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INCOMPLETE RUPTURE OF THE AORTA: A HERETOFORE UNRECOGNIZED STAGE OF DISSECTING ANEURYSM AND A CAUSE OF CARDIAC PAIN AND CARDIAC MURMURS

INCOMPLETE RUPTURE OF THE AORTA: A HERETOFORE UNRECOGNIZED STAGE OF DISSECTING ANEURYSM AND A... Abstract Dissecting aneurysm has been recognized at autopsy for many years, and more recently the clinical signs and symptoms of that condition have become sufficiently well established for the diagnosis to be made ante mortem in a fairly large number of cases. In most instances actual dissection is preceded by a tear of the intima, through which the column of blood gains access to the media to cause dissection. Not infrequently dissection does not occur immediately after the intimal tear, and the tear may heal by the formation of scar tissue, leaving a defect in the aortic wall. This early stage without dissection has not been recognized clinically, however, and has seldom been recognized as such at autopsy. Clinical recognition of incomplete rupture is important in that actual dissection may be prevented or postponed in some cases. Its manifestations are dramatic enough and the condition is common enough for the correct References 1. Gallavardin, L., and Gravier, L.: Rupture incomplète de l'aorte: Insuffisance aortique fonctionelle consécutive , Paris méd. 45:29, 1922. 2. Maresch, R.: Zur Kenntnis der Insuffizienz der Aortenklappen , Wien. klin. Wchnschr. 42:417, 1929. 3. Cases 1, 2, 3, 4, 6 and 7 were encountered in the Pathology Service of the Medical College of the State of South Carolina, Charleston, and are used in this report with the consent of Dr. Kenneth M. Lynch, professor of pathology. Cases 5, 8, 9, 10 and 11 were encountered in the Pathology Service of the George Washington University School of Medicine and are used with the consent of Dr. Roger M. Choisser, professor of pathology. 4. Oppenheim ( Gibt es eine Spontanruptur der gesunden Aorta und wie kommt sie zustande? München. med. Wchnschr. 45:1234, 1918) 5. Heller, A.: Ueber ein traumatisches Aortenaneurysma und traumatische Insuffizienz der Aortenklappen , Deutsches Arch. f. klin. Med. 79:306, 1904. 6. Nordlander, T. A.: Partially Healed Spontaneous Rupture of the Aorta , Tr. Chicago Path. Soc. 12:123, 1925. 7. Wood, F. C.; Pendergrass, E. P., and Ostrum, H. W.: Dissecting Aneurysm of the Aorta with Special Reference to Its Roentgenographic Features , Am. J. Roentgenol. 28:437, 1932. 8. Hardaway, R. M., and Green, M. M.: Intrapericardial Rupture of Aorta , Am. Heart J. 10:384, 1935.Crossref 9. Chiari, H.: Ueber die Differenz im mikroskopischen Befunde bei aus geheilten Aortenrissen entstandenen und bei "spontanen" Aortenaneurysmen , Verhandl. d. deutsch. path. Gesellsch. 7:180, 1904. 10. Letulle, M.: Anévrisme disséquant étendu à la totalité de l'aorte et spontanément gueri , Bull. et mém. Soc. méd. d. hôp. de Paris 22:1045, 1905. 11. Roemer, R.: Ueber zwei Fälle von spontaner Querruptur der Aorta bei Aorteninsufficienz, Inaug. Dissert., Erlangen, 1906. 12. MacCallum, W. G.: Dissecting Aneurysm , Bull. Johns Hopkins Hosp. 20:9, 1909. 13. Uhles, B.: Ueber einen Fall von Aortenruptur mit Blutung in die Perikardhöhle , Med. Klin. 20:49, 1924. 14. Resnik, W. H., and Keefer, C. S.: Dissecting Aneurysm with Signs of Aortic Insufficiency , J. A. M. A. 85:422 ( (Aug. 8) ) 1925.Crossref 15. Hall, E. M.: Healed Dissecting Aneurysm of Aorta , Arch. Path. 2:41 ( (July) ) 1926. 16. Hamilton, W. F., and Abbott, M. E.: Coarctation of the Aorta of the Adult Type , Am. Heart J. 3:381, 1928.Crossref 17. Lundberg, Å: Three Cases of Healed Aortic Rupture , Acta med. Scandinav. 73:19, 1930.Crossref 18. Klotz, O., and Simpson, W.: Spontaneous Rupture of the Aorta , Am. J. M. Sc. 184:455, 1932.Crossref 19. Narr, F. C., and Wells, A. H.: Rupture of the Aorta , Am. Heart J. 8:834, 1933.Crossref 20. Hamman, L., and Apperly, F.: An Instance of Spontaneous Rupture of the Aorta with Aortic Insufficiency , Internat. Clin. 4:251, 1933. 21. Hamburger, M., Jr., and Ferris, E. B., Jr.: Dissecting Aneurysm , Am. Heart J. 16:1, 1938.Crossref 22. Roberts, J. T.: Medionecrosis Aortae Idiopathica Cystica , Am. Heart J. 18:188, 1939.Crossref 23. Gouley, B. A., and Anderson, E.: Chronic Dissecting Aneurysm of the Aorta, Simulating Syphilitic Cardiovascular Disease , Ann. Int. Med. 14:978, 1940.Crossref 24. Dissecting Aneurysm of Aorta, Cabot Case 27292 , New England J. Med. 225:116, 1941.Crossref 25. Dissecting Aneurysm of Aorta with Rupture into Pericardium, Cabot Case 27302 , New England J. Med. 225:155, 1941.Crossref 26. In some instances in which diastolic murmurs have been noted at the aortic area no tear has been found near the commissures, but dissection has extended proximally in the media of the vessel, so that the attachments of the commissures are loosened and the effect is much the same as if an intimal tear had occurred at the commissures. Other explanations have been advanced for the insufficiency in cases of dissecting aneurysm—dilatation of the valve ring or a mechanism similar to that operative in arteriovenous fistula—but they seem inadequate when compared to the purely mechanical concept. 27. Asahi, K.: Ueber die Differenz in mikroskopischen Befunde bei aus geheilten Aortenrissen entstandenen und bei "spontanen" Aneurysmen der Aorta , Ztschr. f. Heilk. 6:163, 1905. 28. Gravier, L.: Insuffisance aortique fonctionnelle par rupture incompléte de l'aorte , J. de méd. de Lyon 5:563, 1924. 29. Eskelund, V.: Aortic Insufficiency as Result of Spontaneous Rupture of Aorta , Ugesk. f. læger 103:240, 1941 30. abstracted, J. A. M. A. 117:814 ( (Aug. 30) ) 1941. 31. A similar situation doubtless prevails when the mouth of an aneurysm, either syphilitic or mycotic, is located just above one of the commissures of the aortic valve. Two cases of such a condition, in which there were clinical signs of aortic insufficiency, are represented by specimens preserved in the pathology museum of the George Washington University School of Medicine. 32. Garvin, C. F.: Functional Aortic Insufficiency , Ann. Int. Med. 13:1799, 1940.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

