Surgical Strategy for Protecting Major Branch Arteries during Thoracic Endovascular Aortic Repair for Shaggy Descending Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

Clinical value of left atrium-descending aorta distance measured on ultrasound images in the diagnosis of fetal total anomalous pulmonary venous connection / 中国基层医药

Objective:To investigate the clinical value of ultrasonic measurement of left atrium-descending aorta distance in the diagnosis of fetal total anomalous pulmonary venous connection (TAPVC).Methods:Pregnant women who underwent fetal anatomy scans in the second trimester of pregnancy in Central Hospital of Panyu District between January 2018 and June 2019 were included in this study using prospective and case-control study methods. The GE Voluson E8 and Philips EPIQ 7 ultrasound machines were used to measure the left atrium-descending aorta distance in the four-chamber view of the fetal heart. Pulmonary vein was carefully examined. Fetuses with isolated TAPVC were included in the positive group. The pregnancy outcomes were followed up during all participants. 200 healthy fetuses were randomly selected and included in the control group. The correlation between left atrium-descending aorta distance in normal fetuses and gestational weeks was analyzed. The average value of left atrium-descending aorta distances was compared between positive and control groups.Results:A total of 2 156 pregnant women received fetal anatomy scans, with the completion rate of 100%. Among them, 1 786 pregnant women were successfully followed up and 370 were lost to follow up. Among the 1 786 pregnant women, four fetuses were diagnosed with isolated TAPVC, consisting of three fetuses with intracardiac type TAPVC and one fetus with supracardiac type TAPVC, as confirmed by prenatal ultrasound. The left atrium-descending aorta distance in 200 normal fetuses was weakly related to gestational weeks ( r2 = 0.35, P < 0.000 1). The mean left atrium-descending aorta distance in the positive group was significantly greater than that in the control group (5.4 mm vs. 2.1 mm). Conclusion:Ultrasonic measurement of left atrial posterior spatial distance is simple and it is hardly affected by gestational weeks. It is innovative to diagnose TAPVC through quantitative analysis. The widening of left atrium-descending aorta distance has a certain value in suggesting fetal TAPVC. The sample size is small in this study. Multi-center studies involving larger sample sizes are needed to further validate the clinical significance of widened left atrium-descending aorta distance.

Experimental study on mechanical properties of the ventral and the dorsal tissues of porcine descending aorta / 生物医学工程学杂志

The mechanical properties of the aorta tissue is not only important for maintaining the cardiovascular health, but also is closely related to the development of cardiovascular diseases. There are obvious differences between the ventral and dorsal tissues of the descending aorta. However, the cause of the difference is still unclear. In this study, a biaxial tensile approach was used to determine the parameters of porcine descending aorta by analyzing the stress-strain curves. The strain energy functions Gasser-Ogden-Holzapfel was adopted to characterize the orthotropic parameters of mechanical properties. Elastic Van Gieson (EVG) and Sirius red stain were used to observe the microarchitecture of elastic and collagen fibers, respectively. Our results showed that the tissue of descending aorta had more orthotropic and higher elastic modulus in the dorsal region compared to the ventral region in the circumferential direction. No significant difference was found in hyperelastic constitutive parameters between the dorsal and ventral regions, but the angle of collagen fiber was smaller than 0.785 rad (45°) in both dorsal and ventral regions. The arrangement of fiber was inclined to be circumferential. EVG and Sirius red stain showed that in outer-middle membrane of the descending aorta, the density of elastic fibrous layer of the ventral region was higher than that of the dorsal region; the amount of collagen fibers in dorsal region was more than that of the ventral region. The results suggested that the difference of mechanical properties between the dorsal and ventral tissues in the descending aorta was related to the microstructure of the outer membrane of the aorta. In the relatively small strain range, the difference in mechanical properties between the ventral and dorsal tissues of the descending aorta can be ignored; when the strain is higher, it needs to be treated differently. The results of this study provide data for the etiology of arterial disease (such as arterial dissection) and the design of artificial blood vessel.

