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Cardiac > Thoracic aorta > Flashcards

Thoracic aorta Flashcards

1
Q

Tubular candy cane shaped structure that connects the left ventricle to systemic circulation

A

Thoracic aorta

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2
Q

Thoracic aorta extends from what level down to what level before it becomes the abdominal aorta

A

Aortic valve to diaphragmatic hiatus

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3
Q

Thoracic aorta us divided into

A

Aortic root, ascending aorta, transverse arch, and descending aorta

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4
Q

Extends from the aortic annular ring to the sinotubular junction

A

Aortic root

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5
Q

Fibrous oval ring where the leaflets of the aortic valve attach and extend superiorly toward the sinuses of valsalva

A

Aortic valve annulus

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6
Q

Coupled to the mitral annulus via aortomitral fibrous tissue, which is a defining feature of the left ventricle

A

Aortic annulus

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7
Q

Pulmonary valve is supported by the

A

muscular right ventricular outflow tract

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8
Q

Superior to the annulus which are 3 anatomic bulges of aorta

A

Sinuses of valsalva

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9
Q

Arise from the sinuses of valsalva above the valve plane but below the sinotubular junction

A

Coronary artery ostia

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10
Q

Arise from the right sinus of valsalva which is directed anteriorly

A

Right coronary artery

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11
Q

Arises from the leftward facing left sinus of valsalva

A

Left coronary artery

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12
Q

Usually directed posteriorly between the right and left atria

A

Noncoronary sinus

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13
Q

Above the sinuses of valsalva is the ______, which is an anatomic waist between the sinuses of valsalva and tubular ascending aorta

A

Sinotubular junction

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14
Q

Aorta is generally largest in diameter at the

A

Sinuses of valsalva

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15
Q

Normal diameter of aortic root is

A

3.5 to 3.72 cm in females and 3.63 to 3.91 in males

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16
Q

Serves as both a physical and hemodynamic boundary between the left ventricle and aorta

A

Aortic valve

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17
Q

Normal aortic valve is composed of how many leaflets/cusps

A

3

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18
Q

Contact points between valve leaflets are termed

A

Valve commissures

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19
Q

Valve commissures are best visualized during

A

End diastole when aortic valve is closed

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20
Q

Most common congenital cardiovascular anomaly with a prevalence of 0.5 to 2 %

A

Bicuspid aortic valve

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21
Q

Congenital anomalies of aortic valve

A

unicuspid, bicuspid or quadricuspid valve

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22
Q

2 morphologic types of bicuspid aortic valve

A

True bicuspid valve and one with fused raphe

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23
Q

Common morphologic type of bicuspid valve

A

With fused raphe

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24
Q

With a raphe bicuspid aortic valve, fusion between what coronary cusp is the most common

A

Right and left coronary cusp

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25
Q

common complication in patients with a bicuspid aortic valve secondary to myxoid degeneration

A

aortic stenosis

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26
Q

aortopath, aneurysm formation and coarctation are also associated with

A

bicuspid aortic valve

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27
Q

repair or aortic aneurysms are recommended when they measure between

A

4.5 to 5 cm

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28
Q

the single opening in unicuspid aortic valve is usually in what side

A

left

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29
Q

type of aortic valve with cloverleaf morphology, is extremely rare and more typically associated with early onset regurgitation

A

quadricuspid aortic valve

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30
Q

ascending aorta extends from

A

sinotubular junction to the origin of the right brachiocephalic artery

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31
Q

normal ascending aorta arises where

A

posterior and to the right of the MPA

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32
Q

CT or MR evaluation of the aortic root and ascending aorta should use ____ to minimize cardiac motion artifact

A

ECG gating

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33
Q

evaluation of valvular function or dysfunction requires wht gating technique

A

retrospective

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34
Q

basic anatomic evaluation will require what gating technique

A

prospective

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35
Q

transverse segment from which the great vessels arise

A

aortic arch

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36
Q

normal aortic arch is ___sided and courses where

A

left-sided, courses above the pulmonary arteries

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37
Q

first vessel to branch from the aorta is

A

right brachiocephalic or innominate artery

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38
Q

second and third vessels to branch from the aortic arch

A

left common carotid artery and left subclavian artery

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39
Q

vertebral arteries normally arise from the

A

proximal aspect of the subclavian arteries

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40
Q

narrowing of the subclavian arteries proximal to the origin of the VA, whether degenerative, inflammatory or iatrogenic can result in _____ if there is hemodynamically significant obstruction

