Aortic Valve ; pathology ; Calcinosis ; Heart Defects, Congenital ; pathology ; Heart Valve Diseases ; pathology ; Humans

BACKGROUND: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the postoperative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). MATERIAL AND METHOD: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, 6~10 months and more than 18 months (mean follow-up duration: 38 months) postoperatively. RESULT: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups. CONCLUSION: In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.
Aortic Diseases ; Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography ; Follow-Up Studies ; Hand ; Heart Valve Diseases ; Humans ; Male ; Mitral Valve Insufficiency* ; Pathology* ; Retrospective Studies

We report a case of surgically treated abdominal aortic aneurysm (AAA) in a patient having crossed ectopia with fusion anomaly of the kidney. One artery from the abdominal aorta above the aneurysm supplies the right kidney while three renal arteries (two from the aneurysm itself and one from the left common iliac artery) supply the crossed ectopic kidney. Preoperative imaging to define the arterial and collecting systems along with a detailed planning of the operation is essential to prevent ischemic renal injury as well as ureteral injury during AAA repair.
Aged ; Aortic Aneurysm, Abdominal/*complications/pathology/*surgery ; Choristoma/*complications/pathology ; Human ; *Kidney ; Kidney Diseases/*complications/pathology ; Magnetic Resonance Angiography ; Male

Endovascular aortic repair is a new alternative to conventional surgical repair of aortic pathology. It is a less invasive technique and gives less hemodynamic stress to the patients who may have concomitant systemic diseases, compared with open aortic reconstruction. We report 2 cases of patients with thoracic aortic diseases, who underwent endovascular stent graft placement under general anesthesia. We also include a review of the literature about anesthetic management of endovascular aortic repair and present our opinions about the need to choose a suitable anesthetic technique for each patient, the method to recognize and handle the possible complications and hemodynamic changes to which we have to pay attention during procedures.
Anesthesia, General ; Aortic Diseases* ; Blood Vessel Prosthesis* ; Hemodynamics ; Humans ; Pathology ; Stents*

Due to its low prevalence and because there is lack of awareness about it, Loeys-Dietz syndrome is often mis-diagnosed as Marfan syndrome, which has similar skeletal abnormalities and aortic pathology. However, the differential diagnosis between these two connective tissue diseases is critical because they correspond to different surgical indications and surgical decision-making. We report two cases of successful thoracoabdominal aortic replacement in patients with previously undiagnosed Loeys-Dietz syndrome.
Aortic Aneurysm ; Connective Tissue Diseases ; Diagnosis, Differential ; Humans ; Loeys-Dietz Syndrome* ; Marfan Syndrome ; Pathology ; Prevalence

Interrupted aortic arch is a rare congenital vascular malformation associated with a high mortality rate in infancy, and is therefore very unusual in adults. We report a case of interrupted aortic arch in a 42-year-old male hypertensive patient who was found to have a disruption of aorta continuity distal to the left subclavian artery with massive collateral circulation into the descending aorta by computed tomography angiography. The patient was discharged after the blood pressure was controlled by antihypertensive therapy. This case suggests the necessity of careful auscultation for young patients with hypertension. Once murmur in the chest and back is heard, computed tomography angiography should be performed at once to avoid missed diagnosis and misdiagnosis.
Adult ; Aorta, Thoracic ; pathology ; Aortic Diseases ; complications ; Humans ; Hypertension ; etiology ; Male

BACKGROUND: The specificity of aortic alteration in the pathogenesis of aortic dissection has been challenged. To obtain comprehensive morphologic data that may enhance the appreciation of the pathogenesis of aortic disease in normal aorta among Koreans, we performed a morphologic study of aorta with aging. METHODS: The histologic and morphometric studies of ascending aorta without cardiovascular disease were carried out on seventy-two autopsy cases. Alcian blue-stained sections were subjected to morphometric study using image analysis system. The age range of the cases was from newborn to those who had been in their eighties. RESULTS: The most prominent feature of aging aorta was fragmentation and loss of elastic lamellae, and expansion of interlamellar spaces. Cystic medial necrosis of varying degrees was observed in almost every specimen. On the morphometric study, the percentage area of mucoid degeneration revealed no statistically significant differences among the varying age groups. Compared to males, female subjects exhibited significant mucoid degeneration (p<0.05). CONCLUSIONS: The alteration of elastic lamellae is increased with age. Cystic medial necrosis is not considered merely an aging phenomenon, but is enhanced in the aorta of females.
Age Factors ; Aging ; Aorta* ; Aortic Diseases ; Autopsy ; Cardiovascular Diseases ; Female ; Humans ; Infant, Newborn ; Male ; Necrosis* ; Pathology ; Sensitivity and Specificity

Using SEM, we have observed surface structures of atherosclerotic lesions of human aortas obtained from autopsies ranging from 59 to 84 years of age (5 males and 4 females). We have found four major interesting features on the lumenal surface of the aortas: 1) blood cells including leukocytes adhering to the endothelial surface, 2) a de-endothelialized surface showing both elastogenesis and elastolysis, 3) abundant cholesterol-ester crystals in extracellular spaces, and 4) cave-like structures possibly suggesting new capillarization in the thrombotic atherosclerotic plaques. We concluded that SEM has a great value in revealing more interesting surface structures if morphological studies are previously done in detail so that the characteristic shapes can be identified, and perhaps then meaningful interpretations can be made on the mechanism of human atherogenesis.
Aged ; Aged, 80 and over ; Aorta/ultrastructure* ; Aortic Diseases/pathology* ; Arteriosclerosis/pathology* ; Human ; Male ; Microscopy, Electron, Scanning* ; Middle Age

BACKGROUND AND OBJECTIVES: Thoracic endovascular aortic repair exhibits limitations in cases where the aortic pathology involves the aortic arch. We had already developed a fenestrated aortic stent graft (FASG) with a preloaded catheter for aortic pathology involving the aortic arch. FASG was suitable for elective cases. MATERIALS AND METHODS: An aortic arch stent graft with a window-shaped fenestration (FASG-W) for supra-aortic arch vessels is suitable for emergent cases. This study aims to test a FASG-W for supra-aortic arch vessels and to perform a preclinical study in swine to evaluate the safety and efficacy of this device. Six FASG-Ws with 1 preloaded catheter were advanced through the iliac artery in 6 swine. The presence of endoleak and the patency and deformity of the grafts were examined with computed tomography (CT) at 4 weeks postoperatively. A postmortem examination was performed at 8 weeks. The mean procedure time for FASG-W was 27.15±4.02 minutes. The mean time for the selection of the right carotid artery was 5.72±0.72 minutes. RESULTS: Major adverse events were not observed in any of the 6 pigs who survived for 8 weeks. For the FASG-W, no endoleaks, no disconnection, and no occlusion of the stent grafts were observed in the CT findings or the postmortem gross findings. CONCLUSION: The procedure with the FASG-W was able to be performed safely in a relatively short procedure time and involved an easy technique. The FASG-W was found to be safe and convenient for use in this preclinical study of swine.
Animal Experimentation ; Aorta, Thoracic* ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Autopsy ; Blood Vessel Prosthesis* ; Carotid Arteries ; Catheters ; Congenital Abnormalities ; Endoleak ; Iliac Artery ; Pathology ; Stents* ; Swine* ; Transplants

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation