Diagnosis and Treatment of Aortic Diseases

293 Pages·1999·24.39 MB·English

by  Christoph A. Nienaber (auth.), Christoph A. Nienaber, Rossella Fattori (eds.)

DIAGNOSISAND TREATMENTOF AORTIC DISEASES
Developments in
Cardiovascular Medicine
VOLUME 212
The titles publishedin this series are listedat the end of this volume.
Diagnosis and Treatment
of Aortic Diseases
editedby
CHRISTOPH A. NIENABER
Department of Cardiology,
University Hospital Eppendorf,
Hamburg, Germany
and
ROSSELLA FATTORI
Institute of Radiology and Cardiac Surgery,
University Hospital S. Orsola,
Bologna, Italy
SPRINGER SCIENCE+BUSINESS MEDIA, B.V.
Library of Congress Cataloging-in-Publication Data
Oiagnosis and treatment of aortic diseases / edited by Christoph A.
Niehaber, Rossella Fattori.
p. c •. -- (Oevelopaents in cardiovascular medicine ; 212)
Includes blbl10graphlcal references and Index.
ISBN 978-94-010-6024-0 ISBN 978-94-011-4828-3 (eBook)
DOI 10.1007/978-94-011-4828-3
1. Aorta--Oiseases. 2. Aorta--Surgery. 1. Nlenaber, Chrlstoph
A. II. Fattorl, Rossella. III. Ser les.
[ONLM: 1. Aortlc 01seases--dlagnosls. 2. Aortlc 01seases
-therapy. WG 410 05353 19991
RC691 .0485 1999
616. 1 '38--dc21
ONLM/OLC
for Llbrary of Congress 98-49373
ISBN 978-94-010-6024-0
Printed an acid-free paper
AII Rights Reserved
© 1999 Springer Science+Business Media Dordrechl
Originally published by Kluwer Academic Publishers in 1999
Softcover reprint of the hardcover 1s t edition 1999
No part of the material protectec\ by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any information storage and
retrieval system, without written permission from the copyright owner
Table ofContents
ListofContributors xi
ForewordbyHansB. Borst 1
Prefacebytheeditors 3
1. AorticDissection
ChristophA.Nienaber 5
1.1. Introduction 5
1.2. Definition 6
1.3. Etiologyandpathogenesis 6
1.4. Classification 11
1.5. Clinical presentation 11
1.6. Diagnosis 15
1.6.1. Magnetic resonance imaging 18
1.6.2. Echocardiography 24
1.6.3. Computedtomography 27
1.6.4. Theoptimal diagnostic approach 27
1.6.5. Coronaryangiography in aortic dissection 32
1.7. Managementofacute aorticdissection 32
1.7.1. Medical treatment 33
1.7.2. Treatmentofcardiac tamponade 34
1.7.3. Managementofmalperfusion 35
1.7.4. Chronic medical treatment 36
1.7.5. Surgical treatmentofaortic dissection 38
1.7.6. Technicalaspects ofsurgery 43
1.7.7. Repairoftheaortic arch 44
1.7.8. Follow-up strategy 45
1.8. References 48
2. Aortic Aneurysm
ArturoEvangelista,lordi-Soler-Soler, Herminio
GarciaDelCastillo, Carmen Sebastia, andRosaDominguez 57
v
vi TABLEOFCONTENTS
2.1. Etiology 58
2.1.1. Atherosclerosis 58
2.1.2. Ulcer 59
2.1.3. Cystic medialdegeneration 59
2.1.4. Trauma 60
2.1.5. Infectious aortitis 61
2.1.6. Noninfectious aortitis 61
2.1.7. Congenital aneurysm 62
2.2. Pathophysiology 63
2.3. Diagnostic approach 65
2.3.1. Clinicalpresentation andphysical examination 65
2.3.2. Imagingmodalities 66
2.3.2.1. Ultrasound 67
2.3.2.2. Angiography 70
2.3.2.3. Computedtomography 71
2.3.2.4. Magnetic resonance imaging 75
2.3.2.5. Currentdiagnostic approach 79
2.3.3. Pathology 81
2.3.3.1. Intraoperative andnecropsy findings 81
2.4. References 83
3. SurgicalTreatmentofAortic Aneurysms
James I. FannandD. Craig Miller 87
3.1. Introduction 87
3.2. Pathogenesis andnatural history 88
3.3. Diagnosis 90
3.4. Indicationsfor surgery 92
3.5. Surgicaltechniques 93
3.5.1. Ascending thoracic aortic aneurysm 93
3.5.2. Compositevalvegraft 97
3.5.3. Aortic arch aneurysm 101
3.5.4. "Elephanttrunk" adjunctive procedures forthoracic aortic
aneurysms 103
3.5.5. Descending thoracic aortic aneurysm 104
3.5.6. Abdominal aortic aneurysm 107
3.6. Results 107
3.6.1. Ascending aortic aneurysm 107
3.6.2. Archaneurysm 108