A

subclavian steal syndrome

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41
Q

physiologic narrowing of the aortic arch between the left subclavian artery origin and ligamentum arteriosum, the embryologic remnant of ductus arteriosus

A

aortic isthmus

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42
Q

focal prominence of aorta at the ligamentum arteriosum is a normal variant termed, _____ which should not be confused for an aneurysm or pseudoaneurysm

A

ductus diverticulum or ductus bump

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43
Q

aorta continues to become the descending aorta at what level

A

distal to ligamentum arteriosum

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44
Q

characterized by common origin of the the right brachiocephalic and left common carotid arteries; often termed as the bovine arch

A

two-vessel aortic arch

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45
Q

a true bovine arch has

A

only single vessel from the aortic arch

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46
Q

left arch variants in which the left vertebral artery has an independent origin from the aortic arch

A

four-vessel arch

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47
Q

in four-vessel arch, left vertebral artery originates between

A

left common carotid artery and subclavian arteries

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48
Q

left arch variant in which instead of the normal origin from the right brachiocephalic artery, the right subclavian artery arises distal to the left subclavian artery from the distal aortic arch and travels through the mediastinum behind the esophagus to supply the right upper extremity

A

left aortic arch with aberrant right subclavian artery

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49
Q

the aberrant right subclavian artery is associated with an aneurysm, at its origin, termed

A

diverticulum of Kommerell

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50
Q

it is an embryologic remnant of the dorsal aortic arch and can cause compressive symptoms on the esophagus if large

A

diverticulum of Kommerell

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51
Q

dysphagia secondary to extrinsic compression of the esophagus from aberrant right subclavian artery with diverticulum of Kommerell and vascular ring

A

dysphagia lusoria

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52
Q

right aortic arch can have variable arch branching patterns but the most common are

A

aberrant left subclavian artery and mirror-image branching

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53
Q

in right arch with aberrant left subclavian artery, the first branch from the aortic arch is the

A

left common carotid artery, followed by right carotid artery, right subclavian artery, and the aberrant left subclavian artery

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54
Q

the aberrant left subclavian artery passes where, in relation to the esophagus, and often with an associated diverticulum of Kommerell

A

posterior

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55
Q

aberrant left subclavian artery is also commonly accompanied by _______ which forms a vascular ring that can cause symptoms due to compression. However, it is not usually visualized on imaging

A

ligamentum arteriosum

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56
Q

in right aortic arch with mirror-image branching, the first branch is the

A

left brachiocephalic artery which divides into the left common carotid and subclavian arteries, followed by the right common carotid artery and right subclavian artery

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57
Q

true or false: if there is an aberrant subclavian artery, there cannot be mirror-image branching

A

true

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58
Q

congenital heart disease that is commonly seen with right arch and mirror-image branching

A

TOF

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59
Q

Two most common vascular rings

A

right aortic arch with aberrant left subclavian artery and double aortic arch

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60
Q

results from persistence of both right and left embryologic aortic arches. the common carotid and subclavian arteries arise from their ipsilateral arch, resulting in a four-vessel branching pattern

A

double aortic arch

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61
Q

presents as bilateral indentations on the lower trachea on frontal projection radiograph

A

double aortic arch

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62
Q

on CT or MR images, it presents as symmetric, four vessel branching at the thoracic inlet, in contrast to right or left variants, which results in asymmetric vessel branching

A

double aortic arch

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63
Q

in double aortic arch, what side of the arch is typically hypoplastic and is located inferior to the dominant arch

A

left arch

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64
Q

true or false: double aortic arch is uncommonly associated with congenital heart disease

A

true

65
Q

high location of the aortic arch above the level of the clavicle

A

cervical aortic arch

66
Q

discontinuity of the aortic arch in which there is complete absence or a fibrous remnant of the interrupted segment

A

interrupted aortic arch

67
Q

type of interrupted aortic arch that occurs distal to the left subclavian take off at the isthmus

A

type A

68
Q

type of interrupted aortic arch that occurs between the left common carotid and subclavian origins

A

type B

69
Q

type of interrupted aortic arch that occurs between the right brachiocephalic and left common carotid origins

A

type C

70
Q

most common type of interrupted aortic arch

A

type B

71
Q

type of the interrupted aortic arch that is associated with VSD, bicuspid aortic valve and left ventricular outflow tract anomalies

