C4d analysis in endomyocardial biopsies of heart transplant patients: is there a correlation with hemodynamic data?

BACKGROUND: Endomyocardial biopsy (EMB) is the gold standard for immunologic follow-up to detect acute cellular rejection after cardiac transplantation. Conversely, protocols for the diagnosis and treatment of antibody-mediated rejection (AMR) are not well defined. Histologically, AMR is diagnosed by the presence of capillary damage associated with complement activation. The aim of this study was to correlate C4d expression of activated complement in EMB with hemodynamic compromise upon right heart catheterization. METHODS: Heart transplant patients underwent hemodynamic and histologic follow-up with EMB and right heart catheterization between January 2008 and December 2009 for a total of 491 procedures. The cardiac biopsy was evaluated for acute cellular and AMR by means of the presence of the C4d complement fraction. The histologic results were compared with hemodynamic data registered during right heart catheterization. RESULTS: Comparison of the hemodynamic data of subjects with versus without C4d positivity showed no significant difference. Furthermore, there was no significant difference comparing patients with versus without C4d positivity in the absence of significant acute cellular rejection episodes. (C4d-/ACR- vs C4d+/ACR-). The variation of each single hemodynamic parameter from its basal value (defined as the mean value in case of C4d-/ACR-) seemed to not be influenced by the presence of C4d+. CONCLUSIONS: In our experience, C4d has been routinely evaluated in the majority of EMBs. We could not demonstrate a significant correlation of C4d positivity with hemodynamic compromise. These findings suggest that significant allograft dysfunction is not related to C4d positivity. Therefore, the diagnosis of AMR is difficult to establish, because allograft dysfunction is 1 of the 3 fundamental criteria.

The use of CO2 removal devices in patients awaiting lung transplantation: an initial experience.

BACKGROUND: Lung transplantation is the treatment of choice for patients with end-stage lung failure. Limitations are presented by the shortage of donors and the long waiting list periods. New techniques, such as extracorporeal membrane ventilator devices with or without pump support, have been developed as bridges to transplantation for patients with severe, unresponsive respiratory insufficiency. METHODS: Between November 2005 and September 2009, 12 patients (7 males and 5 females), of overall mean age of 43.3 +/- 15.5 years underwent decapneization with extracorporeal devices. In 6 cases, a NovaLung system was used; in the remaining 6 patients, it was a Decap device. Causes of respiratory failure that led to implantation of such devices were cystic fibrosis (n = 6), pulmonary emphysema (n = 5), and chronic rejection of a previous double lung transplant (n = 1). RESULTS: Mean time on extracorporeal decapneization was 13.5 +/- 14.2 days. Eight patients died on the device. Three patients were bridged to lung transplantation; 1 recovered and was weaned from the device after 11 days. Mean PaCO(2) on the extracorporeal gas exchanger was significantly lower for both the devices at 24, 48, and 72 hours after implantation (P < .05). No significant difference was observed for the 2 systems. CONCLUSION: In our initial experience, decapneization devices have been simple, efficient methods to support patients with mild hypoxia and severe hypercapnia that is refractory to mechanical ventilation. This could represent a valid bridge to lung transplantation in these patients.

Results with cyclosporine monotherapy in long-term cardiac transplant recipients.

BACKGROUND: Triple therapy is the gold standard after heart transplantation while few reports have described experiences with cyclosporine monotherapy (CM). We have analyzed our experience with CM in long-term heart transplant recipients, surviving >5 years. METHODS: Of the 219 patients transplanted between January 1990 and December 1998, 143 survived >5 years (mean age, 49.6 +/- 10.4). There were 124 (86.7%) male subjects. Matching patients respect to follow-up length, we obtained 2 groups: group A of 41 patients on double therapy (DT; cyclosporine plus Azathioprine) and group B of 41 patients on CM. RESULTS: After a mean follow-up of 119.8 +/- 32.2 months, we did not observe a significant difference in terms of survival and major events: heart failure, malignancy, dialysis, infections, and CAV. CONCLUSION: We strongly support the use of triple therapy in cardiac transplant recipients because of its known safety and efficacy. However, our experience with CM suggests the utility of this approach.

Biventricular pacing concomitant to on-pump heart surgery: a case series.