The ratio between descending aorta and ascending aorta diameter for rapid diagnosis of Stanford type B aortic dissection / 中华急诊医学杂志

Objective To investigate the significance of diameter measurement in descending aorta and ascending aorta as predictors of Stanford B type aortic dissection.Methods A total of 156 patients with chest pain and 100 healthy volunteers as control were enrolled in this study.The descending aorta diameter (dDA) and ascending aorta diameter (dAA) were measured by computed tomography (CT) and CT angiography(CTA),and the ratio of dDA to dAA or to rDA(radius of descending aorta) was calculated.Various metrics were analyzed for their specificity and sensitivity as screening measurements for Stanford B type aortic dissection.Results Fifty-six cases were diagnosed with Stanford B type aortic dissection by CTA with significant increases in dDA and rDA compared with control group(P＜0.05).When dDA was ≥ 30 mm,the sensitivity was 94.6％ and specificity was 82.0％ for Stanford B type aortic dissection,and when the rDA was ≥ 0.8,sensitivity and specificity were 96.4％ and 91.0％,respectively.Conclusions The dDA ≥ 30 mm and rDA ≥ 0.8 may be used to predict Stanford B type aortic dissection in suspected patients with chest pain,and the latter is more accurate than the former.

Endovascular aortic repair for Stanford type B aortic dissection: learning curve analysis / 介入放射学杂志

Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 70 patients with Stanford type B aortic dissection,who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years,were retrospectively analyzed.According to the sequence of operation date,the patients were equally divided into group A,B,C,D and E with 14 patients in each group.The operation time,procedure-related complications,postoperative hospitalization days were compared among the 5 groups,and the curative effects at different stages were evaluated.Results No statistically significant differences in the age,sex,classification,concurrent hypertension,concurrent diabetes,active smoking,maximum diameter of false lumen,viscera artery supplied by the false lumen,etc.existed between each other among the 5 groups (P＞0.05).The operation time of group A and group B was (3.29±0.61) hours and (2.87±0.37) respectively (P＜0.05),while the operation time of group C,group D and group E was (1.80±0.62) hours (1.74±0.34) hours and (1.52±0.39) hours respectively (P＞0.05).The operation time of group A and group B was significantly longer than that of group C,D,and E (P＜0.001).The difference in the occurrence of complications was not statistically significant between each other among the 5 groups (P＞0.05).The hospitalization time was gradually shortened from group A to group E,although the difference was not statistically significant (P＞0.05).The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively,with an operation frequency being 3.3 patients per year and 7 patients per year respectively;while the surgeries of 42 patients in group C,group D and group E were completed within 2.2 years,1.2 years and 0.5 years respectively,with an operation frequency being 6.4 patients per year,11.7 patients per year and 17.5 patients per year respectively.Conclusion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases;after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist,the operation time becomes significantly shortened,and the surgical skills of theinterventional physician team can been significantly improved.

Endovascular repair or medication for the management of uncomplicated type B aortic dissection / 介入放射学杂志

Objective To compare the curative effect of thoracic endovascular repair (TEVAR) plus medication with that of pure medication in treating uncomplicated type B aortic dissection,and to discuss the treatment strategy for uncomplicated type B aortic dissection.Methods The clinical data of 118 patients with definitely confirmed uncomplicated type B aortic dissection,who were admitted to authors' hospital during the period from 2004 to 2015,were retrospectively analyzed.Among the 118 patients,57 patients received TEVAR plus medication (TEVAR group) and 61 patients were treated with pure medication (drug group).The complications and mortality within one month and during follow-up period in both groups were calculated respectively,and Kaplan-Meier survival curves were used to compare the survival rate between the two groups.Results The incidences of complications and morbidity during hospitalization and within one month after treatment in TEVAR group were 5.2％ and 0％ respectively,which in the drug group were 0％ and 0％ respectively.The patients were followed up for 1-110 months,with a mean of (43.3±36.7) months.The incidence of main complications and the mortality in TEVAR group were 7.0％ and 5.3％ respectively,which in the drug group were 6.6％ and 8.1％ respectively.The one-,2-,4-and 7-year cumulative survival rates in TEVAR group were 100％,97.1％,93.5％ and 78.0％ respectively,which in the drug group were 98.4％,96.4％,90.8％ and 72.7％ respectively,the differences between the two groups were not statistically significant (~=0.019,P=0.890).Conclusion For the treatment of uncomplicated type B aortic dissection,TEVAR plus medication is superior to pure drug therapy in reducing expansion rate of false cavity,but TEVAR carries some procedure-related complications,besides,TEVAR can not improve the survival rate.(J Intervent Radiol,2017,26:266-269)

