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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aneurysm of thoracic aorta was found in 20 from 7175 autopsies (0.25%) of persons deceased at the age of more than 15 years. The aneurysm was localized in 4 cases, diffuse in 14 and combined in two cases. Its pathogenesis was related to medionecrosis in 6 cases, to chronic aortitis in 5 and to isthmic aortic coarctation in two cases. Left ventricle hypertrophy which was found in 17 cases was related to arterial hypertension in 10 cases but only twice to a diffuse aneurysm. The aneurysm was closely connected with the cause of death in 10 patients. In a control study of subsequent 100 autopsies the mean aortic circumference was 75 mm in men and 71 mm in women, 59 mm in patients under the age of 50 and 82 mm over the age of 71 years. Medionecrosis was found in 45 cases, mucodystrophy in 8 and chronic aortitis in two cases.
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PMID:[Morphologic study of aneurysms of the thoracic aorta]. 134 Apr 3

Two autopsy cases of aortitis syndrome (Takayasu's aortitis) in the elderly are presented. Case 1 was an 81-year-old woman in whom hypertension was observed at age 37, and difference of right and left arm blood pressure was pointed out at age 65. She was referred to the authors' hospital at age 72. Chest X-ray and computed tomography of the thorax indicated atypical coarctation and diffuse calcification of the aorta. Case 2 was a 69-year-old woman in whom hypertension was pointed out at age 49, and blood pressure in the arms was found to differ from that in the legs at age 63. Chest X-ray and computed tomography showed diffuse calcification and marked narrowing of the descending aorta. Pathological examination revealed marked calcification in the thickened adventitia of the aorta with mild atherosclerotic change. Irregular fibrotic changes of the adventitia and degeneration of elastic fibers of the media of the aorta were noted in both cases, and were consistent with Takayasu's aortitis. This disorder is common in young women and only a small number of elderly cases are reported although its incidence is increasing. Diffuse calcification of the aorta with an absence of inflammatory signs, which is frequent in older patients, were observed in both case. Systemic hypertension is the most important risk factor with coarctation of the aorta in Takayasu's aortitis. Bypass surgery is recommended in young patients, however in elderly patients, it is generally avoided, in favor of medical control of hypertension.
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PMID:[Two autopsy cases of aortitis syndrome in the elderly]. 143 55

Four surgically treated cases of aortic valve regurgitation associated with the aortitis syndrome were reported. All patients were female and ranged in age from 38 to 51 years. In two cases, obstructive lesions of the aortic arch branch were seen in aortograms. Three patients had no inflammatory findings at the operation and one was operated on after improvement of inflammatory findings by steroid therapy. Aortic regurgitation was caused by annuloaortic ectasia, and aortic valve replacement was performed by the everting mattress suture method in all cases. One patient with stenosis of the left carotid artery, occlusion of the left subclavian artery, and hypertension died of extended cerebral damage due to suspected low flow cerebral perfusion during cardiopulmonary bypass. The other three patients are doing well 4 months to 11 years after surgery without paravalvular leakage. In cardiac surgery for the aortitis syndrome with an obstructive lesion of the aortic arch branch, deep hypothermic and high flow cardiopulmonary perfusion is required to prevent ischemic brain complications during surgery.
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PMID:[Four cases of aortic valve replacement in aortitis syndrome]. 156 8

Six children presented with severe hypertension caused by Takayasu's arteritis (TA), of whom four had bilateral renal artery narrowing and two coarctation syndrome. Two presented with hypertensive encephalopathy and four with congestive cardiac failure. All had a strongly positive skin reactions to purified protein derivative of mycobacterium tuberculosis. Bilateral renal arterial bypass grafts performed in two children resulted in prolonged normalization of their blood pressures, but the grafts clotted 12-18 months later. Primary renal autotransplantation was unsuccessful in two children, one with bilateral renal arterial narrowing and iliac vessel involvement and one with a long coarctation. Secondary renal autotransplantation was successful in a third child with localized aortitis. A successful aortic patch graft was performed in one child with coarctation of the aorta. Angiotensin-converting-enzyme inhibitors should be used with caution in treating the hypertension caused by TA, since bilateral renal arterial narrowing is common and their administration may result in renal insufficiency. The long-term prognosis is guarded in severely hypertensive children with extensive vascular disease due to TA.
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PMID:Management of severe hypertension in childhood Takayasu's arteritis. 167 62