AIM: The aim of this paper was to report the authors' experience on biventricular epicardial pacing (BEP) as first-choice procedure concomitant to on-pump heart surgery for other definite indications. METHODS: BEP was performed in 13 consecutive patients with stage IV heart failure (HF) undergoing on-pump cardiac surgery for other definite indications. All patients were treated with optimized pharmacologic therapy, and showed complete left bundle branch block and reduced (<30%) left ventricular ejection fraction. RESULTS: In all patients, effective BEP was achieved. All patients were discharged alive; functional, ECG and echocardiographic parameters showed significant improvement, better observed at 4-month interval. However, a high mortality rate was noticed during follow up (about 70% at 6 months) with a significant number of sudden cardiac deaths. The absence of functional improvement in the mid-term period (4-month control) related to a poor prognosis. CONCLUSIONS: Epicardial lead placement during cardiac surgery of severe HF patients is safe and effective. A clear evaluation of the effect of BEP alone is precluded because of the interference of the concomitant indications for cardiac surgery and the absence of randomization. The high rate of sudden death noticed in this study raises the important question of whether implantation of a defibrillator would be warranted in such population.

Does everolimus associated with a low dose of cyclosporine in long-term cardiac transplant recipients improve renal function? Initial experience.

BACKGROUND: Cyclosporine (CsA) renal toxicity is a well-known side effect. Various immunosuppressive strategies have been developed to minimize renal insufficiency. The use of everolimus associated with low levels of CsA can be an alternative strategy. METHODS: From October 2007 to April 2008, everolimus was started with a lower dose of cyclosporine (trough levels from 109.3 +/- 27.5 to 93.7 +/- 30.1 ng/mL after 45 days) in 21 cardiac transplant recipients (18 male and 3 female patients, mean age 56.4 +/- 10.7 years). Pre-everolimus therapy creatinine levels, creatinine clearances, and glomerular filtration rates were 1.9 +/- 0.9 mg/dL, 54.2 +/- 18.1 mL/mins and 44.3 +/- 16.5 mL/min/m(2), respectively. RESULTS: We observed a significant reduction in creatinine levels (from 1.9 +/- 0.9 to 1.4 +/- 0.3 mg/dL, P = .022) as well as a significant improvement in creatinine clearances (from 54.2 +/- 18.1 to 69.0 +/- 19.0 mL/min, P = .020) and glomerular filtration rates (from 44.3 +/- 16.5 to 57.1 +/- 16.3 mL/min/m(2), P = .010) after 7 days of everolimus therapy. Upon univariate analysis patient age, pretransplantation creatinine clearance, creatinine clearance after everolimus introduction, glomerular filtration rate at 45 days, and time from transplantation were associated with renal improvement. Upon multivariate analysis, only creatinine clearance at 7 days was related to the renal improvement. CONCLUSIONS: These preliminary data suggested that everolimus with a low dose of CsA may be safe and effective to reduce CsA-related renal insufficiency among selected, heart transplant patients.

Role of oral sildenafil in the treatment of right ventricular dysfunction after heart transplantation.

OBJECTIVE: Right ventricular dysfunction (RVD) after heart transplantation is a major complication, especially in patients with pulmonary hypertension (PH). Herein we have presented our initial experience with oral sildenafil for RVD following heart transplantation. MATERIALS AND METHODS: From February 2006 to February 2008, 10 patients (7 males and 3 females) of overall mean age of 56.7 +/- 9.5 years suffered from acute RVD immediately after heart transplantation. Preoperative hemodynamic data before and after a vasodilatation test (sodium nitroprusside; NTP) showed: systolic pulmonary arterial pressure (SPAP) 59.5 +/- 12.9 and 44.2 +/- 12.4 mm Hg; cardiac output (CO) 3.3 +/- 0.9 and 3.7 +/- 0.8 L/min; transpulmonary gradient (TPG) 11.7 +/- 3.9 and 8.7 +/- 3.6 mm Hg; and pulmonary vascular resistance (PVR) 3.9 +/- 2.1 and 2.4 +/- 1.3 wood units (WU), respectively. All patients required inotropes and inhaled nitric oxide (iNO) to be weaned from cardiopulmonary bypass (CPB). RESULTS: Intravenous (IV) or inhaled vasodilators could be weaned using oral sildenafil in all patients. The hemodynamic data obtained during IV or inhaled drugs (between postoperative days 5 and 10) compared with those obtained on sildenafil therapy alone (about 1 month after transplantation) showed a significant decrease in SPAP (39.0 +/- 8.2 vs 32.0 +/- 6.5 mm Hg; P = .049). CONCLUSION: These data suggested that oral sildenafil may have a role in the treatment of RVD after heart transplantation.

