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

Among 161 necropsy cases of aortic dissection, 87 (54%) were type I, 34 (21%) type II, and 40 (25%) type III, and an intimal tear was identified in each. Systemic hypertension had been present in 63 of 121 cases (52%) with type I or II dissection and in 30 of 40 (75%) with type III dissection. Aortic dissection involved 7 of 16 cases (44%) with the Marfan syndrome. In the 154 cases without the Marfan syndrome, grade 3 or 4 medial degeneration (cystic medial necrosis) was observed in the ascending aorta in only 27 (18%). The risk of aortic dissection in persons with congenitally bicuspid and unicommissural aortic valves, respectively, was 9 and 18 times that in subjects with tricuspid aortic valves. The mean age of those with aortic dissection and tricuspid, bicuspid and unicommissural aortic valves was 63, 55 and 40 years, respectively, and aortic dissection was more common in men than in women. Grade 3 or 4 atherosclerosis involved the intimal tear in only 11 of 121 type I or II dissections (9%) but 32 of 40 type III dissections (80%). Accordingly, the major risk factors for aortic dissection were systemic hypertension, the Marfan syndrome, and, for type I and II dissections, congenitally bicuspid or unicommissural aortic valves. Aortic medial degeneration was a less important risk factor. Rupture of ulcerocalcific aortic atheromas may have initiated the intimal tear in some type III dissections.
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PMID:Risk factors for aortic dissection: a necropsy study of 161 cases. 670 37

The pathogenesis of dissecting aneurysms of the aorta is controversial. We reviewed the records of the 204 patients with aortic dissecting aneurysms who underwent autopsy at the John Hopkins Hospital, Baltimore, from 1889 to the present and compared them with age-, race-, and sex-matched controls. The results show that hypertension, Marfan's syndrome, and traumatic, atherosclerotic, or inflammatory injuries of the aortic media are factors associated with dissection. The gross and histologic findings and associated circumstances suggest that most spontaneous aortic dissections originate from tears of the inner layers of the aorta followed by intramural cleavage. In other patients, rupture of the intra-aortic course of branch arteries or vasa vasorum may lead to dissection. Thus, no pathogenetic mechanism is common to all aortic dissections.
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PMID:Aortic dissecting aneurysms: causative factors in 204 subjects. 689 89

Twenty-eight cases of dissecting aneurysms of the thoracic aorta in patients with hypertension, syphilis, Marfan's syndrome and with unknown aetiology are analyzed with regard to the origins and extent of the dissection angiographically. The most common symptoms and evident radiological findings of the plain radiographs of the chest are stressed. The prognosis depends on the type of dissection.
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PMID:Dissecting aneurysms of the thoracic aorta. 722 1

Patients with aortic dissection are divided into two main groups: those with hypertension and those with syndromes involving hereditary defects of the aortic wall. The common finding in the setting of both Marfan syndrome and hypertension is dilatation of the aorta. The biological events that may lead to dissection are a decrease in the holding power of the internal layer, an increase in blood pressure, or an increase in aortic diameter combined with a decrease in wall thickness. Treatment of established acute type A dissection is still associated with a hospital mortality of greater than 10% and long-term complications from persistent blood flow in the distal false lumen. The main therapeutic challenge is to prevent aortic dissection by screening of aortic root diameter in patients at risk, together with life-long beta-blockade for Marfan patients. In patients with suspected dissection, the preference is for rapid noninvasive diagnosis and early surgical repair to reduce the risk of malperfusion and irreversible organ damage. Results of surgery have improved, with an increasingly conservative approach to repair of the aortic valve with biological glues. Repair is now routinely carried into the aortic arch using improved methods of cerebral protection such as retrograde cerebral perfusion through the superior vena cava. Nevertheless, there remains scope for further innovation in the prevention and treatment of this difficult problem.
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PMID:Management of aortic dissection. 749 60

