[Congenital aortic arch anomalies and vascular rings (author's transl)]. / Congenitale vasculaire ringen door aortabooganomalieën

The anomalies of the aortic arch are consequences of malformations in the first twelve weeks of the intrauterine life. Embryologically it is possible to explain and classify all of them. Most remain asymptomatic and do not need treatment. About one third of all anomalies are causing tracheo-esophageal compression with consequent complaints. In most cases the symptomatology starts in the first days of life. Some of them can be temporarily treated conservatively. The prognosis of patients, who need surgery is good, even in small infants. Surgery consists mainly in section of the atretic or hypoplastic part of the double aortic arch, section of the aberrant subclavian artery, section of the Botal ligament or duct and liberation of the trachea and esophagus. A normal configuration of trachea and esophagus is reached after several months or even more than a year. There are no reports on reoperations for secondary strictures. In the University Hospital of Nijmegen and Leiden we operated on 17 patients. There were 8 patients of group I A --- Edwards classification -- double aortic arch with both aortic arches open and left Botal duct or ligament; 4 patients of group I B, double aortic arch with one atretic aortic arch with a left Botal ligament; 3 patients of group II B, with a left aortic arch and aberrant right subclavian artery and a left Botal ligament; 2 patients of group III B with a right aortic arch and an aberrant left subclavian artery and a left Botal duct or ligament. Of our 17 patients one died during the operation because of a haemorrhage and overtransfusion; an other one died three weeks postoperatively from an endotracheal bleeding. All the other patients are without complaints and remained so.

[Blunt and open trauma of the heart and thoracic aorta in 26 patients (author's transl)]. / Stompe en scherpe traumata van hart en thoracale aorta bij 26 patiënten.

Twenty-six patients with blunt or open trauma to the heart and thoracic aorta were admitted and 23 were operated on. Among 19 blunt trauma there were 15 ruptures of the aorta among which 12 were operated and 3 were not, 2 lesions of the ventricular septum, 1 coronary thrombosis and 1 rupture of the right atrium. In 7 open wounds there were 3 ventricular lesions; 3 cases of pericarditis and 1 aortic lesion. Among operated patients 1 died of a rupture of the aortic isthmus and another of a rupture of the aortic arch and left carotid artery. The 3 patients that were not operated died of a rupture of the aortic isthmus. In these cases the diagnosis must be set early and the aortography must be followed by an operation. In cases of an open wound early thoracotomy is recommended.

Traumatic rupture of the thoracic aorta.

The experience in the surgical treatment of traumatic rupture of the thoracic aorta is discussed. Twenty-two patients were seen from 1970 to 1980. They were divided into three groups, according to delay between injury and aortic repair: 1 degree emergency group: 16 patients; 2 degree delayed group: 3 patients; 3 degrees chronic group: 3 patients. All patients had a widened mediastinum and the aortography confirmed the diagnosis. In the first group four patients died before surgery could be started and four after aortic repair from 10 days to 6 seeks postoperatively. In the second and third group all patients survived. Of 22 cases, 21 ruptures were located at the aortic isthmus and 1 at the aortic arch. Many patients had various other injuries, skeletal, abdominal or cerebral. All, but one patient, were operated with the aid of a partial pulsatile left heart bypass to avoid cerebral hypertension and cardiac overload, and to prevent kidney and spinal cord ischemia. One patient was operated, according to the method of Crawford, with blood pressure controlled with nitroprusside. We have not observed in our patients paresis or paraplegia after surgery. The hospital mortality of the surgical treated patients was 34% in the emergency group and 0% in the delayed and chronic group. Surgical treatment is essential in emergency situation, as a complete rupture may be fatal and repair of the chronic post-traumatic false aneurysm is advocated, as their prognosis is unpredictable.