INCOMPLETE RUPTURE OF THE AORTA: A HERETOFORE UNRECOGNIZED STAGE OF DISSECTING ANEURYSM AND A CAUSE OF CARDIAC PAIN AND CARDIAC MURMURS

Archives of Internal Medicine , Volume 70 (5) – Nov 1, 1942

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1942 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1942.00200230002001
Publisher site
See Article on Publisher Site

Abstract

Abstract Dissecting aneurysm has been recognized at autopsy for many years, and more recently the clinical signs and symptoms of that condition have become sufficiently well established for the diagnosis to be made ante mortem in a fairly large number of cases. In most instances actual dissection is preceded by a tear of the intima, through which the column of blood gains access to the media to cause dissection. Not infrequently dissection does not occur immediately after the intimal tear, and the tear may heal by the formation of scar tissue, leaving a defect in the aortic wall. This early stage without dissection has not been recognized clinically, however, and has seldom been recognized as such at autopsy. Clinical recognition of incomplete rupture is important in that actual dissection may be prevented or postponed in some cases. Its manifestations are dramatic enough and the condition is common enough for the correct References 1. Gallavardin, L., and Gravier, L.: Rupture incomplète de l'aorte: Insuffisance aortique fonctionelle consécutive , Paris méd. 45:29, 1922. 2. Maresch, R.: Zur Kenntnis der Insuffizienz der Aortenklappen , Wien. klin. Wchnschr. 42:417, 1929. 3. Cases 1, 2, 3, 4, 6 and 7 were encountered in the Pathology Service of the Medical College of the State of South Carolina, Charleston, and are used in this report with the consent of Dr. Kenneth M. Lynch, professor of pathology. Cases 5, 8, 9, 10 and 11 were encountered in the Pathology Service of the George Washington University School of Medicine and are used with the consent of Dr. Roger M. Choisser, professor of pathology. 4. Oppenheim ( Gibt es eine Spontanruptur der gesunden Aorta und wie kommt sie zustande? München. med. Wchnschr. 45:1234, 1918) 5. Heller, A.: Ueber ein traumatisches Aortenaneurysma und traumatische Insuffizienz der Aortenklappen , Deutsches Arch. f. klin. Med. 79:306, 1904. 6. Nordlander, T. A.: Partially Healed Spontaneous Rupture of the Aorta , Tr. Chicago Path. Soc. 12:123, 1925. 7. Wood, F. C.; Pendergrass, E. P., and Ostrum, H. W.: Dissecting Aneurysm of the Aorta with Special Reference to Its Roentgenographic Features , Am. J. Roentgenol. 28:437, 1932. 8. Hardaway, R. M., and Green, M. M.: Intrapericardial Rupture of Aorta , Am. Heart J. 10:384, 1935.Crossref 9. Chiari, H.: Ueber die Differenz im mikroskopischen Befunde bei aus geheilten Aortenrissen entstandenen und bei "spontanen" Aortenaneurysmen , Verhandl. d. deutsch. path. Gesellsch. 7:180, 1904. 10. Letulle, M.: Anévrisme disséquant étendu à la totalité de l'aorte et spontanément gueri , Bull. et mém. Soc. méd. d. hôp. de Paris 22:1045, 1905. 11. Roemer, R.: Ueber zwei Fälle von spontaner Querruptur der Aorta bei Aorteninsufficienz, Inaug. Dissert., Erlangen, 1906. 