Type A aortic dissection still presents an emergency situation in cardiac surgery that is associated with high morbidity and mortality rates. There has been a significant improvement in the surgical outcome since the introduction of deep hypothermia and circulatory arrest. In this study, we discuss our results after operative repair of ascending aortic dissections, using deep hypothermia and circulatory arrest. This study presents the results of 67 patients (43 men, 24 women) from 18 through 81 years of age (mean, 54 years) who underwent surgery for type A dissecting aneurysm over a period of 4 years. Type A dissection (52 acute and 15 chronic cases) was due to Marfan syndrome in 12 patients, to atherosclerotic disease of the aorta in 27 patients, and to traumatic injury in 1 patient. Hypertension as the only pathologic finding was observed in 27 patients. Deep hypothermia (confirmed by isoelectric electroencephalogram) and circulatory arrest were induced in all patients. Two patients died intraoperatively due to massive bleeding (intraoperative mortality, 3%). The 30-day mortality rate was 30% (n = 20). Causes of perioperative deaths in order of frequency were multi-organ failure (n = 11), myocardial infarction (n = 2), postoperative bleeding (n = 2), cerebrovascular insult (n = 2), and sepsis (n = 1). The mean intensive care unit stay of the surviving 47 patients (72%) was 8 days, followed by a mean of 21 additional days in the hospital. Our experience with profound hypothermia and circulatory arrest, used in combination with coated grafts, supports our conviction that this is the method of choice for the treatment of type A dissecting aneurysm.
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PMID:Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. 868 Feb 82

The purpose of this study was to compare thoracic aortic pathologies of 30 patients with Marfan's syndrome and a group of 78 patients with arterial hypertension. With a mean age of 35 +/- 12 years, patients with Marfan's syndrome were younger than hypertensives (59 +/- 11) (p < 0.01) and Marfan's syndrome, women (52%) were more frequently affected than in hypertensive patients (21%; p < 0.05). While aortic dissection and intramural hemorrhage in patients with Marfan's syndrome were usually confined to the ascending thoracic aorta (62%), in the hypertensive patients aortic disease frequently extended to distal segments of the thoracic or abdominal aorta (p < 0.05). Aortic pathology was complicated by aortic regurgitation in 95% of the patients with Marfan's syndrome and in 56% of the hypertensive patients (p < 0.01). Signs of renal, mesenteric or coronary malperfusion, cardiac effusion and severe hypotension (p < 0.05) were more frequently seen in the hypertensive group. While there was no early death in the Marfan group, only 67% of the patients having aortic dissection or intramural hematoma survived the first 30 days in the hypertensive group (p < 0.01). Aortic dissection, intramural hematoma and aortic aneurysms were as often found in the Marfan's syndrome patients with 60%, 10%, and 30%, as in patients with arterial hypertension with 55%, 6%, and 38% (n.s.). One-year survival rates were high in patients with Marfan's syndrome (93%) as well as in patients with arterial hypertension (73%) (n.s.). The diagnosis of aortic dissection, intramural hematoma, and aneurysms could in all cases be established by the use of noninvasive imaging techniques, such as TEE, XCT, and MRI. Moreover, noninvasive imaging modalities were both highly sensitive and specific for the diagnosis of aortic regurgitation, pericardial effusion, or mediastinal hematoma complicating acute aortic disease.
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PMID:[Acute and chronic aortic diseases in Marfan syndrome and arterial hypertension--a comparison of anatomy, clinical aspects and prognosis]. 767 24

The occurrence of familial dissecting aortic aneurysms without Marfan syndrome is rare. This report describes two aged siblings who underwent successful surgery for this disease. Neither patient had the clinical features of Marfan syndrome, and both had histories of systemic hypertension. Case 1: A 76-year-old man had dissecting aortic aneurysm, DeBakey type IIIa, which was localized and had multiple lumina with thrombi. Case 2: A 71-year-old man (younger brother of case 1) had retrograde dissecting aortic aneurysm, DeBakey type IIIa. Histological examinations of the aortae showed cystic medial necrosis in both cases, and also showed atherosclerotic changes in case 1. These two siblings had no familial history of cardiovascular incidents and were much older than previously reported cases. Therefore it may be possible that the dissecting aortic aneurysms of these two cases occurred coincidently rather than due to hereditary factors.
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PMID:[Dissecting aortic aneurysms that occurred in aged brothers without Marfan syndrome]. 783 22