A

type B

72
Q

all types of interrupted aortic arch requires ____ for survival

A

patent ductus arteriosus

73
Q

can occur with either a left or right-sided aortic arch; the arch travels posteriorly as usual but crosses the midline behind the esophagus, above the tracheal carina at the level of the distal arch/descending thoracic aorta and continues distally contralateral to the aortic arch side

A

circumflex aorta

74
Q

descending thoracic aorta begins where

A

after the ligamentum arteriosum and transitions to the abdominal aorta after passing through the diaphragmatic hiatus

75
Q

gives rise to multiple systemic vessels, including intercostal and bronchial arteries

A

descending thoracic aorta

76
Q

defined as focal narrowing of the aorta adjacent to the ductus arteriosus and often occurs with varying degrees of aortic arch hypoplasia

A

aortic coarctation

77
Q

aortic coarctation has strong associated with

A

bicuspid aortic valve and Turner syndrome

78
Q

etiology of aortic coarctation remains unclear, but a common pathogenesis with bicuspid aortic valve has been proposed including

A

abnormalities of neural crest tissue migration, decreased in utero blood flow and aortopathy with cystic medial necrosis

79
Q

two main types of aortic coarctation

A

preductal and postductal

80
Q

type of aortic coarctation that tends to be more severe, involving a longer segment. commonly presents in infancy, with systemic hypoperfusion following closure of the ductus arteriosus

A

preductal

81
Q

type of aortic coarctation that usually presents in adulthood with hypertension and signs of left heart failure

A

postductal

82
Q

to bypass the area of aortic narrowing in aortic coarctation, collateral systemic blood flow occurs via

A

adjacent internal mammary and intercostal arteries which become enlarged

83
Q

differential blood pressure and asymmetric pulses between right and left upper extremities is seen in what type of coarctation

A

preductal

84
Q

differential blood pressure between upper and lower extremities is seen in what type of aortic coarctation

A

postductal

85
Q

true or false: radiographic findings of aortic coarctation may only be apparent in severe cases

A

true

86
Q

indentation of the distal aortic arch with pre- and postenotic dilation results in a _____ sign on chest radiograph

A

“figure-of-3”

87
Q

ribs involved in hypertrophied intercostal arteries causing bilateral central rib notching

A

4th to 8th posterior ribs

88
Q

surgical intervention for aortic coarctation is recommended when the coarctation pressure gradient exceeds __ mmHg

A

20 mmHg

89
Q

congenital elongation with prominent kinking of the aorta at the aortic isthmus can mimic the appearance of coarctation and is termed

A

pseudocoarctation

90
Q

pseudocoarctation lacks the hemodynamic changes of true coarctation, such as a significant pressure gradient and arterial collateral formation. although usually asymptomatic, pseudocoarctation is associated with

A

hypertension, aortic aneurysm and bicuspid aortic valve

91
Q

cyclical process that starts with lipoprotein phagocytosis by macrophages, which are then incorporated into the subintima of the aortic wall. intracellular processes within the macrophage lead to formation of “foam cells”. Eventually, the marophages die, with a resultant influx of additional white blood cells and fibroblasts. the result of this cycle is an intramural mass consisting of the inner extracellular lipid core with an outer layer of inflammatory cells and connective tissue that can narrow the arterial lumen

A

atheroma formation

92
Q

similar to coronary plaques, noncalcified or mixed plaques with a thin fibrous cap and a large necrotic core are more likely to rupture and are termed

A

vulnerable plaques

93
Q

in some patients with severe atherosclerotic disease, thih layers of diffuse, predominantly noncalcified atherosclerotic plaques can layer much of the thoracic and abdominal aortia which has been termed

A

complex atheroma

94
Q

this is an indirect sign of previous plaque rupture, and are independent risk factors for the development of future ischemic events and should be mentioned as they may change medical or surgical management

A

complex atheroma

95
Q

sign of intimal disruption and lies in the “acute aortic syndrome” spectrum

A

penetrating atherosclerotic ulcer

96
Q

congenital aneurysms of the sinuses of valsalva are also associated with what conditions

A

bicuspid aortic valve and VSD

97
Q

acquired sinus of Valsalva aneurysms often represent pseudoaneurysms and result from

A

bacterial aortic valve endocarditis or aortic surgery

98
Q

rupture associated with sinus of valsalva aneurysms can occur into a cardiac structure, most commonly in the