Anatomic data and clinical significance analysis of 150 cases of type A aortic dissection / 临床外科杂志

Objective To analyse of 150 cases of type A aortic dissection anatomic parameter and the relationship between anatomic parameter and clinic date and prognosis.Methods We identified 150 cases of type A aortic dissection who were diagnosed clearly.All patients were divided into groups by gender and surgical approaches.General clinic data and radiological data were recorded.Survival rate was evaluated by follow up 3 months after surgery.Results The aortic root diameter of group aortic root replacement was(53.25±13.17)mm,group aortic root sparing was (49.08±6.94)mm,there was significant difference between the two group(P0.05).There were gender differences between type A dissection parameters of descending aorta,the start diameter of male and female's descending aorta were (41.09±8.86)mm and(37.44±5.60)mm,respectively.The descending aorta in parallel to the pulmonary artery diameter were(34.31±0.59)mm and(31.11±0.88)mm,respectively.Descending aorta diameter of the diaphragm were(31.45±6.50)mm and(28.46±5.20)mm,respectively(all P>0.05).Conclusion In patients who suffer from type A aortic dissection,Parameter of aortic root is one of factors which determine surgical approach to aortic root.When treating descending aorta,surgeon should consider the influence of gender.Our study provided data references for selection and design of endovascular stent-graft.

A Case of Replacement of the Chronic Dissecting Descending Aortic Aneurysm after the Frozen Elephant Trunk Technique / 日本心臓血管外科学会雑誌

<p>A-54-year-old man with an extensive dissecting thoracic aortic aneurysm underwent staged surgery which consisted of preceding total aortic arch replacement with the frozen elephant trunk technique using J Graft Open Stent Graft, followed by open descending aorta repair. During the second operation, a Dacron graft was anastomosed directly to the stent graft and the true lumen thus, the true lumen could be preserved around the stent graft. We herein discuss our approach in this case, focusing on prevention of bleeding from the elephant trunk.</p>

Sex-specific parameters of ascending aorta, descending aorta and pulmonary trunk by computed tomographic angiography with impact of age, hypertension, smoking and diabetes / Parámetros específicos de la parte ascendente de la aorta, parte descendente de la aorta y tronco pulmonar analizados mediante angiografía por tomografía computadorizada relacionados con el sexo, impacto de la edad, hipertensión, tabaquismo y diabetes

This study aims at establishing whether transverse diameter (TD) and cross sectional-area (CSA) of the ascending aorta (AA), descending aorta (DA) and pulmonary trunk (PT) measured by computerized tomographic angiography (CTA) altered by sex, age, hypertension, smoking and diabetes. CTA examinations of the TD and CSA of the AA, DA and PT of 100 patients aged 49.5±16.9 years (range 16­78 years) selected between January 2009 to May 2011 from those referred to Radiology Department, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan for advanced evaluation. Measurements were made in the axial plane at the upper border of the six thoracic vertebrae. Patients were divided into three age groups. Significance of differences in parameters between age groups was calculated. Assessment ratios were considered. It was found that parameters of the three arteries were significantly larger in men than in women (P= < 0.05) and increased with age. Hypertension increased diameters of AA and DA in both genders (P= 0.001) and of PT in men (P= 0.01). Smoking significantly decreased parameters of PT in men (P= 0.01). Diabetes increased parameters of the three arteries in both genders, significantly increased parameters of PT in men (P= <0.05) and parameters of DA in women (P= <0.05). It is concluded that studied parameters were larger in men and increased with age of our patients. Distinctive differences in measurements appeared in hypertensive, smokers, and diabetic patients.