Arterial dissection occurs when an intimal tear allows blood to enter the arterial wall, potentially compromising the lumen and reducing blood flow. Carotid and vertebral artery dissections typically occur after major trauma, although they also can arise spontaneously or after trivial injury. Arterial dissection has been associated with a variety of factors, including hypertension, fibromuscular dysplasia, Marfan syndrome, cystic medial necrosis, oral contraceptives, drug abuse (sympathomimetics), and infection [1-8]. It is important to recognize arterial dissection early so that prompt treatment can be initiated to prevent ischemic complications [1]. In this essay, we illustrate the use of MR angiography in the diagnosis of carotid and vertebral artery dissection.
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PMID:Dissection of the carotid and vertebral arteries: imaging with MR angiography. 786 92

The clinical features, etiologies, pathogenesis, treatment and prognosis of 70 patients with aortic dissecting were studied. Patients with age ranging from 31 to 70 years consisted 93% of the total. The proportion of proximal to distal types is 0.8: 1. Hypertension was present in 67% and Marfan's syndrome 18% of the patients. The pathologic finding was scattered rupture with myxomatous and cystic necrosis of the mecial elastic fibers. 80% of the patients suffered from the disease without any inducing cause. Of the 76% patients had chest pain, it was very severe in 69%. Chest X-ray, ultrasound, computed tomography and magnetic resonance imaging together with clinical manifestations may accurately diagnose the disease. The sensitivity and specificity of the ultrasound are 97% and 94% respectively. The mortality in hospital with surgical and medical therapy of the proximal type was 14% and 22% respectively, while that of the distal type was 63% and 27% respectively. Rupture of the aneurysm was the cause of death in 68% of the patients.
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PMID:[A clinical study of aortic dissecting]. 786 28

Arterial involvement is an important feature of the diagnosis and, above all, prognosis of heritable disorders of connective tissue. In pseudoxanthoma elasticum, a progressive occlusive syndrome is associated with hemorrhage and especially with gastrointestinal bleeding. Aneurysms are uncommon. Hypertension occurs frequently. Cutaneous signs (yellowish pseudo xanthomatous papules of the large folds) the ocular changes (angioid streaks) and pathology showing numerous, thickened, fragmented, disorganized, calcified elastic fibers in the deep dermis and arterial walls, allow the diagnosis to be made. In the heterogeneous group of Ehlers-Danlos syndromes, type IV is characterized by sudden spontaneous rupture of the large arteries. Aneurysms and carotido-cavernous fistulae are rather frequent. Owing to friability of the arterial walls, arteriograms and other procedure requiring arterial puncture may prove hazardous and surgery difficult. Such patients have an acrogeric morphotype, and thin, fragile skin, but cutaneous hyperelasticity and joint hyperlaxity are usually minimal. Pathology evidences collagen hypoplasia in the skin and arterial walls. The severity of Marfan syndrome is due to aortic involvement. A fusiform aneurysm of the ascending aorta represents a vital risk of rupture. Aortic root dilatation is associated and responsible of severe aortic regurgitation. Aortic dissection is also a serious threat. Improved surgical techniques for repairing a dilated or dissected aortic root with simultaneous replacement of the aortic valve increases the life expectancy of such patients. Dolichomorphism is the characteristic skeletal abnormality, particularly with arachnodactyly and upward ectopia lentis, which is almost bilateral, is a very frequent feature of Marfan syndrome. The most typical histological finding is aortic cystic median necrosis. The basic defect in Marfan syndrome concerns the fibrillin, whose gene is located on chromosome 15. The three diseases detailed in this paper constitute the main areas of this subject, but arterial involvement may occur in other inheritable disorders of connective tissue (osteogenesis imperfecta, cutis laxa, Werner syndrome, Menkes syndrome, etc).
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PMID:[Arterial involvements in hereditary dysplasia of the connective tissue]. 805 35


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