12. MacCallum, W. G.: Dissecting Aneurysm , Bull. Johns Hopkins Hosp. 20:9, 1909. 13. Uhles, B.: Ueber einen Fall von Aortenruptur mit Blutung in die Perikardhöhle , Med. Klin. 20:49, 1924. 14. Resnik, W. H., and Keefer, C. S.: Dissecting Aneurysm with Signs of Aortic Insufficiency , J. A. M. A. 85:422 ( (Aug. 8) ) 1925.Crossref 15. Hall, E. M.: Healed Dissecting Aneurysm of Aorta , Arch. Path. 2:41 ( (July) ) 1926. 16. Hamilton, W. F., and Abbott, M. E.: Coarctation of the Aorta of the Adult Type , Am. Heart J. 3:381, 1928.Crossref 17. Lundberg, Å: Three Cases of Healed Aortic Rupture , Acta med. Scandinav. 73:19, 1930.Crossref 18. Klotz, O., and Simpson, W.: Spontaneous Rupture of the Aorta , Am. J. M. Sc. 184:455, 1932.Crossref 19. Narr, F. C., and Wells, A. H.: Rupture of the Aorta , Am. Heart J. 8:834, 1933.Crossref 20. Hamman, L., and Apperly, F.: An Instance of Spontaneous Rupture of the Aorta with Aortic Insufficiency , Internat. Clin. 4:251, 1933. 21. Hamburger, M., Jr., and Ferris, E. B., Jr.: Dissecting Aneurysm , Am. Heart J. 16:1, 1938.Crossref 22. Roberts, J. T.: Medionecrosis Aortae Idiopathica Cystica , Am. Heart J. 18:188, 1939.Crossref 23. Gouley, B. A., and Anderson, E.: Chronic Dissecting Aneurysm of the Aorta, Simulating Syphilitic Cardiovascular Disease , Ann. Int. Med. 14:978, 1940.Crossref 24. Dissecting Aneurysm of Aorta, Cabot Case 27292 , New England J. Med. 225:116, 1941.Crossref 25. Dissecting Aneurysm of Aorta with Rupture into Pericardium, Cabot Case 27302 , New England J. Med. 225:155, 1941.Crossref 26. In some instances in which diastolic murmurs have been noted at the aortic area no tear has been found near the commissures, but dissection has extended proximally in the media of the vessel, so that the attachments of the commissures are loosened and the effect is much the same as if an intimal tear had occurred at the commissures. Other explanations have been advanced for the insufficiency in cases of dissecting aneurysm—dilatation of the valve ring or a mechanism similar to that operative in arteriovenous fistula—but they seem inadequate when compared to the purely mechanical concept. 27. Asahi, K.: Ueber die Differenz in mikroskopischen Befunde bei aus geheilten Aortenrissen entstandenen und bei "spontanen" Aneurysmen der Aorta , Ztschr. f. Heilk. 6:163, 1905. 28. Gravier, L.: Insuffisance aortique fonctionnelle par rupture incompléte de l'aorte , J. de méd. de Lyon 5:563, 1924. 29. Eskelund, V.: Aortic Insufficiency as Result of Spontaneous Rupture of Aorta , Ugesk. f. læger 103:240, 1941 30. abstracted, J. A. M. A. 117:814 ( (Aug. 30) ) 1941. 31. A similar situation doubtless prevails when the mouth of an aneurysm, either syphilitic or mycotic, is located just above one of the commissures of the aortic valve. Two cases of such a condition, in which there were clinical signs of aortic insufficiency, are represented by specimens preserved in the pathology museum of the George Washington University School of Medicine. 32. Garvin, C. F.: Functional Aortic Insufficiency , Ann. Int. Med. 13:1799, 1940.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1942

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