[Female sex is not an independent risk factor in mortality during myocardial revascularization]. / Il sesso femminile non rappresenta un fattore di rischio indipendente di mortalità negli interventi di rivascolarizzazione miocardica.

To assess if female sex is an independent risk factor for perioperatory mortality and morbidity, we have evaluated 971 consecutive patients (16% women) undergoing coronary artery bypass graft surgery at the Cardiovascular Disease Institution of the University of Turin from 1988 to 1990. In this study at baseline women were older and more likely to have diabetes, lower ventricular score and body surface area than men. As compared to men, women underwent surgery with delay: the surgical mortality rate and prevalence of arrhythmias were higher, and the size of the left anterior descending was smaller. At univariate analysis perioperative risk factors were as follows: age, diabetes, clinical instability, low body surface area, perioperatory infarction, postoperative infections, extracorporeal circulation time and left coronary size. At multivariate analysis only diabetes, left ventricular score, left anterior descending coronary size and emergency surgery were independent risk factors while sex, age and body surface area were not predictors of perioperatory mortality and morbidity. It is concluded that gender is not the cause of worse outcome in women.

[Conservative surgical treatment of rheumatic mitral stenosis]. / Terapia chirurgica conservativa della stenosi mitralica reumatica.

We prospectively evaluated 50 patients with mitral stenosis (43 women and 7 men; mean age 45 years) to assess the results of surgical reconstruction of the mitral valve. All patients underwent a complete echocardiographic examination before and after operation. Surgical reconstruction was extensive, and included commissurotomy, thinning of the valvular leaflets, calcification removal, splitting of subvalvular apparatus, and posterior annuloplasty. Surgical reconstruction resulted in increasing mitral functional area from 0.89 +/- 0.23 to 2.07 +/- 0.42 cm2. NYHA functional class decreased from 2.76 +/- 0.55 to 1.52 +/- 0.71. Before discharging, 10% of patients had moderate mitral insufficiency. All patients were followed at 6-month intervals in our clinic. Mean follow-up was 37 +/- 18 months. During follow-up 5 patients (10%) developed severe mitral incompetence, which required mitral valve replacement. Chi-square and Student t-test were used to analyze the correlation between variables and outcome. The occurrence of severe mitral incompetence was correlated with: the degree of enlarged left atrium; chronic atrial fibrillation; postoperative more than mild mitral regurgitation. No correlation was found with anatomical parameters detected by echocardiography, or intraoperative anatomy. In conclusion, surgical reconstruction of mitral stenosis provides satisfactory short-term results. We believe that the low mortality rate and the low incidence of complications justify an effort to save the native mitral valve before considering prosthetic replacement. More attention to the development of residual mitral incompetence with intraoperative control may improve long-term results.

Effect of pleurotomy on pulmonary function after coronary artery bypass grafting with internal mammary artery.