El objetivo fue determinar si el sexo, edad, hipertensión, tabaquismo y la diabetes alteran el diámetro transversal (DT) y área transversal (AT) de la parte ascendente de la aorta (AA), parte descendente de la aorta (AD) y tronco pulmonar (TP), medidos por angiografía por tomografía computadorizada (ATC). Exámenes de ATC de 100 pacientes de 49,5±16,9 años (rango 16­78 años) fueron seleccionados entre enero del año 2009 a mayo del año 2011 por el Departamento de Radiología, Hospital de la Universidad de Jordania, Facultad de Medicina de la Universidad de Jordania, Amman, Jordania para una evaluación avanzada del DT y AT de la AA, AD y TP. Las mediciones se realizaron en el plano axial en el margen superior de las seis vértebras torácicas. Los pacientes fueron divididos en tres grupos según edad. Se determinó la existencia de significancia estadística de los diferentes parámetros entre los grupos etarios. La evaluación de las razones también fueron consideradas. Se encontró que los parámetros de las tres arterias fueron significativamente mayores en los hombres que en las mujeres (p= <0,05) y que aumentaron con la edad. La hipertensión aumentó los diámetros de la AA y AD en ambos sexos (p= 0,001) y del TP en los hombres (p= 0,01). En fumadores disminuyeron significativamente los parámetros del TP en los hombres (p= 0,01). La diabetes aumentó los parámetros de las tres arterias en ambos sexos. Ademas, aumentaron significativamente los parámetros del TP en los hombres (p= <0,05) y los parámetros de la AD en las mujeres (p = <0,05). Se concluye que los parámetros estudiados eran mayores en los hombres y aumentaron con la edad de nuestros pacientes. Diferencias distintivas en las mediciones aparecieron en hipertensos, fumadores y pacientes diabéticos.

Cirugía abierta versus cirugía endovascular en el tratamiento de la patología de la aorta torácica descendente / Open Surgery versus Endovascular Surgery in the Treatment of the Descendent Thoracic Aortic Disease

Introducción: El reparo endovascular de la aorta torácica (REVAT) se ha incrementado en el mundo en los últimos años con relación al abierto. Objetivo: Comparar los resultados clínicos del REVAT frente al reparo abierto en la Fundación Cardio Infantil (Bogotá, Colombia) entre 2002 y 2011. Metodología: Análisis retrospectivo de la cohorte de pacientes sometidos a reparo abierto (grupo 1) en comparación de REVAT (grupo 2). En cada uno de los grupos se evaluó tiempo quirúrgico, tasa de morbilidad, mortalidad, reintervención y estancia hospitalaria. Resultados: Se incluyeron 57 pacientes en el análisis (26 % reparo abierto; 74 % REVAT). Se reintervinieron dos pacientes por endofugas tipo 1 en el grupo 2 y un caso por sangrado en el grupo 1. La mortalidad operatoria fue para el grupo 1 de 20 %, y para el grupo 2, de 2,3 %. El tiempo quirúrgico fue de 398 ± 180 min (grupo 1) versus 85,5 ± 35 min (grupo 2 (p = 0,0001) y el tiempo de estancia hospitalaria promedio fue de 9,8 días (grupo 1) y 5,3 días (grupo 2) [p = 0,01]). El tiempo promedio de seguimiento fue 4,8 ± 3,1 años. Conclusiones: El REVAT parece ofrecer menor morbilidad, mortalidad, tiempo quirúrgico y estancia hospitalaria respecto al reparo abierto, aunque las poblaciones de pacientes incluidos no fueron estrictamente comparables. Se requieren nuevos análisis en un diseño prospectivo, idealmente aleatorizado para documentar los beneficios a largo plazo de este tipo de reparo...