A

RV and RA

99
Q

aortic enlargement to greater than 4 cm with preservation of vessel wall integrity — that is, without intimal disruption– may occur anywhere along the vessle

A

thoracic aortic aneurysm

100
Q

50% of thoracic aortic aneurysms happens in

A

ascending aorta (proximal to the right brachiocephalic artery)

101
Q

thoracic aortic aneurysms has highest association with

A

atherosclerosis

102
Q

Homocystinuria, Marfan syndrome and other connective tissue disorders may result in dilation of the aortic annulus and proximal ascending aorta termed

A

annuloaortic ectasia

103
Q

noninfection conditions that may result in ascending aortic aneurysms

A

giant cell arteritis, rheumatic fever and relapsing polychondritis

104
Q

this noninfective condition may result in aneuryms involving the ascending aort, aortic arch, arch vessels, abdominal aorta and/or pulmonary arteries

A

Takayasu arteritis

105
Q

infective aortitis may arise in the setting of bacterial endocarditis, with resultant aneurysm formation most often in the

A

proximal ascending aorta

106
Q

more common infectious cause of ascending aortitis and aneurysm

A

syphillis

107
Q

may lead to mycotic aneurysm

A

streptococcus and staphylococcus species

108
Q

true or false: ascending aortic contour may be exaggerated if the patient is rotated to the right and this should not be confused for an aneurysm

A

true

109
Q

ascending thoracic aneurysm diameter greater than ___ cm and/or interval growth greater than __ cm in 6 months or ___ cm in 1 year are indication for intervention, either surgical or endovascular

A

5.5 cm diameter, increase of greater than 0.5 cm in 6 months or 1 cm in 1 year

110
Q

in the setting of connective tissue disease such as Marfan syndrome in patients with ascending aorta aneurysm, there is a lower threshold for repair, usually greater than ___ cm

A

5 cm

111
Q

indications for open surgical or endovascular treatment of descending thoracic aortic aneurysm

A

size greater than 6.5 cm and/or interval growth (greater than 0.5 cm in 6 months or 1 cm in 1 year)

112
Q

acute aortic syndrome includes ____ which share the common classical clinical presentation of excruciating chest pain that may radiate to the back

A

aortic dissection, acute intramural hematoma, and PAU

113
Q

thoracic dissections Stanford type: involve the ascending aorta (proximal to the innominate artery) and require immediate surgical management with stent-graft placement

A

type A

114
Q

thoracic dissections Stanford type: involve only the descending aorta (distal to th left subclavian artery)

A

type B

115
Q

Standford type B dissections are often managed

A

medically, unless there is evidence of end-organ ischemia or impending rupture, in which case surgial or endovascular stent grafting is indicated

116
Q

pathogenesis of aortic dissection

A

degeneration of aortic media, a dynamic structure that plays a vital role in regulating aortic compliance among other functions

117
Q

dissections involving the ascending aorta may be complicated by

A

severe aortic regurgitation, cardiac tamponade due to hemopericardium, and/or coronary artery occlusion depending on propagation

118
Q

diagnostic modality for aortic regurgitation and is particularly useful in root dissections

A

MR, using retrograde flow dephasing across the aortic valve on steady state free precession

119
Q

true or false: proximal dissections may rupture into the pericardium, resulting in hemopericardium

A

true

120
Q

provides the best imaging for the intima

A

transesophageal echocardiography

121
Q

inciting event in intramural hematoma

A

intimal microtear

122
Q

IMH is classified by the

A

Stanford system

123
Q

describes internal erosion into the aortic media and typically manifests on the background of severe atherosclerotic disease

A

penetrating atherosclerotic ulcer

124
Q

PAU commonly occurs in the

A

descending aorta

125
Q

area with PAU with worst prognosis

A

aortic root or along the proximal ascending aorta

126
Q

typically has a crater-like shape which extends beyond the calcified intima of the aorta, while complex ulcerated plaques are often more jagged appearing and do not extend beyond the intima

A

penetrating atherosclerotic ulcer

127
Q

when PAU and IMH are seen together, complications include

A

formation of saccular aneurysm, aortic rupture and dissection

128
Q

focal irregular outpouching of the aorta secondary to intimomedial disruption, with extravasation contained by a variable amount of adventitia and by the surrounding mediastinal tissue

A

aortic pseudoaneurysm

129
Q

most common site of traumatic thoracic pseudoaneurysm

A

aortic isthmus, the narrowing between the distal arch and ligamentum arteriosum

130
Q

post operative pseudoaneurysms are typically seen along the

A

ascending aorta at the sites of aortic puncture, annulation and/or cross-clamping

