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Related Concept Videos

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aneurysm I: Introduction01:30

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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aortic Regurgitation III: Medical Management01:25

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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[True Ascending Aortic Aneurysm Late after Total Arch Replacement].

Yuki Hiraoka1, Keiichi Ishiwari, Hirokazu Niitsu

  • 1Department of Cardiovascular Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 27, 2022
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Summary

A 75-year-old woman developed a new aortic aneurysm 17 years after aortic arch replacement. Strict blood pressure control and proximal ascending aorta repair are crucial for preventing future aortic aneurysms.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Medicine
  • Aortic Disease

Background:

  • A 75-year-old female patient with a history of total arch replacement (TAR) for aortic arch aneurysm 17 years prior presented for unrelated medical issues.
  • Incidental diagnosis of a new proximal aortic aneurysm during a comprehensive medical evaluation.

Observation:

  • Contrast-enhanced computed tomography (CT) revealed a proximal aortic aneurysm with a maximum diameter of 67 mm, exhibiting lateral protrusion.
  • The patient underwent elective ascending aortic replacement for the newly diagnosed aneurysm.

Findings:

  • Histopathological examination confirmed the resected aortic lesion was a true aneurysm, not a pseudoaneurysm.
  • Potential etiologies include chronic hemodynamic stress from left ventricular output and suboptimal blood pressure management, compounded by the residual proximal aorta's anatomy post-TAR.

Implications:

  • Emphasizes the importance of maximizing the proximal replacement of the ascending aorta during initial aortic arch surgery.
  • Highlights the necessity of rigorous, long-term postoperative blood pressure control to mitigate the risk of subsequent aneurysm formation in the residual aorta.