The thoracic aorta is one of the portions frequently involved with atherosclerotic lesions. We estimated atherosclerotic lesions in the thoracic aorta in consecutive 137 patients (59 +/- 10 years old) using transesophageal echocardiography. The study population consisted of 60 with coronary artery disease (CAD), 36 with hypertension (HT), 28 with hypercholesterolemia (HC, total cholesterol greater than or equal to 230 mg/dl), eight with dissecting aneurysm, nine with true aneurysm and two with aortitis syndrome. We used a single transverse scan-plane probe with ultrasound frequency of 5 MHz. We could obtain satisfactory echograms of whole thoracic aorta except upper portion of the ascending aorta. We defined atherosclerotic lesions as an increased echo-density of the intima, protruded plaque, ulceration or aneurysm. Atherosclerotic lesions were observed in 71 of 137 patients (52%). High incidence of the atherosclerotic lesions was seen in patients with HT (72%), HC (57%) and CAD (57%), whereas incidence of atherosclerotic lesions was low (15%) in patients without HT, HC, CAD or aortic aneurysm. Atherosclerotic lesions were observed more frequently in patients aged greater than or equal to 60 years (69% vs 34%, p less than 0.001). In patients with HT or HC, atherosclerotic lesions were frequently observed even in patients younger than 60 years old (HT: 58%, HC: 53%). We concluded that HT, HC and aging were important risk factors for the atherosclerotic process in the thoracic aorta, and transesophageal echocardiography was a useful approach for the detailed estimation of atherosclerotic lesions in the thoracic aorta.
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PMID:[Estimation of atherosclerotic lesions in the thoracic aorta by transesophageal echocardiography]. 193 Aug 92

Coronary artery bypass grafting (CABG) was performed in a 67-year-old woman with aortitis. She had a past history of right radical mastectomy. Preoperative coronary angiogram showed diffuse stenotic lesions in both right and left coronary arteries. The pressure gradient between ascending aorta and peripheral radial artery was 90 mmHg and the cause of coronary stenosis seemed to be hypertension due to stenotic distal aorta. The aortogram showed occluded bilateral internal thoracic arteries (ITA) and stenotic abdominal aorta. The cephalic artery was supplied by a large meandering artery via dilated gastroepiploic artery (GEA). And thus the GEA was not useful for CABG. Quadruple CABG was performed with mild varicose saphenous vein (saphenous vein grafts to left anterior descending artery and third branch, and sequential saphenous vein graft to right posterior descending and atrioventricular branches). It seemed to be important to demonstrate the arterial lesion of ITA and GEA before CABG in patients with aortitis.
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PMID:[Coronary artery bypass grafting for ischemic heart disease combined with aortitis]. 207 95

We investigated 663 patients with renovascular hypertension (349 males and 314 females), who were surgically treated at 73 institutions of Urology or Surgery in Japan from 1963 to 1988. There were 294 cases with fibromuscular dysplasia (FMD), 178 with atherosclerosis (SC), 104 with aortitis syndrome (AO) and 87 with other causes. The mean age was 27 years old for FMD, 52 years for SC and 29 years for AO. Thirteen % of FMD, 19% of SC and 38% of AO had stenoses in both renal arteries. Since percutaneous transluminal angioplasty (PTA) has begun in early 1980's, the number of operative cases has been decreased, especially in the case of FMD due to a good result by PTA. Nephrectomy was done in 38% of 704 operations. Aortorenal bypass and autotransplantation were performed in 49% and 26% of the rest, respectively. Recently, autotransplantation has increasingly been applied for complicated vascular lesions. As regards prognosis of the surgical treatment, 77% of FMD, 59% of SC and 50% of AO presented normal blood pressure with or without antihypertensive drugs at least for 10 years after an operation. However, among the patients with normal blood pressure who were observed for more than 5 years, 30% of FMD, 56% of SC and 44% of AO had taken antihypertensive drugs. Eleven patients (1.7% of all) died within one month after the operation, 5 patient of whom had bilateral stenoses. In conclusion, PTA is the first choice for renovascular hypertension and surgery has been done for more difficult and complicated cases in which PTA is ineffective.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension. Changes and prognosis of the surgical treatment]. 240 14