Coronary artery by-pass grafting with internal mammary artery (IMA) has become the graft conduit of choice, due to improved survival and its long term patency rate. However, some studies have shown that, in comparison with saphenous vein grafts, after IMA grafting, there is increased postoperative impairment of pulmonary function, possibly due to the frequent performance of pleurotomy. In 57 consecutive patients, admitted for elective CABG with IMA, we prospectively evaluated the early (2nd and 6th day) postoperative chest X-ray complications and the late (2 months) respiratory function tests changes. Thirty-two patients had been subjected to pleurotomy (group 1) and 25 not (group 2). The incidence of pulmonary atelectasis and pleural effusion in 2nd and in 6th postoperative days was not different in the two groups: 22 vs. 19%, 74 vs. 52% in 2nd, and 29 vs. 19%, 48 vs. 38% in 6th postoperative day respectively. The incidence of elevated hemidiaphragm in 6th postoperative day was not different in the two groups (18.5 vs. 14%). Two months after surgery the mean values of spirometric tests were significantly lower than the preoperative values: VC from 88.5 +/- 1.26 to 80 +/- 1.65% of predicted, P < 0.001, FEV1 from 96.1 +/- 1.27 to 84.7 +/- 1.73% of predicted, P < 0.001, MEF50 from 84.9 +/- 3.14 to 69.2 +/- 3.18% of predicted, P < 0.001. No significant changes were detected in RV and in AaPO2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antibiotic prophylaxis in cardiovascular surgery: comparison of sulbactam-ampicillin and cefuroxime]. / Profilassi antibiotica in chirurgia cardiovascolare: confronto fra sulbactam/ampicillina e cefuroxima.

A total of 200 patients (131 males and 69 females), scheduled for cardiovascular surgery were randomly assigned to receive either sulbactam/ampicillin 1 g IV of cefuroxime 2 g IV before the surgical incision and then, postoperatively, 8-hourly x 3 days. There were five failure of prophylaxis (all in the cefuroxime group): 3 sternal incision abscesses (1 Pseudomonas aeruginosa and 2 Staphylococcus epidermidis), one urinary tract infection (Staphylococcus aureus) and one Micrococcus pneumoniae. Tolerance to both antibiotics was excellent. In our sample of patients, the efficacy and safety of sulbactam/ampicillin were not different from those of cefuroxime in prophylaxis in cardiovascular surgery.

[The midterm clinical results of myocardial revascularization with the internal mammary artery]. / Risultati clinici a medio termine della rivascolarizzazione miocardica con arteria mammaria interna.

After a 3-year (1985-1988) experience of myocardial revascularization using internal mammary artery (AMI) grafts and after having excluded (1986) an higher operative mortality and morbidity, clinical medium-term results have been analysed. The first 144 patients discharged alive after AMI bypass surgery in 1985 were clinically evaluated, with a mean interval of 21 months from surgery (range: 5-29 months). Exercise electrocardiographic test was performed by 100 patients, and angiography repeated in 15. Actuarial survival function was estimated by Cutler-Ederer method: 2-year actuarial survival was 99.3 +/- 0.7% (94 +/- 1.8%, when operative deaths were included). Non fatal myocardial infarction occurred in 3 patients and, at follow-up, 26 were symptomatic for angina: 2 patients underwent re-operation and 2 angioplasty. Two years after AMI bypass surgery, actuarial estimate of ischemic event-free patients was 70.9 +/- 4.5% (67.7 +/- 4.5%, when operative deaths were included): 73 out of 100 exercise tests were negative for both angina and ischemia, although only 43 patients, reached maximal work load; 9 were positive for both angina and ischemia and 18 for ischemia only. All patients who underwent angiographic evaluation (15 patients, 11 of whom because of angina relapse) had AMI grafts open, while in only 4 patients all the implanted grafts were open.

[Single cell preparation of the human heart. Technic of dissociation and isolation of myocytes]. / Preparato unicellulare di cuore umano. Tecnica di dissociazione ed isolamento del miocita.

This paper describes a procedure of cellular dissociation which allows the isolation of single cells from the human heart while preserving their integrity and physiological function necessary for electrophysiological studies in vitro. During open heart surgery, biopsies were obtained from the right atrium of the beating heart in 16 patients immediately before starting the extracorporeal circulation. The tissue was immediately placed in a cardioplegic solution at 4 degrees, and subsequently in a free-calcium solution at 20 degrees from 20' to 30'. It was then exposed to the proteolytic action of Collagenase type I and Protease type VII (Sigma Chemical Co., St Louis, USA) at 35 degrees for a maximum of 5 hours. The cells were finally transferred into a Tyrode solution at room temperature. With this method we obtained up to 70% of intact human myocytes, 40% of which calcium-tolerant. The subsequent electrophysiological studies performed showed that the cells maintained their morphological and physiological properties.

[Pseudomonas aeruginosa infection of the sternum and costal cartilages in cardiosurgery. Therapeutic experience using aztreonam]. / Infezioni da Pseudomonas aeruginosa dello sterno e delle cartilagini costali in cardiochirurgia. Esperienza terapeutica con Aztreonam.