Introduction: Thoracic Endovascular Aortic Repair(TEVAR) has increased worldwide morethan open repair in the last few years. Objective:To compare clinical outcomes of TEVARversus open surgery at Fundación Cardio Infantil(Bogota, Colombia), between 2002 and 2011.Methods: Retrospective analysis of the cohort ofpatients with open repair (group 1) in comparisonto TEVAR (group 2). In each group, surgicaltime, morbidity rates (infection, hemorrhage,medular ischemia, cerebrovascular event, andpostoperative renal failure), mortality, reintervention,and hospital stay were evaluated. For comparisonsa univariate analysis was used, being a p< 0.05 statistically significant. Results: 57 patientswere included (26 % open repair; 74 % TEVAR).Two type 1 endoleaks on group 2 and 1 bleedingpatient in group 1 required a second surgery. Surgicalmortality was 20 % in group 1, and 2.3 % ingroup 2); surgical time was 398 ± 180 (group 1)versus 85.5 ± 35 min (group 2) (p = 0.0001); andhospital stay was 9,8 days (group 1) and 5.3 days(group 2). Average follow-up time was 4.8 ± 3.1years. Conclusions: TEVAR may be associatedwith less morbidity, mortality, surgical time, andhospital stay than open repair, although the populationsincluded were not strictly comparable.New, prospective studies, ideally randomized,are needed to support the long term benefits ofthis type of repair...

Clinical experience in 36 cases of T4 esophageal carcinoma radical surgery combined with descending thoracic aortic segment replacement / 中国综合临床

Objective To summary the experience of T4 esophageal carcinoma surgery and to explore the methods and operating skills on descending thoracic aortic resection with prosthetic vascular graft replacement in patients with T4 locally advanced esophageal carcinoma invading descending thoracic aorta.Methods From Jan.2001 to Dec.2010,36 patients with esophageal carcinoma underwent esophagectomy and descending aortic replacement simultaneously in our hospital.The clinical data were retrospectively reviewed.All patients had a left posterior lateral incision via the 6th intercostal space.The vascular adventitia of the descending thoracic aorta in the left side was incised,and the aorta was clamped in the proximal and distal side of the invaded segment.Then the invaded segment was resected and replaced with artificial vessels.Esophageal carcinoma was radically resceted,and left cervical esophageal-gastro anastomosis was performed in all patients.Results Radical resection of esophageal carcinoma was achieved in all patients.There was no perioperative death,or severe complications such as paraplegina,acute renal failure and intestinal dysfunction occurred.Two patients had chylous hydrothorax,and one had late stage anastomotic stoma fistula.The post-operative hospital stay was 10-42 d,mean (15.5 ± 7.2 )d.The pathological examination revealed that all the patients had squamous cell carcinoma.The aortic tunica adventitia was invaded in all the patients,9(25％ ) had tunica media invasion,and there was no tunica intima invasion observed.The 1-,3-,and 5-year survival rate was 80.6％,46.2％ and 20.0％ respectively.Conclusion Combined esophagectomy and descending aortic replacement for locally advanced T4 esophageal carcinoma invading aorta can be considered as radical operation for selected patients,and it can improve the survival rate and life quality of the patients.

Midterm Outcomes of Open Surgical Repair Compared with Thoracic Endovascular Repair for Isolated Descending Thoracic Aortic Disease

OBJECTIVE: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. MATERIALS AND METHODS: From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. RESULTS: The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). CONCLUSION: Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.

Early Postoperative Descending Aortic Rupture Following Ascending Aorta Replacement for Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

We report the findings in an 82-year-old man diagnosed with acute type A aortic dissection. Computed tomography scan showed that the primary entry site was located in the ascending aorta. This finding was confirmed intraoperatively, and emergency ascending aorta replacement of ascending aorta was performed. He subsequently died on postoperative 7 day due to descending aortic rupture. During autopsy, another entry site was found at the root of the brachiocephalic trunk with a patent false lumen, which might have led to the descending aortic rupture.

Amplatzer septal occluder found in the thoracic descending aorta by transesophageal echocardiography: A case report / 대한마취과학회지

Percutaneous device closure of atrial septal defect (ASD) has proven to be safe and effective, and become a widely accepted option to the surgical repair. However, the embolization of Amplatzer septal occluder (ASO) occurs in about 0.55% to 3.5% of cases, regardless of ASD size, device size, or the physician's expertise. We report a case of embolization of an ASO into the thoracic descending aorta, successfully removed through a surgical approach.