3.6.3. Descending thoracic aortic aneurysm 109
3.6.4. Abdominal aortic aneurysm 110
TABLEOFCONTENTS vii
3.7. Endovascularstent-grafting ofdescending thoracic
aortic aneurysm 111
3.8. Endovascularstent-grafting ofabdominal aortic aneurysm 115
3.9. Summary 118
3.10. References 120
4. InheritedDisordersoftheAorta
DianfUlM. Milewicz 129
4.1. Introduction 129
4.2. Singlegenedisorders 130
4.2.1. Marfan syndrome 130
4.2.2. Marfan-like connective tissuedisorder 142
4.2.3. Ehlers Danlos syndrome 143
4.2.4. Familialthoracic aortic aneurysms anddissections
(Erdheim's cystic medial necrosis) 145
4.2.5. Supraventricularaortic stenosis 147
4.2.6. Arterial tortuosity syndrome 148
4.2.7. Polycystic kidney disease 149
4.3. Genetic basis to commonaortic diseases 149
4.3.1. Abdominal aortic aneurysms 149
4.3.2. Thoracic aortic aneurysms and dissections 150
4.4. Acknowledgments 151
4.5. References 152
5. AorticTrauma
RossellaFattori andAngeloPierangeli 161
5.1. Demography and mechanism 161
5.2. Pathology 163
5.3. Clinical presentation 164
5.4. Natural history 166
5.5. Infrequentlocations oftraumatic aortic lesion 168
5.6. Diagnosis 169
5.6.1. Chestradiography 169
5.6.2. Computedtomography 172
5.6.3. Echocardiography 176
5.6.4. Aortography 179
5.6.5. Magnetic resonance 181
5.6.6. Optimaldiagnostic approach 184
5.6.7. Surgery 186
5.6.8. Chronicposttraumatic aneurysm 194
5.7. Acknowledgments 194
viii TABLEOFCONTENTS
5.8. References 195
6. Aortitis
Toru Suzuki 201
6.1. Introduction 201
6.2. Etiology and historical perspective toTakayasu's aortitis 201
6.3. Pathophysiology 202
6.3.1. Classification 203
6.4. Diagnostic procedures 204
6.4.1. Clinical/laboratory assessment 205
6.4.1.1. Clinical manifestations 205
6.4.1.2. Physical examination 205
6.4.1.3. Laboratory findings 206
6.4.1.4. Physiological testing 206
6.4.2. Imaging 207
6.5. Pathology 212
6.6. Treatment/management 214
6.6.1. Medicaltreatment 214
6.6.2. Surgical treatment 214
6.7. Outcome 215
6.8. Otheraortic inflammatorydiseases 216
6.8.1. Giantcellarteriitis 216
6.8.2. Beh~et's disease 217
6.8.3. Buergerdisease 218
6.8.4. Kawasakidisease 218
6.8.5. Cogan's syndrome 218
6.8.6. Ankylosing spondylitis 219
6.8.7. Reiter's syndrome 219
6.8.8. HLAB-27 positive aortic disease 219
6.8.9. Infectious aortic disease 220
6.8.10. Miscellaneous diseases 221
6.9. Conclusion 221
6.10. References 222
7. Etiology andPathology oftheAorticArch Malformations
Carla Frescura andGaetano Thiene 225
7.1. Developmentoftheaortic arch system 225
7.2. Obstructive anomaliesoftheaortic arch 227
7.2.1. Aorticcoarctation andtubularhypoplasia 227
7.2.2. Aorticarch interruption 240
7.3. Otheranomalies oftheaortic arch 247
TABLEOFCONTENTS ix
7.3.1. Aberrantsubclavian artery 248
7.3.2. Rightaortic arch 250
7.3.3. Vascularrings 253
7.3.4. Double aortic arch 254
7.3.5. Cervicalaorta 257
7.3.6. Minoranomalies ofbrachiocephalic arteries 257
7.4. Supravalvularaortic stenosis 257
7.5. Dysplasiaofthe greatarteries ["Maccheroni syndrome"] 260
7.6. Bicuspid aortic valveandaortic dissection 262
7.7. Anatomo-pathologic experience atthe University ofPadua 263
7.8. References 269
Index 277
Contributors' List
HansB. Borst
Widenmayerstr. 7
0-80538 MUNICH
Germany
Arturo Evangelista
DepartmentofCardiology
University Hospital
Valld'Hebron 119-129
E-08035 BARCELONA
Spain
JamesI. Fann
DepartmentofCardiovascular andThoracic Surgery
FalkCardiovascularResearchCenter
StanfordUniversity Medicine School
STANFORD,CA94305-5247
U.S.A.
RossellaFattori
Institute ofCardiology
University Hospital S. Orsola-Malpighi
ViaMassarenti 9
1-40138 BOLOGNA
Italy
DiannaM. Milewicz
DepartmentofMedical Genetics
TheUniversity ofTexas-Houston
Health Science Center
6431 Fannin, Rm. 1-614
HOUSTON,TX77030
U.S.A.
Xl