Clinical effectiveness of Aztreonam was studied. This new monobactam antimicrobial agent was tasted in the treatment of post-operative infectious complications of cardiac surgical sternal wounds. Ten patients (4 men and 6 women, age range 20 to 68 years) were entered into the study. All had a Pseudomonas aeruginosa infection of sternum or sternum and ribs and all underwent an extensive regional surgery of the infection wound and received a topical and/or IV treatment with Aztreonam. In all cases we obtained a satisfactory result, with complete eradication of the infection. Both local and systemic tolerance to the drug were excellent and no side-effect was registered. Therefore Aztreonam can be considered an active and safe antibiotic for the treatment of sternal and/or costal postsurgical infections by Pseudomonas aeruginosa.

[Clinical results and modification of left ventricular function after emergency revascularization for acute myocardial infarction]. / Risultati clinici e modificazioni della funzione ventricolare sinistra dopo rivascolarizzazione d'emergenza per infarto miocardico acuto.

Results of emergency revascularization for evolving myocardial infarction have been evaluated in 43 consecutive patients operated between January 1985 and March 1988. Time interval between onset of symptoms and coronary bypass averaged 6.7 +/- 0.5 hours (0.75-48). Intravenous or intracoronary thrombolysis was attempted pre-operatively in 26 cases. Overall hospital mortality was 6.9% (3/43) but this decreased to only 2.7% if patients in cardiogenic shock were excluded. Follow-up averaged 20.6 +/- 9.5 months (4-42). Actuarial survival was 82.9 +/- 7.3% at 36 months. Of the 36 survivors, 28 were free from angina and reinfarction at control. Nineteen patients were evaluated with angiography at follow-up (averaging 10.1 +/- 5.7 months). Left ventricular and regional ejection fraction were calculated on pre- and post-operative angiograms; regional ejection fraction was determined with the centerline method. Left ventricular ejection fraction increased from 0.49 +/- 0.15 to 0.52 +/- 0.19 (NS), regional ejection fraction improved from 0.20 +/- 0.1 to 0.27 +/- 0.16 (35% increment, p less than 0.05). The analysis of left ventricular and regional ejection fraction variations with the time elapsed from the onset of symptoms to surgery identified two subgroups of patients: those operated within and after six hours. In the first subgroup, left ventricular ejection fraction increased from 0.52 +/- 0.16 to 0.62 +/- 0.13 (p less than 0.005) and regional ejection fraction from 0.19 +/- 0.08 to 0.36 +/- 0.14 (89% increment, p less than 0.0005). In the second subgroup, both left ventricular and regional ejection fractions decreased from 0.44 +/- 0.13 to 0.36 +/- 0.11 (NS) and from 0.20 +/- 0.13 to 0.12 +/- 0.08 (NS), respectively. These results lead to the conclusion that improved left ventricular performance may be achieved in selected groups of patients if they undergo surgery within six hours of the onset of pain.

[Results of coronary artery bypass surgery. Surgical mortality, survival and follow-up functional state. Multivariate discriminant analysis of relative risk factors]. / Risultati dell'intervento di bypass aortocoronarico. Mortalità operatoria, sopravvivenza e stato funzionale a distanza ed analisi multivariata discriminante dei relativi fattori di rischio.