The cyclic burst effect of myostimulator on the thoracic aortomyoplasty

BACKGROUND: Descending thoracic aortomyoplasty (DTA) is a simple surgical procedure designed to use patient's own skeletal muscle based on the principle of aortic counterpulsation. Clinical application is limited. We have investigated the acute effect of DTA depending on the surgical configurations and cyclic bursts of stimulator parameter. METHODS: In 14 Mongrel dogs, the left latissimus dorsi muscle (LD) was wrapped around the descending aorta. Pacing leads were placed around the thoracodorsal nerve and sensing lead on the left ventricular apex. Cyclic burst 5-6 pulses were applied. Different surgical configurations are clockwise or counter-clockwise wrapping method of LD and whole type or band type of LD. Millar catheter and Swan-Ganz catheter were introduced to measure hemodynamics. Aorta pressure, right atrial pressure, mean aortic systolic and diastolic pressure, systolic and diastolic time, pulmonary wedge pressure, coronary perfusion pressure, endocardial viability ratio were measured in normal heart and pump failure heart. RESULTS: In normal heart, mean aortic diastolic pressure changed from 49.6+/-15.0mmHg to 55.5+/-17.1mmHg(p=0.012), endocardial viability ratio changed from 1.13+/-0.31 to 1.59+/-0.23 (p<0.001). In pump failure heart, mean aortic diastolic pressure changed from 40.0+/-12.8mmHg to 43.2+/-11.2mmHg(p=0.018), endocardial viability ratio changed from 0.69+/-0.22 to 1.01+/-0.40 (p=0.018). In clockwise configuration, mean aortic diastolic pressure changed from 50.3+/-14.0mmHg to 56.9+/-14.8mmHg(p=0.004). In whole type configuration, mean aortic diastolic pressure changed from 49.814.6mmHg to 57.1+/-15.6mmHg(p=0.003). CONCLUSIONS: Train stimulation of 5-6 pulses and surgical configurations of clockwise rotation with whole LD type play a role to maximize acute effect of DTA.

The Compression of Left Main Bronchus Caused by Dilated Descending Aorta After Ligation of PDA / 대한흉부외과학회지

Vascular compression of the tracheobronchial tree can create troublesome respiratory problems after an otherwise successful correction of a cardiac defect. This case represents a left main bronchial obstruction caused by dilated descending aorta after ligation of patent ductus arteriosus. An 8-month-old boy received an operation of mitral valve repair and PDA ligation due to mitral regurgitation and PDA. After the operation, atelectasis of left lung developed. The left main bronchial obstruction by dilated descending aorta was found on chest CT scan. The second operation was done. In the operative field, it was found that the sight of ligation of PDA was too close to left pulmonary artery, and redundant descending aorta compressed anteriorly left main bronchus. Ligated PDA was divided, the redundant descending aorta was opened and sutured to decrease the size. After the operation, atelectasis of left lung was resolved.

A Case of Slowly Progressing Aneurysm of Left Ventricle and Thoracic Aorta Due to Automobile Blunt Trauma

A five-year-old boy received a blunt trauma on chest by a kindergarten bus on Feb. 29, 1996. Pulmonary hemorrhage and pericardiac effusion were developed, followed by multi-organ failure threatening his life. All symptoms were improving when pansystolic harsh murmur (III/IV) originating from a tiny ventricular rupture with a blood leak to the pericardial space was auscultated on the 12th day after the trauma. This murmur disappeared with the left ventricular healing and progressive aneurysmatic formation. Howeve, on the 61st day after the trauma a continuous murmur (II/III) of aortic dissecting aneurysm on the left upper sternal border and dorsum was newly auscultated. Two-dimensional color doppler echocardiogram and aortogram by femoral artery catheterization revealed aneurysmatic dilatations of both the left ventricular free wall and descending aorta immediately after the origin of the subclavian artery with mild mitral regugitation. The patient underwent successful corrective surgery.