Thoracic Aortic Aneurysms

General Classification and Principles

Thoracic aneurysms are most commonly located in the ascending and descending thoracic regions (Fig. 7.10). The more difficult transverse arch and thoracoabdominal locations are also less common. Several etiologies exist for chronic aortic aneurysms. The most common cause is atherosclerotic degeneration of the aorta (Fig. 7.11a-d), usually occurring in elderly smokers. Chronic aortic dissection (Fig. 7.12a-c), Marfan's syndrome (Fig. 7.13a-c), cystic medial necrosis or aortitis secondary to syphilis or granuloma are other etiologies.

The indications for surgical correction include a diameter greater than 6 cm, or a dramatic increase in size or symptoms over a short time interval. Those gen-

Fig. 7.11d. The valved conduit has been seated in the aortic annulus. An 8 mm graft has been anastomosed to the left and right coronary orifices and now will be sutured to the valved conduit. Courtesy of Dr Jeff Milliken, Harbor-UCLA

Fig. 7.11a. CT scan of a patient with a 9 cm aneurysm confined to the ascending aorta resulting in aortic insufficiency.

Fig. 7.11b. Aneurysm as seen at sternotomy. Notice the normal sized distal ascending aorta encircled by vascular tape. Cannula-tion of the normal aorta and car-diopulmonary bypass are performed. Courtesy of Dr Jeff Milliken, Harbor-UCLA

Fig. 7.11c. The aorta has been opened, aortic valve excised, and annular sutures placed. A St. Jude valved conduit will be positioned and the Cabrol procedure performed. Courtesy of Dr Jeff Milliken, Harbor-UCLA

Fig. 7.11d. The valved conduit has been seated in the aortic annulus. An 8 mm graft has been anastomosed to the left and right coronary orifices and now will be sutured to the valved conduit. Courtesy of Dr Jeff Milliken, Harbor-UCLA

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