131
Q

thoracic aortic pseudoaneurysms may be complicated by

A

aortoenteric and/or aortobronchial fistulas, mediastinal hemorrhage, hemothorax and pulmonary hemorrhage

132
Q

aortic fistulas that common present with hematemesis and /or hemoptysis

A

aortoesophageal and aortobronchial

133
Q

those with traumatic injuries in this aortic segment rarely survive

A

aortic root

134
Q

graft containing an attached prosthetic valve is termed a

A

composite graft

135
Q

synthetic grafts are composed of polyethylene and appear slightly hyper/hypo to the aorta on noncontrast CT but hyper/hypoattenuating to the aorta in CTA

A

slightly hyperattenuating to the aorta on noncontrast CT but hypoattenuating to the aorta on CTA

136
Q

grafts may also be placed in the native aorta without resection, termed the ______ resulting in a soft tissue density surrounding the graft representing fluid and thrombosis within the native aorta

A

inclusion technique

137
Q

technique in which the distal aspect of the aorta is left floating in the native aorta, can mimic a dissection

A

elephant trunk

138
Q

in the immediate postoperative perior, perigraft air can be normal and should eventually resolve by

A

6 weeks postsurgery

139
Q

perigraft fluid and soft tissue can also be normal, representing organizing hematoma/fibrosis or edema, and lasts for

A

months to years following repair

140
Q

contained rupture that manifests as a contrast-containing collection contiguous with the aortic lumen, usually occuring at the anastomotic margins

A

postoperative aneurysm

141
Q

can be mistaken for contrast leak in CT, mimicking a pseudoaneurysm in postoperative repair of aorta

A

graft reinforcements sych as fely and pledgets which are hyperattenuating

142
Q

entails placement of a metallic stent-graft into the aorta via an endovascular approach

A

thoracic endovascular aortic repair

143
Q

indications for TEVAR (thoracic endovascular aortic repait) include

A

aortic dissection, PAU, pseudoaneurysm and enlarging aneurysm

144
Q

characterized by contrast extenral to the stent graft and represents continued blood flow within the exlcuded aortic lumen, which can result in expansion of an aortic aneurysm, pseudoaneurysm or dissection false lumen with increased risk for rupture

A

endoleak

145
Q

type of endoleak that is most common and occurs at the proximal or distal margins of the stent graft

A

Type 1; type 1a- proximal; type 2v- distal

146
Q

type of endoleak that has retrograde opacification of the excluded aortic lumen through an aortic branch vessel such as an intercostal or bronchial artery within the thorax and inferior mesenteric or lumbar arteries in the abdomen

A

type 2

147
Q

type of endoleak that results from device failure, with contrast leaking through a fracture or defect in the stent graft

A

type 3

148
Q

type of endoleak that is caused by graft wall porosity and does not require repair. this is usually seen in anticoagulated patients as a blush of contrast around the stent graft on catheter angiography around the time of stent placement

A

type 4

149
Q

type of endoleak that is referred to as endotension leak, is a diagnosis of exclusion in which there is expansion of the excluded aortic lumen without a visible contrast leak

A

type 5

150
Q

refers to inflammation of the aortic wall (specifically the media and/or adventitia), which may be focal/segmental or multifocal, may also affect large and small branch vessels and is broadly classified into noninfectious and infectious causes

A

aortitis

151
Q

infectious aortitis is now most commonly caused by

A

staphylococcus aureus and Salmonella

152
Q

giant cell arteritis and Takayasu arteritis predominantly affects the

A

ascending aorta, aortic arch and branch vessles

153
Q

acute complications associated with aortitis include

A

intramural thrombus and aneurysm formation

154
Q

inflammatory wall thickness size in aortitis

A

greater than 3mm

155
Q

more specific sign of mural inflammation and may be reduced or absent after initiation of treatment

A

intramural enhancement

156
Q

valuable tool for assessment of aortitis

A

PET-CT with 18F-FDG

157
Q

aortic tumors include

A

leiomyosarcomas, hemangioendotheliomas, fibrosarcomas, myxoid sarcomas and angiosarcomas

158
Q

most aortic tumors are ____ and will typically manifest on both CT and MR as an eccentric, pedunculated and/or lobulated intramural filling defect

A

sarcomas

Cardiac (8 decks)

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