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Ascending Aortic Aneurysm/Type A Dissection

George J. Arnaoutakis, Nimesh D. Desai, Joseph E. Bavaria
Ascending Aortic Aneurysm/Type A Dissection is a topic covered in the Adult and Pediatric Cardiac.

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Historical Background

Vesalius is credited with the first description of a thoracic aortic aneurysm in 1543. The first death due to a ruptured thoracic aortic aneurysm was reported by Pare in the late 1500s. In the late 1700s, Monro elucidated the 3 layers of the aortic wall and commented on destruction of the arterial wall in both true and false aneurysms.[1] Morgagni reported the first cases of aortic dissection in 1773, and Maunoir is credited with coining the entity “aortic dissection.”[2]

Despite these early descriptions of thoracic aortic disease, it was not until 1952 that the first descending thoracic aortic repair was successfully performed by Drs. DeBakey and Cooley on a patient who underwent lateral resection for a saccular aneurysm.[3] In 1956 DeBakey and Cooley replaced the ascending aorta with use of cardiopulmonary bypass (CPB) and homograft for conduit.[4] Dr. Wheat resected the entire ascending aorta and aortic root except for the aortic tissue surrounding the coronary arteries in 1964, and is also credited with pioneering the conservative management of type B aortic dissection.[5],[6] Grafts composed of polyester cloth were subsequently used as the preferred conduit for aortic replacement. The hemostatic properties of artificial grafts have been enhanced by improvements in textile engineering through the impregnation of collagen or gelatin.

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Historical Background

Vesalius is credited with the first description of a thoracic aortic aneurysm in 1543. The first death due to a ruptured thoracic aortic aneurysm was reported by Pare in the late 1500s. In the late 1700s, Monro elucidated the 3 layers of the aortic wall and commented on destruction of the arterial wall in both true and false aneurysms.[1] Morgagni reported the first cases of aortic dissection in 1773, and Maunoir is credited with coining the entity “aortic dissection.”[2]

Despite these early descriptions of thoracic aortic disease, it was not until 1952 that the first descending thoracic aortic repair was successfully performed by Drs. DeBakey and Cooley on a patient who underwent lateral resection for a saccular aneurysm.[3] In 1956 DeBakey and Cooley replaced the ascending aorta with use of cardiopulmonary bypass (CPB) and homograft for conduit.[4] Dr. Wheat resected the entire ascending aorta and aortic root except for the aortic tissue surrounding the coronary arteries in 1964, and is also credited with pioneering the conservative management of type B aortic dissection.[5],[6] Grafts composed of polyester cloth were subsequently used as the preferred conduit for aortic replacement. The hemostatic properties of artificial grafts have been enhanced by improvements in textile engineering through the impregnation of collagen or gelatin.

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Last updated: August 31, 2020