We present a rare case of aortitis syndrome associated with dilatation of aorta and coarctation-like effect due to the intraluminal flap formation originated from dissected wall of the aorta. A 31-year-old woman was admitted to our hospital complaining of shortness of breath, palpitation and cough. On admission, her physical status showed congestive heart failure and hypertension of upper extremities and hypotension of lower extremities. Bruits were audible over the neck, the anterior chest and the back. Serological studies showed active inflammation. Chest X-ray film showed upper mediastinal widening, cardiomegaly and pulmonary edema. Aortitis syndrome was strongly suggested by these clinical findings, so that prednisolone therapy was started on 3rd hospital day. Special examinations were performed several days later when inflammatory changes showed a tendency to improve. Chest CT scan, RI angiography and MRI studies showed an aneurysmal dilatation from the ascending aorta to the mid-thoracic aorta. Aortography demonstrated a flap at the terminal portion of this aneurysmal dilatation and grade II (Sellars) aortic regurgitation. There was a pressure difference of 80 mmHg between the parts abutting cranial and caudal sides of the flap. A surgical operation was, then, performed to correct the pressure difference. The dissected wall was extruded toward the aortic lumen creating a flap (2 cm in length). This flap was resected and an artificial graft was inserted. Histologically, the flap consisted of adventitia, media and intima.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of aortitis syndrome which presented coarctation of aorta due to intraluminal flap formation in the middle of the thoracic aorta]. 272 9

The records of 22 patients, aged 61 to 85 years, with histologically proven cholesterol embolism (CE) were reviewed. All had one or more risk factors. Twenty-one patients had preexisting symptomatic or recognized atherosclerotic disease. Twenty patients had one or more identifiable precipitating factors, including warfarin administration (4), angiography (15), angioplasty (2), intra-aortic balloon pump placement (2), vascular surgery (11), aortitis (2), and cardiopulmonary resuscitation (1). These preceded the onset of symptoms by as many as 3 months, but usually by less than 3 weeks. Eight patients had peripheral CE alone. Fourteen patients had visceral CE. All 14 had renal CE that was characterized by abrupt deterioration of renal function after a precipitating event (13), evidence of concurrent CE to the lower extremities or other organs (10), accelerated hypertension (9), gross hematuria (6), or flank and back pain (3). Unusual presentations included one case each of spinal cord infarction, penile gangrene, adrenal insufficiency, and symptomatic splenic infarct. If patients with visceral CE survived after initial hospitalization, they often required dialysis and later hospitalizations because of complications. Premortem diagnoses were made in 18 patients: nine from surgical specimens and nine from biopsies (one kidney, eight muscle and skin). Attempts at definitive vascular surgery were possible in only two patients and successful in one. The challenges encountered in managing these patients' conditions are reviewed.
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PMID:Cholesterol embolism: experience with 22 histologically proven cases. 272 1

The thromboexclusion method was successfully applied to a 43-year-old male with aortitis syndrome. Preoperative aortogram showed a fusiform aneurysm of the descending aorta just below the left subclavian artery and atypical coarctation of the descending aorta distal to this aneurysm. Pressure gradient across the stenosis was about 70 mmHg. The technique of flow reversal and thromboexclusion was performed in this patient because of severe calcification in the aortic arch and the entire descending aorta. A long extra-anatomical bypass between the ascending aorta and the infrarenal abdominal aorta was made, and a permanent aortic clamp was placed across the aorta at the left subclavian artery. Hypertension in the arm disappeared immediately after the operation, and postoperative catheterization revealed no pressure gradient between the ascending and the abdominal aorta. Computed tomogram performed 18 days after the operation and aortogram done 44 days postoperatively disclosed thrombi formation in the aneurysm.
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PMID:[A case of coexisting descending thoracic aortic aneurysm and atypical aortic coarctation treated successfully by surgery using the thromboexclusion method]. 273 43


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