transient simulations.
METHODS
Steady-state simulations were performed for dSINE, prior and after its development and prior to aortic rupture. To account for potential turbulences due geometric changes at the dSINE location, Reynolds-averaged Navier-Stokes equations with the realizable -ε model for turbulences were applied. Transient simulations were performed for comparison. Hemodynamic parameters were assessed at various locations of the aorta.
RESULTS
Post-dSINE, jet-like flow due to luminal narrowing was observed which increased prior to rupture and resulted in focal neighbored regions of high and low wall shear stress (WSS). Prior to rupture, aortic diameter at the rupture site increased lowering WSS at the entire aortic circumference. Concurrently, WSS and turbulence increased locally above the entry tear at the inner aortic curvature. Turbulent kinetic energy and WSS elevation in the downstream aorta demonstrated enhanced stress on the native aorta. Results of steady-state simulations were in good qualitative agreement with transient simulations.
CONCLUSION
Steady-flow CFD simulations feasible at clinical time scales prior to aortic rupture reveal a hostile hemodynamic environment at the dSINE rupture site in agreement with lengthy transient simulations. Consequently, our developed approach may be of value in treatment planning where a fast assessment of the local hemodynamic environment is essential.
Topics: Humans; Aortic Rupture; Models, Cardiovascular; Treatment Outcome; Hemodynamics; Computer Simulation; Stents; Stress, Mechanical; Hydrodynamics
PubMed: 37506731
DOI: 10.1055/s-0043-1771357 -
Journal of Cardiac Surgery Jan 2012Aortic dissection in a cardiac allograft is an uncommon complication of heart transplantation with only few cases reported in the literature. (Review)
Review
BACKGROUND
Aortic dissection in a cardiac allograft is an uncommon complication of heart transplantation with only few cases reported in the literature.
METHOD
We report a case of 46-year-old female who underwent orthotopic heart transplantation for dilated cardiomyopathy 22 years earlier. During surveillance echocardiographic examination she was diagnosed with type A aortic dissection limited to the donor aorta. The aortic root was successfully replaced using a valve-sparing David procedure. The pathogenesis and surgical management of these dissections is reviewed.
CONCLUSION
Appropriate surgical repair performed in a timely fashion leads to excellent results improving the prognosis of these patients.
Topics: Aortic Rupture; Cardiomyopathy, Dilated; Female; Heart Transplantation; Humans; Middle Aged; Postoperative Complications
PubMed: 22321119
DOI: 10.1111/j.1540-8191.2011.01390.x -
Heart, Lung & Circulation Jan 2013
Topics: Aortic Rupture; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 23219313
DOI: 10.1016/j.hlc.2012.11.004