DISEASES OF THE AORTA

Question 1

Aneurysm is a pathologic dilation of a segment of a blood vessel. What type of aneurysm affects the entire circumference of a segment of the vessel, resulting in a diffusely dilated artery.

Answer 1

Fusiform aneurysm

Question 2

This type of aneurysm involves only a portion of the circumference resulting in an outpouching of the vessel wall

Answer 2

Saccular aneurysm

Question 3

_________ characterize most aneurysms of the abdominal and descending thoracic aorta

Answer 3

Degenerative processes

Question 4

Most common pathologic condition associated with degenerative aortic aneurysms

Answer 4

Atherosclerosis

* Factors associated with degenerative aortic aneurysms include aging, cigarette smoking, hypercholesterolemia, hypertension, and male sex.

Question 5

The pathologic condition of aortic aneurysms associated with genetic or developmental diseases

Answer 5

Medial degeneration

* affects the proximal aorta, results in circumferential weakness and dilation, and leads to the development of fusiform aneurysms involving the ascending aorta and the sinuses of Valsalva

Question 6

Pathophysiology of tuberculous aneurysm

Answer 6

affects the thoracic aorta and result from direct extension of infection from hilar lymph nodes or contiguous abscesses as well as from bacterial seeding.

Question 7

The most common pathology associated with ascending aortic aneurysms

Answer 7

Medial degeneration

Question 8

The most frequently associated with aneurysms of the descending thoracic aorta

Answer 8

Atherosclerosis

Question 9

The following are indications for operative repair with placement of a prosthetic graft for ASCENDING aortic aneurysm

A. Symptomatic ascending thoracic aortic aneurysms
B. Asymptomatic aneurysms, including those associated with bicuspid aortic valves when the aortic root or ascending aortic diameter is ≥5.5 cm, or when the growth rate is >0.5 cm per year.
C. Patients with Marfan’s syndrome, ascending thoracic aortic aneurysms of 4–5 cm
D. ALL of the above

Answer 9

ALL OF THE ABOVE

Question 10

Operative repair for patients with degenerative descending thoracic aortic aneurysms when the diameter is

Answer 10

> 6cm

Question 11

Endovascular repair for degenerative descending thoracic aortic aneurysms should be considered if feasible when the diameter is

Answer 11

> 5.5 cm

Question 12

It is an important and common (>50%) complication of proximal aortic dissection.

Answer 12

Acute aortic regurgitation

* bounding pulses, a wide pulse pressure, a diastolic murmur often radiating along the right sternal border, and evidence of congestive heart failure

Question 13

Pleural effusion in cases of aortic dissection are usually ____-sided

Answer 13

• A pleural effusion is usually left-sided. This effusion is typically serosanguineous
• In dissections involving the ascending aorta - the chest x-ray often reveals a widened superior mediastinum.

Question 14

The preferred treatment for acute ascending aortic dissections and intramural hematomas (type A).

Answer 14

Emergent or urgent surgical correction

Question 15

Target hear rate in patients with aortic dissection

Answer 15

60bpm

• β-adrenergic blockers should be administered parenterally, using intravenous propranolol, metoprolol, or the short-acting esmolol to achieve a heart rate of ~60 beats/min.

Question 16

This type of infective aortitis has * predilection for the suprarenal abdominal aorta. Patients may present with fever, sepsis, and chest, back, or abdominal pain

Answer 16

Mycotic aneurysms

• Treatment: antibiotic therapy and surgical removal of the affected part of the aorta and revascularization of the lower extremities with grafts placed in uninfected tissue.

Question 17

This type of infective aortitis affects the proximal ascending aorta, particularly the aortic root, resulting in aortic dilation and aneurysm formation

Answer 17

Syphilitic Aortitis

* Initial lesion is an obliterative endarteritis of the vasa vasorum, especially in the adventitia.
* Treatment: penicillin and surgical excision and repair.

Question 18

It is also termed pulseless disease and often affects the ascending aorta and aortic arch with frequent occlusion of the large arteries originating from the aorta

Answer 18

TAKAYASU ARTERITIS

• Acute stage - fever, malaise, weight loss, and other systemic symptoms may be evident.
  * Elevations of the ESR and CRP
• Chronic stages - present with symptoms related to large artery occlusion, such as upper extremity claudication, cerebral ischemia, and syncope
• Process is progressive, and there is no definitive therapy