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Natural History of Thoracic Aortic Aneurysms 203 We have seen an abstract on this topic, but not a subsequent paper. There is no question that dissection can occur at small sizes. In our studies of weight lifters suffering aortic dissection (see Chapter 10), most young men dissected at a dimension between 4 and 5 cm. We feel these individuals imposed an extreme blood pressure stress (likely above 300 mmHg) on their aortas. We know (see Chapter 7) that wall stress depends on both aortic size and blood pressure. Aortic dissection at small sizes does, additionally, occur in nonweight lifters. Here one must keep in mind how huge is the denominator of patients with aortas in this size range. If aortic dimension follows a bell curve, like most physical traits, the number of patients must increase immensely as one comes back from the tails of the curve. Our feeling is that there are so many (probably millions) of patients with aortas of size 4 cm or more that the observed cases of dissection at these sizes represent a very low percentage. This is certainly the case in our careful follow-up of patients with known aortic size, whose percentage likelihood of dissection is represented in the figures and tables in this chapter. The likelihood of dissection in this population under direct observation is very low. In fact, once a patient has entered our system, and a decision made for medical management because of lack of symptoms and small aortic size, we are not aware of any instances of aortic dissection under such observation. We are now looking at this phenomenon from a heuristic, decision-making standpoint, to determine precisely how many patients may dissect when our recommended algorithms are applied. In short, we are not aware of a means to apply clinically the observation that some patients dissect at very small sizes. To operate prophylactic on all patients with minor enlargement of the aorta (say those with aortas between 4 and 5 cm) would probably cause more harm (surgical) than good.
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
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Preface Over 100 years ago, the gre
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Preface xi Some distinguishing feat
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xiv Acknowledgments Above all, than
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xvi Contents 6. Genetic Basis of Th
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Contributors Nili Avidan Division o
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Contributors xxi Arun Raghupathy Di
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2 Nienaber and Ince Table 1 Risk Co
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4 Nienaber and Ince In addition to
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6 Nienaber and Ince CLASSIFICATION
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8 Nienaber and Ince Lansman’s Cla
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10 Nienaber and Ince Figure 4 Curve
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12 Nienaber and Ince Figure 6 Evolu
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14 Nienaber and Ince dissection, su
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16 Nienaber and Ince (A) (B) Probab
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18 Nienaber and Ince Table 5 Risk P
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20 Nienaber and Ince of the predila
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22 Nienaber and Ince 34. Pieters FA
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24 Nienaber and Ince 75. Mehta RH,
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26 Nienaber and Ince hematoma (IMH)
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28 Nienaber and Ince One good featu
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30 Isselbacher SYMPTOMS Pain Experi
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32 Isselbacher and wane in severity
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34 Isselbacher The mechanisms are u
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36 Isselbacher deficits are most co
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38 Isselbacher 3. Nallamothu BK, Me
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40 Danias spinal arteries) and the
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42 Danias Figure 2 Anteroposterior
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44 Danias However, due to the dista
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46 Danias TEE is highly sensitive f
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48 Danias faster, with higher resol
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50 Danias Figure 6 Transverse slice
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52 Danias hematoma, CT was reported
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54 Danias Figure 9 Transverse black
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56 Danias Figure 12 Single phase-co
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58 Danias restricted to the absolut
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60 Danias In conclusion, in the rig
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62 Danias DISCUSSION AND COMMENTARY
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64 Danias tomography, among others.