Clinical results of coronary artery bypass surgery, have been evaluated by analyzing operative mortality, late survival, late functional results and their related risk factors. Four hundred and thirty-seven consecutive patients who underwent coronary artery bypass surgery between January, 1979, and December, 1983, were the clinical material of this study. The gender of patients was male in 89% of the cases; age ranged from 34 to 78 years with a mean of 54.8 +/- 8.2 (SD). Patients with combined surgical procedures were excluded. Follow-up averaged 55.7 months; 404 survivors have been contacted (97% of the total study population, if operative and late deaths are added); 218 patients underwent a control exercise test; postoperative employment status was determined for 242 individuals. The operative mortality was 5.49% (24 patients). Death was due to cardiac causes in 75% of the cases. The overall actuarial survival rate was 85 +/- 1.9% after 5 years and 83.4 +/- 2.2% after 7 years. When non-cardiac related deaths were excluded the actuarial rates were 88 +/- 1.7% and 87.2 +/- 1.9% after 5 and 7 years respectively. Actuarial freedom from all ischemic events (cardiac related death, late myocardial infarction or recurrence of angina) was 66.1 after five years, and was 70.2% if operative deaths were excluded. Actuarial freedom from recurrence of angina for patients alive at follow-up was 78.7% after five years, actuarial freedom from myocardial infarction was 93.5%. The mortality hazard showed a diphasic response, being higher perioperatively and constant in the following 5 years of follow-up. All ischemic events, both singularly and together, showed an accelerated rate of occurrence at the first and after the fifth postoperative year, the slope of the curve being quite flat during the 1 to 5 year interval. The control exercise test was negative for 62.8% of the patients, positive for 33.5% and undeterminable in 3.7%. Employment status was postoperatively unaffected in 49.6% of the cases, while 27.3% of the patients retired: the remaining individuals had already retired before surgery. Statistical analysis (stepwise logistic regression) identified age (p = 0.002) and cross-clamp time (p = 0.016) as significant risk factors of operative mortality. The ejection fraction showed a value close to statistical significance (p = 0.06).(ABSTRACT TRUNCATED AT 400 WORDS)

Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures.

From January, 1979, to December, 1984, at the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients. These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear. Possible risk factors were evaluated by means of a multivariate analysis. For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of treatment in the intensive care unit. Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection. For all other predisposing factors, a p value of less than .05 was demonstrated. These variables were entered in a multiple stepwise logistic regression. Six emerged as significant: hospital environment (p = .0001), interval between admission and surgery (p = .041), reoperation (p less than .0001), blood transfusions (p = .031), early chest reexploration (p less than .0001), and sternal rewiring (p less than .0001). Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection.

[Aortic coarctation and aneurysms of the ascending aorta]. / Coartazione aortica ed aneurismi dell'aorta ascendente.

Dissection and rupture of the aorta account for 20% of death in the natural history of aortic coarctation. We describe here in four patients in whom an ascending aortic aneurysm was associated with aortic coarctation. Three patients had aortic valve incompetence. In two cases there was a dissection. This had not been recognized preoperatively in one, in whom the intimal tear was small; in the other patient, with dissection and shock, the associated mild coarctation was demonstrated only at autopsy. Surgical treatment of patients with aortic coarctation and associated aortic aneurysm must include resection of both the stenotic isthmus and dilated section of the aorta, because of a documented poor prognosis. Furtherly, when evaluating patients with aortic dissection a coexisting coarctation although infrequent must be ruled out. If such an association is identified in emergency cases the dissected aorta should be repaired first, employing a suitable technique (double arterial cannulation, above and below the isthmus) in order to ensure adequate perfusion. When there is no acute dissection, repair of the coarctation should be undertaken first.

Coronary artery bypass grafting for unstable angina. Risk factors of operative mortality.

In order to identify factors affecting early mortality in patients undergoing CABG for unstable angina, several risk factors have been analysed in a group of 120 patients. Systemic hypertension and left ventricular impairment were shown to be significant risk factors (Systemic hypertension, P less than 0.01; EF less than or equal to 0.35, P less than 0.01; LVEDP greater than or equal to 20 mmHg, P less than 0.025). Overall mortality rate was 5% (6/120). No influence could be recognized for age, sex, previous MI, emergency surgery, extension of coronary disease, completeness of revascularization and mode of onset of symptoms.

Traumatic rupture of the thoracic aorta. (Report of two unusual cases).

Two unusual cases of traumatic aneurysm of the aorta are described. Both presented several days after thoracic trauma sustained in a car accident. The presenting features were progressing dysphagia and displacement of the oesophagus in the first case and a coarctation-like syndrome in the second. Diagnosis was confirmed in each case by aortography and emergency resection of the aneurysm with a dacron prosthesis was carried out. Aortic rupture should be considered in all cases of thoracic trauma, especially when severe, even several days after the trauma itself. Patients should be evaluated with serial chest roentgenograms and an aortography should be performed in any suspicious case. Treatment is surgical and the operative mortality and morbidity is acceptably low.