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66 Danias cardiac silhouette. The a
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68 Raghupathy and Eagle the inciden
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70 Raghupathy and Eagle Figure 1 Sp
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72 Raghupathy and Eagle SIGNS A tho
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74 Raghupathy and Eagle patients ma
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76 Raghupathy and Eagle Table 5 Dia
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78 Raghupathy and Eagle Table 6 A S
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80 Raghupathy and Eagle Figure 6 (A
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82 Raghupathy and Eagle Figure 9 (A
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84 Raghupathy and Eagle EDITOR’S
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86 Raghupathy and Eagle 30. Erbel R
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88 Raghupathy and Eagle is highly l
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90 Elefteriades and Rizzo required
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92 Elefteriades and Rizzo Table 1 S
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94 Elefteriades and Rizzo 70s, this
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96 Elefteriades and Rizzo Table 3 C
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98 Elefteriades and Rizzo DISCUSSIO
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100 Milewicz et al. KNOWN GENETIC S
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102 Milewicz et al. Table 2 Quick G
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104 Milewicz et al. ascending aorti
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106 Milewicz et al. Turner syndrome
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108 Milewicz et al. dissection in t
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110 Milewicz et al. Figure 5 Haplot
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112 Milewicz et al. A genome wide s
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114 Milewicz et al. Structural anal
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116 Milewicz et al. assembly of a h
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118 Milewicz et al. in the nuclei o
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120 Milewicz et al. 22. Furlong J,
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122 Milewicz et al. DISCUSSION AND
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124 Milewicz et al. Figure A Distri
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126 Elefteriades and Koullias Figur
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128 Elefteriades and Koullias prope
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8 Matrix Metalloproteinases in Aort
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Matrix Metalloproteinases in Aortic
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INTRODUCTION 9 Inflammation and Rem
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Inflammation and Remodeling in the
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Inflammation and Remodeling in the
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Page 190 and 191: 10 Weight Lifting and Aortic Dissec
Page 192 and 193: Weight Lifting and Aortic Dissectio
Page 198 and 199: 11 Timing of Acute Aortic Events: H
Page 200 and 201: Timing of Acute Aortic Events 171 F
Page 202 and 203: SECTION IV: TREATMENT OF ACUTE AORT
Page 204 and 205: Natural History of Thoracic Aortic
Page 234 and 235: 13 Treatment of Ruptured Aortic Ane
Page 236 and 237: Treatment of Ruptured Aortic Aneury
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Page 259 and 260: 230 Sanz et al. will summarize curr
Page 261 and 262: 232 Sanz et al. also decrease wall
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Page 265 and 266: 236 Sanz et al. Hydralazin, a direc
Page 267 and 268: 238 Sanz et al. Figure 6 Schematic
Page 269 and 270: 240 Sanz et al. Table 1 Pharmacolog
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Page 273 and 274: 244 Sanz et al. REFERENCES 1. Niena
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Surgical Procedures: A Primer 253 s
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Surgical Procedures: A Primer 255 T
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Surgical Procedures: A Primer 257 F
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Surgical Procedures: A Primer 259 d
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Surgical Procedures: A Primer 267 1
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16 Endovascular Thoracic Aortic Ste
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Endovascular Thoracic Aortic Stent
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Table 4 Meta-Analysis of Tevar for
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17 Long-Term Suppressive Therapy: C
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Long-Term Suppressive Therapy 311 M
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Long-Term Suppressive Therapy 313 T
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Long-Term Suppressive Therapy 315 I
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Long-Term Suppressive Therapy 317 I
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Long-Term Suppressive Therapy 319 i
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Long-Term Suppressive Therapy 321 e
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Long-Term Suppressive Therapy 323 1
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SECTION V: LITIGATION IN AORTIC ANE
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Legal Considerations in Acute Aorti
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SECTION VI: PROSPECTS FOR THE FUTUR
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Future Prospects 349 1 0 1 Y: [PCA
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Future Prospects 351 GENE-DIRECTED
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354 Elefteriades Table 1 A Summary
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AAA. See Abdominal aortic aneurysm
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Index 363 [Aortic dissection imagin
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Index 365 [Imaging] chest X-ray, 40
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Index 367 [Ruptured aortic aneurysm
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Figure 2 (from Preface—see text p
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Figure 6.10 A potential molecular p
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Figure 9.1 Histology of aortic wall
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Number of Patients 25 20 15 10 5 0
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